Myomectomy

Fibroids are non-cancerous lumps that develop in the uterus. They are also known as myomas. Removal of these myomas or fibroids is technically referred to as myomectomy. Please refer to our section on fibroids to know more about them

When is myomectomy required?

It must be emphasized that the majority of fibroids do not cause any trouble and need not be removed. It is only in certain situations that a fibroid needs to be removed. Myometcomy is often done when fibroids cause excessive bleeding during menses, infertility, recurrent abortions, urinary and bowel problems or if they have become very large in size and are not responsive to medications.

How is myomectomy done?

Traditionally, myomectomy was done by open surgery that involved a standard incision in the lower part of the belly. With current advances, most myomectomies are done via laparoscopy. You will under general anesthesia to make the procedure painless. A small key hole sized incision is used to insert a special camera connected to a tube (laparoscope). The camera is connected to a high definition monitor that can be used to see the uterus. Through similar key hole sized incisions, special instruments are passed that can be used to remove the fibroid. If the fibroid is too large to be removed entirely through the laparoscope, we employ a technique called laparoscopic-assisted mini open myomectomy. In this technique, laparoscopy is performed and a small additional incision is made to remove the large fibroid.

What are the advantages of laparoscopic myomectomy?

In laparoscopic myomectomy, only small stab incisions are made and this makes healing and recovery much faster. There is less pain following the procedure and hospital stay can be shortened. Internal scarring within the abdomen is less and this minimizes the chances of adhesion. The external scar which is just key hole sized as opposed to several centimeters in open technique is an obvious advantage.

What do I need to do before a myomectomy?

• Pre- op preparation usually includes blood tests, urine test, ECG, chest X- ray
• Myomectomy will require you to have anesthesia. The anesthetist will see you prior to the surgery and will make sure that anesthesia is safe for you.
• You will be asked to get admitted one day before the surgery and advised liquid diet on that day
• On the day of surgery you will be kept nil per oral (without food or liquids) for approximately 8 hours and started on IV fluids

What to expect after myomectomy?

You will be provided with pain medicine in the immediate period following a laparoscopy. Since the procedure is done close the digestive tract and under general anesthesia, you will be allowed to take food or liquids only after your bowels have resumed function. The hospital stay is generally 2-3 days depending on the nature of the procedure. Absorbable stitches are often used and these do not require to be removed. If non-absorbable stitches have been used you may have to come back to have them removed. The recovery generally takes 1-2 weeks after laparoscopic myomectomy and about 4 weeks after open myomectomy.

Once you have recovered, menstrual pain and blood loss are reduced to physiological levels. For those with infertility or recurrent abortions, the chances of a successful pregnancy increases significantly.

Multiple fibroids removed from the uterus

Should I undergo myomectomy or hysterectomy for fibroids?

Myomectomy refers to removal of the fibroid alone while preserving the uterus. In hysterectomy, however, the entire uterus along with the fibroid is removed. In young women, we strongly favour myomectomy over hysterectomy and make every effort to preserve the uterus. This allows you to retain the uterus and delay menopause.

Problems associated with early menopause such as osteoporosis and increased incidence of cardiovascular problems are avoided. In women with multiple large problematic fibroids, hysterectomy may be done if they have completed their families.

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