Brief Description – Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. After myomectomy, your chances of pregnancy may be improved but are not guaranteed.
Why the Procedure is Performed
Myomectomy preserves the uterus while treating fibroids. It may be a reasonable treatment option for fibroid if you have:
- Anaemia that is not relieved by treatment with medicine
- Pain or pressure that is not relieved by treatment with medicine
- A fibroid that has changed the wall of the uterus causing infertility or repeat miscarriagesHow to Prepare For the Procedure
Before myomectomy, shrinking fibroids with gonadotropin-releasing hormone analogue (GnRH- a) therapy may reduce blood loss from the surgery. GnRH-a therapy lowers the amount of oestrogen your body makes. If you have bleeding from a fibroid, GnRH-a therapy can also improve anaemia before surgery by stopping uterine bleeding for several months.
How the Procedure is Performed
There are 3 known surgical methods for myomectomy and they include:
- Hysteroscopy, which involves inserting a scope through the vagina into the uterus
- Laparoscopy, which uses a scope and one or more small cuts (incisions) in the abdomen
- Laparotomy, which uses a larger incision in the abdomenThe method used depends on the size, location, and number of fibroids.
Hysteroscopy can be used to remove fibroids on the inner wall of the uterus that have not grown deep into the uterine wall.
Laparoscopy is usually reserved for removing one or two fibroids, up to about 2 in. (5.1 cm) across, that are growing on the outside of the uterus.
Laparotomy is used to remove large fibroids, many fibroids, or fibroids that have grown deep into the uterine wall. Need to correct urinary or bowel problems. To repair these problems without causing organ damage, laparotomy is usually needed.
During the Procedure
How you feel or what to expect depends on the method used. You may be sedated or completely unconscious. Ask your doctor to discuss with you what to expect.
After the Procedure
The length of time you may spend in the hospital varies.
- Hysteroscopy is an outpatient procedure.
- Laparoscopy may be an outpatient procedure or may require a stay of 1 day.
- Laparotomy requires an average stay of 1 to 4 days.Recovery time depends on the method used for the myomectomy:
- Hysteroscopy requires from a few days to 2 weeks to recover.
- Laparoscopy requires 1 to 2 weeks.
- Laparotomy requires 4 to 6 weeks.Because fibroids can grow back, it is best to try to conceive as soon after a myomectomy as is safely possible and your recovery from surgery is complete.
Risks may include the following:
- Infection of the uterus, fallopian tubes, or ovaries (pelvic infection) may occur.
- Removal of fibroids in the uterine muscle (intramural fibroids) may cause scar tissue.
- In rare cases, scarring from the uterine incision may cause infertility.
- In rare cases, injuries to the bladder or bowel, such as a bowel obstruction, may occur.
- In rare cases, uterine scars may break open (rupture) in late pregnancy or during delivery.
- In rare cases, a hysterectomy (removal of the entire womb) may be required during a myomectomy. This may happen if removing the fibroid causes heavy bleeding that cannot be stopped without doing a hysterectomy.