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.
Myomectomy surgically removes fibroids from the uterus. The uterus is left intact and this increases the chancncs 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 is 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.), Laparoscopic method uses lighted viewing instrument with cutting incisors in the abdomen and Laparotomy procedure involves larger incision in the abdomen. The type of method to be used is to be individualised based on the size, location, and 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 hospitalisation 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 extend 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 requires 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.
Can fibroids turn into Cancer?
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.
Who are at risk for uterine fibroids?
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.
What If I become pregnant and have fibroids?
Asymptomatic small or medium sized fibroids alone are unlikely to present 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.
Can fibroids recur after myomectomy?
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.
When can one plan for pregnancy after myomectomy?
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.
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination.
A Caesarean section is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterectomy) to deliver one or more babies. A Caesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk.
Childbirth is an intense event with very strong emotions. The process of normal childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and the placenta being expelled. The most prominent sign of labour are the strong contractile waves that move the infant down the birth canal.
Menopause is the stage in a woman's life when menstruation stops and a woman can no longer bear children. This phase leads to gradual depletion in the production of female hormones estrogen and progesterone.
Infertility is the inability of a person to conceive children. Female infertility includes inability of the woman to conceive as well as inability to carry a pregnancy to full term until the child birth. About 40% of the issues involved with infertility are due to the man, another 40% due to the woman, and 20% result from complications with both partners.
Cervical cancer is a cancer arising from the cervix. It is the abnormal growth of cells that invade or spread to other parts of the body. Worldwide, cervical cancer is both the fourth most common cause of cancer and deaths from cancer in women.
Breast cancer is when cancer develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.
Hysterectomy is the surgical removal of the uterus or womb. Depending upon the type of procedure that is performed and the reason for the surgery, hysterectomy may also include removal of the adjacent Fallopian tubes and ovaries. Hysterectomy is the most common major surgical procedure (unrelated to pregnancy) performed on women.