The time it takes for the uterus to heal after a myomectomy varies with patients, and it depends on
- The size and depth of the fibroid (myoma or leiomyoma)
- The number of fibroids
- Type of surgery
- Complications of the surgery
- Any underlying medical conditions, such as diabetes
No particular method has yet become widely accepted to assess the healing of the uterus after the myomectomy.
Who needs a myomectomy?
Myomectomy is a surgical procedure that removes fibroids from the uterus. Fibroids (also called leiomyoma) are noncancerous growths that commonly develop in women of childbearing age over the years. These may or may not cause symptoms, such as heavy bleeding during periods and feelings of heaviness, in the lower abdomen or pelvic region.
Doctors will prefer myomectomy to hysterectomy (surgical removal of the uterus) if
- You want to have children in the future
- You have a large fibroid or multiple fibroids that are affecting your chances of bearing a child
- You want to preserve your uterus
There are conservative (nonsurgical) options, such as GnRH agonist therapy and artery embolization therapy, that may help in the shrinking fibroid. If these options fail to reduce the size of the fibroid, myomectomy can be done to remove the fibroid.
What are the different types of myomectomy?
There are three main types of myomectomy. As per their experience, type of fibroid, and the patient’s preference, surgeons can perform myomectomy with any of the following approaches:
- Open myomectomy: This type of surgery is also known as laparotomy. In this surgery, the surgeon makes a single, large incision of about 6-12 inch over your lower abdomen to remove the fibroid from the uterus.
- Laparoscopic myomectomy: This type of surgery involves making a few (3-4) tiny incisions over the abdomen at first. Next, the surgeon inserts a long tube-like camera, known as a laparoscope, to visualize the uterus. The surgeon uses the remaining incisions to insert the surgical instruments to cut and remove the fibroids from the uterus.
- Hysteroscopic myomectomy: In contrast to the two approaches mentioned above, this type of myomectomy requires no incisions and makes use of the vaginal route to remove the fibroid from the uterus. A long tube-like camera known as a ‘hysteroscope’ is inserted through the vagina that goes through the cervix to reach the uterus. Instruments are inserted through the hysteroscope to remove the fibroid.
What is done before the myomectomy procedure?
Your doctor will see if you have a condition known as anemia, which is low hemoglobin (Hb) level or red blood cell count. Treatment of anemia is crucial to avoid excessive bleeding after myomectomy. Here is what the doctor can recommend to you:
- Iron and multivitamin tablets
- GnRH therapy (a hormonal therapy that will stop your menstrual periods till your surgery)
You will usually get admitted a night before the surgery and will be asked to not eat or drink anything for at least 8 hours before the surgery (in case of abdominal myomectomy). Your doctor will instruct you when you should stop eating or drinking. Hysteroscopic myomectomy can generally be performed as an outpatient procedure. Your doctor will tell you when to get admitted.
Follow your doctor’s instructions regarding medicines that need to be stopped before the surgery.
What is done after the myomectomy?
You are shifted to the surgical ward or the intensive care unit and observed for a few to several hours after the surgery.
If you have been given general anesthesia, you may feel sleepy or drowsy for a few to several hours, and so, you would not be allowed to ambulate for that period.
You will be allowed to eat only after you have your first bowel movement after the surgery.
Your hospital stay can last for 1-4 days depending on the type of surgery you had; it is shorter in case of a laparoscopic myomectomy and hysteroscopic myomectomy.
What are the complications of myomectomy?
Myomectomy carries a low chance of developing complications. Possible risks include:
- Internal bleeding or vaginal bleeding: There is a rare chance of bleeding during the operation for which a blood transfusion is sometimes needed.
- Infection of the surgical site: A short course of antibiotics will help fight off the infection.
- Damage to the surrounding organs: Surgeons are generally successful in fixing this during the surgery.
- Scar formation: Bands of scar tissue (adhesions) can develop after the surgery.
- Anesthetic risks: You may suffer from side-effects of anesthesia, which can be dealt with in the operative room.
- Hysterectomy: This is rare but may happen in cases when the size of the fibroid encompasses the whole of the uterus and removal of the entire uterus cannot be avoided.
- Chances of cesarean delivery: If you become pregnant after a myomectomy that was done for deeply embedded fibroids, chances are that doctors will recommend a cesarean delivery.
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Myomectomy. Available at: https://www.mayoclinic.org/tests-procedures/myomectomy/about/pac-20384710
Myomectomy. Available at: https://my.clevelandclinic.org/health/treatments/15448-myomectomy/
Tinelli A, Hurst BS, Mettler L, et al. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: An observational study. Human Reproduction. 2012 Sep 1;27(9):2664-70.
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