Myomectomy

A myomectomy is an operation performed to remove benign tumours called fibroids from the muscular wall of the uterus.

Fibroids often cause pain and excessive menstrual bleeding

They can also interfere with your ability to become pregnant. They may degenerate or become infected, and therefore your doctor may feel they should be surgically removed. A hysterectomy may be suggested if you are over childbearing age.

Fibroids are categorised by their locations, which include:

• Your doctor may order an ultrasound scan to try to pinpoint the fibroids prior to surgery. Some blood tests may be ordered to see if you are anaemic (symptoms can include excessive tiredness
• breathlessness on exertion
• pale skin
• poor resistance to infection)

A urine test will tell if you have an infection in your urinary system.

The anaesthetist visits you prior to your operation to see if you are suitable to have a general anaesthetic. (If you are not suitable, you may have the operation performed under a spinal or epidural anaesthetic.) For a general anaesthetic, you are usually given a pre-medication injection to dry up your internal secretions and make you feel drowsy.

Some surgeons request you have an enema and a portion of your pubic hair shaved prior to surgery.

In most cases, the surgeon performs a dilatation and curettage (D&C) to check for irregularities in the inner surface of the uterus. The kind of myomectomy performed depends on the type, size, number and location of the fibroids, but can include:

• After the operation
• you can expect: Your temperature
• pulse respiration
• blood pressure is observed

Any vaginal discharge is noted

An intravenous fluid line may still be running into your arm to replace fluids in your body.

Antibiotics may be included to combat infection

You may have some tubes at the wound site to drain off excess fluid if necessary.

If you need pain relief, tell your nurse. You may have a catheter to drain off urine for the next day or so. You are given a normal diet, once your doctor feels it is safe to do so.

Tell your nurses as soon as you pass wind or a bowel motion, as this shows that your digestive system is getting back to normal. Perform your breathing, coughing and leg exercises hourly when you are awake. You are assisted out of bed and taken for a walk the day following surgery.

You may be in hospital for five to seven days following surgery. Possible complications of myomectomy include:

• Eventual re-growth of fibroids. Be guided by your doctor
• but general suggestions include: Try to rest as much as possible for two weeks

Avoid standing for more than a few minutes at a time. Continue to take your medications, and follow strictly the instructions on taking your antibiotics.

After two weeks, aim to walk for about 10 minutes every day, unless advised otherwise by your doctor.

Depending on the type of surgery, you can return to work within two to six weeks (abdominal myomectomy takes the longest recovery time).

If you have any excessive vaginal bleeding, or signs of infection at your wound site (such as redness, increasing pain, swelling, or an increased or offensive discharge from your wound), see your doctor immediately.

You will still have your uterus and all reproductive organs following myomectomy.

Once healed, there should be no effects on your sexual activity, and you should still be able to conceive. Depending on the depth of the scar in your uterus, you may require an elective caesarean section at 38 weeks to safely give birth.

If you are seeking myomectomy as a remedy to excessive menstrual bleeding, it is important to know that the operation is unsuccessful in around 20 per cent of cases - your heavy menstrual flow may be due to factors other than fibroids.

See your doctor for further information and advice

Other possible forms of treatment for fibroids may include:

• size number
• location of the fibroids

You will still have your uterus and all reproductive organs following myomectomy. Uterine fibroids Intramural in the uterine wall.

Intramural fibroids are the most common variety

Submucosal in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain.

Subserosal on the exterior wall of the uterus

They sometimes appear like long stalks

Medical issues to consider Operation procedure Abdominal myomectomy the uterus is accessed via one large incision through the abdomen. Usually, a horizontal cut just on the bikini line is performed; in some cases, the incision may need to be made vertically in the midline of your abdomen. The uterus is cut, sometimes with a laser (which closes off blood vessels and reduces bleeding).

The fibroids are then removed and the uterus, abdominal wall and skin are closed with sutures. This type of myomectomy is preferred for multiple or deeply rooted fibroids. The drawback of abdominal myomectomy is that it takes longer to recover.

Laparoscopic myomectomy subserosal fibroids can often be removed via laparoscopic (‘keyhole’) myomectomy. The surgeon makes a number of small incisions, which allow different instruments access to the uterus. Among these instruments is the laparoscope, which contains fibre-optic camera heads or surgical heads (or both).

The fibroids are removed, and the small wounds sutured (sewn) closed.

Recovery time for the patient is comparatively fast

Hysteroscopic myomectomy the fibroids are removed via the dilated cervix, so no abdominal incisions are needed. The instrument is called a resectoscope, which is a hysteroscope fitted with a wire loop. The instrument is inserted through the cervix, and the wire loop slung over the fibroid.

Electrical energy passes through the loop, which cuts the fibroid loose. The fibroid can then be removed through the vagina. Immediately after the operation Possible complications Haemorrhage Injury to the uterus Damage to the nearby organs of the urinary system Formation of scar tissue (adhesions) within the uterus Infection Blood clots Taking care of yourself at home Long term outlook Other forms of treatment Monitoring if the fibroids are asymptomatic, a ‘wait and see’ approach is often adopted.

Drugs such as hormones, used in combination, to shrink the fibroids prior to surgery. Hysterectomy the surgical removal of some or all of the uterus.

Pregnancy is no longer possible after a hysterectomy

Where to get help Your doctor Things to remember.

Key Points

• Fibroids often cause pain and excessive menstrual bleeding
• Other possible forms of treatment for fibroids may include: Gynaecologist
• Intramural fibroids are the most common variety
• This type tends to cause excessive menstrual bleeding and period pain
• Laparoscopic myomectomy subserosal fibroids can often be removed via laparoscopic (‘keyhole’) myomectomy