Myomectomy is a surgical procedure which involves the removal of symptomatic uterine fibroids. Uterine fibroids are benign muscle growths also known as leiomyomas, they have around a 0.1% chance of developing into cancer. Most women have or have had uterine fibroids in their uterus at some point, especially during child bearing years when hormones are peaking. Open Myomectomy has the advantage that it leaves the uterus intact and retains fertility. It is also known to relieve symptoms of uterine fibroids.
The exact cause of uterine fibroids is not known; scientists however have been able to speculate that factors such as genetic mutations or hormonal fluctuation of oestrogen and progesterone play an important role. They can vary in size and shape. Uterine Fibroids follow growth patterns based primarily on hormones, this is why anti-hormone medication can be used to shrink fibroids, but this is a very temporary solution.
Open abdominal Myomectomy is a form of myomectomy which involves making a single large incision into the lower abdomen in order to access the uterus. The incision then gives the surgeon the space to examine the uterus and extract the fibroids. The alternative to Open Myomectomy, is Laparoscopic Myomectomy, where the surgeon will make several smaller incisions, as opposed to the single large incision in Open myomectomy. Laparoscopic myomectomy is a lesser invasive procedure; it involves the surgeon inserting a camera through a fibre optic instrument known as a laparoscope. The Laparoscope provides the surgeon with images from inside the uterus. Surgical instruments are put through the remaining incisions and the fibroids are extracted from the uterus.
Laparoscopic Myomectomy is generally a more expensive treatment option as compared to Open myomectomy. Open myomectomy is generally considered an economically viable solution to women who are suffering symptoms of uterine fibroids. Most women may live their lives with the presence of uterine fibroids in their uterus without the knowledge that they exist. This may not cause any issues with pregnancy or uterine functions. This is due to the fact that it is uncommon for fibroids to cause issues and only in severe cases generally do patients experience symptoms. In rare cases, women may display several symptoms for uterine fibroids, which may cause considerable discomfort. In this case seeking a medical professional is the best step forward, some symptoms of uterine fibroids are as follows:
- Unusually heavy period
- Menstrual period of duration longer than one week
- Problems during urination – frequent urination or difficulty urinating
- Pain in lower back and legs
- Periods lasting for an unusual amount of time
- Pelvic pain
In the event of a patient is experiencing any of these symptoms, the doctor may first conduct a series of tests to diagnose the patient. The following tests are commonly used to diagnose uterine fibroids:
- Many times, a doctor may discover uterine fibroids during a routine pelvic exam, this could be through physically feeling the irregularities inside the uterus, or coincidentally discovering them during a uterine examination for other purposes.
- Ultrasound: ultrasound uses sound waves to form an image inside the uterus and to locate the fibroids. A technician navigates the ultrasound around the abdomen of the patient or inside the vagina.
- Other Imaging tests: MRI, Hysterosonography, or a Hysteroscopy are some other imaging tests a doctor might use to get more images of the uterus and reveal more details about the size and nature of your uterine fibroids.
- Blood test: This helps rule out the possibility of other conditions which share the similar symptoms.
Prior to the operation, the doctor might ask the patient to fast for a specific duration before the surgery, it is important to closely follow the instructions given. The doctor will most likely inject the patient with General anaesthesia. This puts the patient to sleep during the course of the surgery and makes the process painless. Open myomectomy is a major and invasive procedure, this means it requires the patient to be in the hospital for some days after the surgery as well, as advised by the doctor.
Open myomectomy is a fairly complex surgical procedure involving several steps, and may require the patient to be in the hospital for a number of days. The following process can be expected during the procedure:
- The patient is required to remove their clothes and accessories and wear a hospital gown.
- The patient lies down on an operating table, general anaesthetic is given before the start of the surgery.
- An incision is made on the abdomen to access the inside of the abdomen. There are two possible incisions that could be made
- Bikini-line incision: a horizontal incision that follows your natural skin line, usually less painful and causes less scarring than a vertical incision.
- For larger uterine fibroids a vertical incision is used, this incision starts in the middle of the abdomen and travels down till just above the pubic bone. This wider access allows the surgeon to navigate easily and reduces bleeding.
- The fibroids are identified and extracted from the uterus one by one.
- The uterine muscle is sewn back together firmly.
Due to the invasive nature of Open myomectomy, recovery is observed carefully by doctors and patients can stay in the hospital for up to a week after the procedure.
There are certain risks that come with such a complex procedure:
- Blood loss: Many doctors might advise a patient to take certain steps in order to raise their blood count during the surgery. Many women may already have a low red blood cell count due to blood loss from heavy menstrual bleeding. This puts them at higher risk of becoming anaemic and causing further problems.
- Scar tissue: Although Myomectomy is often chosen specifically because women wish to retain the possibility of becoming pregnant again. With procedures such as a Hysterectomy, there is a small chance of infertility after Open Myomectomy. Bands of scar tissue known as Adhesions could block fallopian tubes, causing infertility. Adhesions could also lead to Asherman’s syndrome, and further issues concerning fertility
- Damage: In some cases, the procedure may injure the uterus or organs nearby, including the urinary system due to its close proximity.
- Tumours: Rarely, a cancerous tumour may be present in the uterus. If it is mistaken for a fibroid and broken into smaller pieces, this can lead to the spread of cancer.
- Infection: Some women could develop an infection post this operation and may have to be treated with antibiotics for a number of days in a hospital.
- Anaemia: If a patient has anaemia, this must be corrected before the procedure can take place. Doctors may prescribe iron supplements to boost blood count prior to the surgery.
Outcome of open myomectomy includes relief from symptoms of uterine fibroids. Most women also find that removal of uterine fibroids has an impact on fertility, and studies show improvement in fertility in many women.
Open myomectomy is a lesser known solution to uterine fibroids and provides a more viable solution for women who wish to retain their fertility after the removal of their fibroids. This is the difference between Myomectomy and Hysterectomy, another solution for fibroids. Myomectomy retains the uterus after the procedure while hysterectomy involves the complete removal of the uterus. At Apollo Cradle Jubilee Hills, the most skilled doctors perform surgeries and patients can ensure a swift and painless recovery. Although the surgery has a very high success rate, patients should keep in mind that there is no way to prevent fibroids from reappearing, especially younger patients have greater chances of developing uterine fibroids again.