Myomectomy is the surgical removal of a uterine fibroid tumor. This operation allows you not to remove the uterus. In addition, myomectomy is the best treatment for uterine fibroids in women who are planning a pregnancy. After the removal of fibroids, the chances of pregnancy may increase, although this does not always work.
Before removing uterine fibroids, anastalsis of the tumor with Gonadoliberin analog therapy is conducted to reduce blood loss during the operation. This therapy reduces estrogen levels. If you have bleeding caused by a fibroid, then it will also prevent anemia by stopping uterine bleeding for several months.
Surgical methods used for myomectomy are:
- Hysteroscopy of the uterus, during which a luminous viewing device is inserted into the vagina and further into the uterus.
- Laparoscopy, during which a luminous examination device is used, and one or several abdominal incisions are made.
- Laparotomy, otherwise known as cuspidation. As the name implies, this method uses a large incision in the abdominal cavity.
The choice of method for myomectomy depends on:
- the need to treat problems of the intestine or urinary system. Laparotomy is used to treat these problems without harming the organs.
- The size, location and number of tumors. Uterine hysteroscopy is used to remove those fibroids on the inner walls of the uterus that did not have time to grow deep. Laparoscopy is usually performed to remove one or two tumors up to 5 cm in size located on the outer walls of the uterus. A laparotomy is used to remove large fibroids that are deeply penetrated in the uterine walls.
Indications for myomectomy
Removal of uterine fibroids prevents fibroids’ development. This is a reasonable method of treatment in those cases if:
- you have anemia that is not amenable to medical treatment.
- you have pain and pressure that is not amenable to medical treatment.
- you have a fibroid that has changed the walls of the uterus. Sometimes it leads to infertility or miscarriages. Prior to in vitro fertilization, myomectomy is often used to increase the chances of pregnancy.
How does it work?
Mainly after the removal of uterine fibroids, pain in the pelvic area and bleeding caused by a fibroid tumor are reduced.
What to expect after surgery?
The hospital rehabilitation period may vary depending on the type of procedure. After hysteroscopy, you will not need to stay in the hospital, with laparoscopy you will need to spend one day in the hospital, and with a laparotomy – from 1 to 4 days.
The recovery period also depends on the method of operation. Hysteroscopy requires from several days to a couple of weeks to recover, laparoscopy – 1-2 weeks, laparotomy – 4-6 weeks.
Recurrence of fibroids
According to various sources, uterine fibroids reappear in 10-50% of women. Large and numerous fibroids return more often. It is recommended to ask your doctor what character your tumors are and what treatment will be optimal for them.
Risks of removal of uterine fibroids include:
- infection of the uterus, fallopian tubes or ovaries;
- removal of intraparietal fibroids can lead to tissue scarring.
In very rare cases there are the following ramifications:
- infertility due to tissue scarring;
- damage to the bladder or intestines (bowel obstruction);
- dilaceration of scar tissue at the time of labor;
- severe nonstop bleeding that requires removal of the uterus.
Myomectomy and pregnancy
Myomectomy is the only treatment for uterine fibroids that can increase the chances of pregnancy. Removal of uterine fibroids also helps in the treatment of a special type of fibroids, a submucous fibroid.
After myomectomy, a cesarean section may be required for labor. It depends on the nature of the transferred operation.
What should a woman think about when planning a pregnancy?
Due to the fact that fibroids of the uterus can appear again, the best solution would be to get pregnant immediately after surgery and the end of the rehabilitation period.
Incisions of the uterus can cause a rupture of the placenta or adrenal placenta. During labor, the uterus may not function correctly, which means it may require a cesarean section.
In rare cases, the doctor has to remove the uterus, since the size of the fibroids is too large for safe operation.