Myomectomy Surgery and Its Overview & Treatment

What is a Myomectomy and how it can be treated?

 Overview

Myomectomy is a procedure used to remove fibroids while preserving uterine function. Myomectomy may be performed through an abdominal incision ( laparotomy), laparoscopically or hysteroscopically. The choice of approach depends on physician preference and on the type and location of the fibroids. Recovery time depends on the surgical approach – myomectomy with an abdominal incision typically requires four to six weeks. The other approaches involve shorter recovery times.

 However, removing fibroids with a myomectomy is an involved surgery – typically more difficult than a hysterectomy- and may result in severe blood loss. Also note that new fibroids may appear after it and that additional treatment may be required.

When is it used?

In general, myomectomy is used for women with symptomatic fibroids who wish to preserve their fertility. Approximately 80 percent of women will experience symptom relief following this surgery. The procedure is easier to perform on women with a few fibroids. The most difficult cases are those where many fibroids are diffused throughout the uterus. 

The exact relationship between infertility and fibroids is unclear. Therefore, myomectomy is usually reserved for cases in which other potential causes of infertility have been ruled out. Fibroids that compress the uterine cavity are likely to be of clinical importance. However, when the fibroids are distant from the uterine cavity, myomectomy is unlikely to impact fertility. A hysterosalpingogram and ultrasound can be used to assess the impact of fibroids on the uterus and whether it  is likely to be beneficial.

Preparation 

Preoperative ultrasound will be performed to help the physician identify the size and location of the fibroids. The physician may recommend drug therapy with leuprolide (Lupron) prior to myomectomy to shrink the fibroids and reduce the possibility of blood loss. You may also wish to consider donating your own blood prior to surgery. 

What are the risks of Myomectomy?

Risks may include:

• Risks associated with general anesthesia
• Infection
• Blood loss
• Weakening of the uterine wall – can occur when large fibroids are removed. Future pregnancies may require Caesarian section for delivery.   
• Pelvic adhesions – may require further surgery.