A myomectomy is when a fibroid is surgically removed from the womb. The fibroid is surgically removed either by an open incision or using minimally invasive techniques like laparoscopy or Robotics. The surgeon removes the fibroid causing symptoms and reconstructs the uterus. Unlike hysterectomy where the whole womb is removed, myomectomy involves only removing the fibroid. In experienced hands this is a safe procedure with minimal complications.
Which patients are suitable for myomectomy?
- Patients who wish to retain their uterus or wish to have pregnancies
- Patients with sub-fertility
Types of Myomectomy
Myomectomy is performed either as an open incision or Laparoscopically. Laparoscopic myomectomy is not suitable for all patients as the feasibility depends on several factors including size and number of fibroids. This is performed through 4 small 10-5mm incisions in your tummy. In comparison to a conventional surgery with a bikini line incision.
What are the main complications of myomectomy?
Although complications are uncommon, there are a few important ones to consider.
As with any surgery there is a risk for infection and bleeding. If the bleeding is excessive and cannot be controlled, hysterectomy may be performed as a last resort. This happens very rarely with a reported incidence of roughly 1 in 100. If bleeding is excessive blood transfusion may be considered.
Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. This is less common after laparoscopic surgery. Adhesions can make other surrounding structures like loop of bowel or fallopian tube to stick to the scar. This may cause pain or infertility. We routinely use adhesion prevention agents to reduce this risk.
Development of new fibroids
Myomectomy doesn’t eliminate your risk of developing more fibroids in future. Tiny tumours (seedlings) that your doctor doesn’t detect during surgery could eventually grow and cause symptoms. New tumours also can develop. Women who had only one fibroid have a lower recurrence rate than do women with multiple fibroids. If fibroids return, future treatment — a repeat myomectomy, hysterectomy or other procedure — may be necessary.
Pregnancy and delivery
Having had myomectomy can pose some risk factors for pregnancy and delivery. You may be recommended to have a Caesarean section to avoid dehiscence of scar or scar rupture. This depends on whether the incision on the uterus was superficial or deep.
How should I prepare?
You should optimise your blood count. Take regular iron tablets along with multivitamins.
Hormonal injections or tablets may be given to shrink the fibroids and reduce bleeding at the time of surgery. This will also help to stop any heavy periods you might have.
How soon can I try for pregnancy?
We would advice you to wait for 3 months before trying for pregnancy.
Please see your GP as soon as pregnancy test is positive so that you may be referred to an antenatal clinic.
Where can I get more information?
The NHS Choices website has lots of information on fibroids and treatments: http://www.nhs.uk/Conditions/Fibroids