Myomectomy is a surgical procedure to remove uterine fibroids, benign or non-cancerous growths appearing in your uterus. Many women with uterine fibroids do not experience any symptoms. However, some women may experience symptoms that are mild and they include heavy and prolonged menstrual bleeding, bleeding between periods, pelvic pain, lower back pain, pain during intercourse and urinary problems. In rare cases, some women may have difficulty emptying the bladder, difficulty moving the bowels, anaemia due to heavy menstrual bleeding and reproductive problems such as infertility.
Myomectomy is the treatment of choice in women with fibroids who are planning to have children in the future. Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.
Preparation before Surgery
Before your surgery, gonadotropin-releasing hormone analogue (GnRH-a) therapy which lowers oestrogen levels may be used to shrink the uterine fibroids, thus reducing the risk of excessive bleeding during the surgery.
Indications for Myomectomy
A myomectomy is a treatment option if you have anaemia and pain or pressure not relieved with medications. Myomectomy is also done if the fibroids have changed the uterus so as to cause infertility or repeated miscarriages as this method improves your chances of becoming pregnant even after the procedure. After myomectomy surgery, your pelvic pain and bleeding from fibroids are reduced and your chances of having a baby are improved. If the fibroids are large and are more in number, they can re-grow after surgery.
Depending on the size, location, and a number of fibroids, your surgeon may choose one of three surgical approaches to remove the fibroids:
Hysteroscopy: This is an outpatient surgical procedure and is performed under general anaesthesia or spinal anaesthesia. Your doctor uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Your doctor can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Your doctor may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that has not gone deep within the wall of the uterus can be removed using this technique.
Laparoscopy: A laparoscopic myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached with a camera is used. A small incision is usually made below the navel and a laparoscope is inserted through this incision. Carbon dioxide gas is injected into the abdominal cavity using a special needle to create more space to work. Your surgeon identifies and removes the fibroids. During the procedure, tissue samples can also be taken for biopsy. This procedure is the preferred option to remove one or two fibroids up to 5.1 cm across that grow on the outside of the uterus.
Laparotomy: A laparotomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall your doctor may opt for laparotomy. Urinary or bladder problems can be corrected using laparotomy.
The possible complications of myomectomy include infection, scar tissue formation, damage to the bladder or bowel, and rupture of the uterine scars in late pregnancy or during labour. Rarely, a myomectomy causes uterine scarring that can lead to infertility.
Because fibroids can grow back, those women who are planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, your doctor will advise you to wait for 4 to 6 months until the uterus heals. Before undergoing any treatment for infertility, your doctor may recommend a hysterosalpingogram, an X-ray test to check the uterus and fallopian tubes.
The incisions made in the wall of the uterus to remove fibroids may cause placental problems and improper functioning of the uterus during labour may need a cesarean delivery. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.