Myomectomy is the surgical treatment procedure which is performed to remove the uterine fibroids which are also called as LEIOMYOMAS. These can be commonly described as non cancerous growth of tissues in the uterus. It usually arises during the child bearing years but can also happen at any age.
The surgeon’s goal during performing Myomectomy is to reconstruct the uterus and remove all the problematic symptoms causing fibroids in the uterus. The women who undergo successful Myomectomy shows improvement like regular menstrual bleeding and improved pelvic pressure.
Symptoms of Uterine Fibroids
- Heavy bleeding during the menstruation
- Extended menstrual phase — seven days or more of menstrual bleeding
- Pelvic stress or pain.
- Frequent or irregular urination.
- Difficulty emptying your bladder
- Backache or leg pain
Why it is done?
The doctor recommends Myomectomy for the removal of the fibroids that causes interference with your routine activities. Myomectomy is preferred over hysterectomy if:-
- If the uterine fibroids interfere your fertility
- You don’t want your uterus to be removed
- You plan to conceive a baby
How to prepare for it?
Stay Updated – You are recommended to collect all the bits and pieces of information and questions regarding your surgery so that you may discuss it with your doctor. A question you may ask is about the type of anesthesia and medications during the surgery along with the consequences of the surgery.
Adhere to instructions – Your doctor will instruct you about the diets and routine activities and you need to follow them. The doctor will prohibit your eating and drinking hours before you go for the surgery. You must ask your doctor how to take your medicine during that course of time if you are already on some other medications.
Plan for your hospital stay after the surgery – You need to stay in the hospital after the surgery and its duration depends upon the type of surgery you undergo. You are advised to pack all the things and medications which you may need during your hospital stay in advance.
How it is performed ?
There are three types of surgical procedures which are performed in Myomectomy and they depend on the size and location of the fibroids. These are:-
The surgeon makes an incision in the abdomen to contact your uterus in order to remove fibroids. The incisions may be done-
Horizontally – It is a horizontal incision about 8 to 10 cm that is made on top of the bikini line, 2.5 cm beyond the pubic bone. It does not allow a proper access to the pelvic cavity hence not recommended in case a patient has larger fibroids.
Vertically – The incision is made just below from your navel and extended to the portion above the pubic bone. This type of incision grants a larger access to the surgeon to your uterus and also reduces bleeding. Additionally it is performed in the case of larger uterine fibroids.
This is done for the treatment of fibroids that grow submucosal i.e. inside the uterine cavity (submucosal fibroids). In this case, the fibroids are accessed and removed through vagina and cervix.
A light and small instrument called as RESECTOSCOPE is inserted in your uterus through vagina and cervix using a laser or electricity beam. A transparent sterile salt solution is inserted into the uterus to enlarge it so that uterine walls could be examined. The surgeon cuts the sections of the fibroids till it lines up with the surface of the uterine cavity. The detached tissues are washed out with the liquid that was used to inflate the uterus.
In very rare cases, a laparoscope is inserted in your abdomen by making small incision to observe pelvic organs and examine the outer surface of the uterus.
This is a minimally invasive procedure in which the surgeon makes several incisions in the abdomen to access and remove the fibroids. During this surgery, a small incision is made inside or near the belly button then a tube fitted camera called as LAPAROSCOPE is inserted in the abdomen. Thereafter the instruments are inserted inside by making identical small incisions. The surgeon regulates the movement of the instruments through a separate device.
The fibroids are cut into smaller pieces and are removed through the same holes in the abdomen. Very rarely, incision is made in the vagina (colpotomy) to drain out the fibroid pieces. There is lesser pain and blood loss and the patient returns back to the normal activity in shorter span of time.
After the surgery
You need to stay for 24 hrs or for few days in the hospital depending upon the type of surgery and your clinical condition. Your doctor will prescribe you the medicine and will instruct you how to take care of yourself. He /she will also tell you how to conduct your routine activities like you may be restricted to driving, climbing stairs, lifting heavy things and vigorous exercising. You also have take care so that no external infection occurs. You may expect some vaginal spots or stains from few days to weeks. The recovery time varies depends upon the type of surgery you had-
- Abdominal Myomectomy – four to six weeks
- Hysteroscopic Myomectomy – less than a week
- Laparoscopic Myomectomy – two to three weeks
- Relief from the above mentioned symptoms
- Improvement in the fertility
Though the chances of severe complications are less in Myomectomy, some risks are still involved. These are:-
Heavy blood loss – women already suffer from heavy menstrual bleeding that is why there is a possibility of anemia. Your doctor will ask you to maintain your blood counts normal in order to avoid complications. However the surgeon tries to block the excessive flow of blood through medications that compress the blood vessels for lesser flow and blocking the blood flow from uterine arteries.
Scar Tissue – Incisions made in the uterus during the surgery may lead to adhesions. Bands of scarred tissues may develop after the surgery and they can interfere with the nearer organs and may block the fallopian tubes or loop of intestine.
Complications in Childbirth – If you have underwent Myomectomy then there is a possibility of complications while your vaginal delivery. In this case cesarean delivery is recommended in order to avoid the rupture of uterine walls.
Very rare chances of hysterectomy – If the bleeding from the uterus is unstoppable or any other abnormalities apart from the fibroids are found then Hysterectomy or removal of uterus is preferred. Though there are very rare chances of hysterectomy.
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