22 Jan Myomectomy Surgery To Treat Fibroids
What Are Fibroids?
Fibroids are non-cancerous tumours that develop in the uterus. Fibroids can grow in any part of the uterus and are classified into subtypes according to which layer of muscle they are located (see diagram below). Treatment options for fibroids include medications, radiological procedures such as uterine artery embolisation and surgery such as myomectomy or hysterectomy. Myomectomy is a surgical removal of fibroid from the uterus by a gynaecologist.
Symptoms
- No symptoms
- Heavy or prolonged painful periods
- Bleeding between periods
- Backache
- Frequent urination
- Constipation
- Pain or pressure in the pelvic area
- Reduced fertility
Treatments
Fibroids can be left untreated if they don’t cause any symptoms. However, when they start impacting your health, treatment options include:
- Non hormonal or hormonal medications to reduce menstrual flow
- Uterine artery embolization to block blood supply to the uterus
- MRI guided ultrasound waves to destroy fibroid cells
- Myomectomy Surgery – surgical removal of the fibroid
- Removal of the uterus (hysterectomy) — for women who have completed their family or do not wish to have children
Myomectomy Procedure
Myomectomy surgery typically involves an incision in the abdomen, through which the surgeon accesses the uterus and removes the fibroids. The surgical method performed will depend on the size, location and type of fibroid. It is also dependent on the training and experience of the gynaecologist performing the surgery. Methods, include:
- Hysteroscopic Myomectomy: A procedure where a hysteroscope (a thin tube attached to a video camera) is inserted through the cervix and into the uterus to remove the fibroid. It is done for submucosal fibroids that grow from within the internal muscle layer of the uterus
- Laparoscopic Myomectomy: A minimally invasive procedure where small 5-10mm incisions are made in the abdomen. A laparoscope (slender tube attached to a video camera) is then inserted for vision. The myomectomy is then performed through these small incisions with or without robotic instruments. It is less invasive than an open surgery, but feasibility depends on the number, size and location of the fibroids.
- Abdominal Myomectomy: A traditional open surgical procedure where an incision is made in the lower abdomen to remove the fibroids. It is usually performed for large fibroids
What to Expect After a Myomectomy
Recovery Time
This varies depending on the type of myomectomy and person’s health. Hysteroscopic myomectomy is typically performed as a day case, with recovery time of a few days. Other minimally invasive myomectomy such as laparoscopic myomectomy may require a night in hospital and up to two weeks of recovery. Recovery is longer with traditional open abdominal myomectomy with typical recovery of 4-6 weeks.
Pain and discomfort
There will be pain following any surgery, this tends to be more pronounced with traditional open surgery. Pain can usually be well managed with various analgesia medications and patients are typically able to mobilise the following day. Patients have less pain with minimally invasive surgery and typically go home the same day or the day after laparoscopic surgery.
Fatigue
You may feel tired and weak for the first few weeks after myomectomy surgery so it is recommended to rest and take time off work as needed.
Bleeding
You may experience some vaginal bleeding or spotting for a few weeks after surgery so it is a good idea to have pads, liners or period underwear at home.
Bowel movements
You may have trouble opening your bowels for a few days after the surgery and require some gentle aperients (stool softeners). This should resolve on its own.
Follow-up
Your gynaecologist will schedule follow-up appointments to monitor your recovery and check for any complications.
It is important to follow your gynaecologist’s instructions on post-surgery care, these include contacting them if you experience any signs of infection.
It is worth noting that myomectomy surgery may have an impact your fertility plans, with implications for future pregnancy and delivery. It is important to discuss these with your gynaecologist before the surgery.
Myomectomy should be performed by specialist gynaecologists who perform a higher volume of more complex cases and are highly experienced in treating fibroids. Dr Kent Kuswanto is available to see his private patients in Epworth Freemasons in East Melbourne and Werribee.