Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential. The fibroids needed to be removed are typically large in size or growing at certain locations such as bulging into the endometrial cavity causing significant cavity distortion. A myomectomy can be performed in a number of ways, depending on the location and number of lesions and the experience and preference of the surgeon. Either a general or a spinal anaesthesia is administered. Using the laparoscopic approach the uterus is visualized and its fibroids located and removed. Development of new fibroids will be seen in 42-55% of patients undergoing a myomectomy. It is well known that myomectomy surgery is associated with a higher risk of uterine rupture in later pregnancy.
A myomectomy surgically removes fibroids from the uterus. The uterus is left intact and this increases the chances of pregnancy in women who have had difficulties in conception.
Before undertaking the procedure the fibroids are made to shrink by giving treatment with fibroids with gonadotropin-releasing hormone analogue (GnRH-a). This helps in reduction of blood loss during the procedure.
There are 3 surgical methods for myomectomy. These are Hysteroscopy,( inserting a lighted viewing instrument through the vagina and into the uterus.), the Laparoscopic method uses lighted viewing instrument with cutting incisors in the abdomen and Laparotomy procedure involves a larger incision in the abdomen. The type of method to be used is to be individualized based on the size, location, and a number of fibroids.
Hysteroscopy can be used to remove superficial fibroids on the inner wall of the uterus and is an outpatient procedure. Laparoscopy is used for removing deeper fibroids and also those that are growing across and on the outside of the uterus. Laparoscopy is also an outpatient procedure. In few cases, hospitalization for a day could be required.
Laparotomy is used to remove large fibroids, many fibroids, or fibroids that have grown deep into the uterine wall. These require hospitalisation from around 2-5 days depending on the scope and extent of the procedure. Recovery periods are variable based on the type method used. Hysteroscopy requires from a few days to 2 weeks recovering whereas Laparoscopy and Laparotomy require 1- 2 weeks and 4 to 6 weeks respectively.
Though these are safe procedures there is always chance of pelvic infections involving in uterus, Infection of the uterus, fallopian tubes, or ovaries. Removal of the fibroids in the uterine muscle leads to scaring of the tissues and in rear cases the uterine incision could be responsible for infertility. Removal of fibroids in the uterine muscle (intramural fibroids) may cause scar tissue.
Women who undergo myomectomy report improvement in fibroid symptoms, including heavy menstrual bleeding and pelvic pressure. Myomectomy helps women to preserve the uterus. Myomectomy is the preferred fibroid treatment for women who want to become pregnant. After myomectomy, your chances of pregnancy may be improved but are not guaranteed.
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) will a cancerous fibroid occur. Having fibroids does not increase the risk of developing a cancerous fibroid.
There are various factors that can increase a woman’s risk of developing fibroids for e.g. age, family history, ethnic origin, obesity and eating habits.
Asymptomatic small or medium-sized fibroids alone are unlikely to present a significant risk to pregnancy. However, fibroids may increase in size as a result of increased levels of hormones and blood flow to the uterus during pregnancy. The growth of fibroids may cause discomfort, feelings of pressure, or pain.
Fibroids can grow back and the chance of recurrence is high. It has been observed that out of 100 cases, 10 patients return back with the growth of fibroids within 2 years.
Due to high incidence of recurring fibroids in young women after myomectomy, it is recommended to try to best to try to conceive at the earliest after the recovery from the procedure. The chances of conception could be the highest.
From fertilization to delivery, pregnancy requires a number of steps in a woman’s body. One of these steps is when a fertilized egg travels to the uterus to attach itself.
Fibroids are almost always benign (not cancerous). Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with.Endometriosis
Hysterotomy is a surgical procedure that involves making an incision in the uterus to remove uterine contents. It can be performed for various reasons including caesarian section