Myomectomy

Myomectomy is surgical removal of uterine fibroids. Its goal is to repair the uterus and bring it back to its usual functioning. It is the only surgical procedure for uterine fibroids that can preserve the possibility of getting pregnant after it.

The main practical goal here is to stop heavy bleeding and pressure on the internal organs from the (possibly large) fibroids. The disadvantage is that fibroids can happen again. Fibroids that are cut out cannot come back, but if nothing else changes in the life of the patient, fibroids that were not operated upon may grow larger, or new ones can form. If there were one or two large fibroids and they were taken out, the risk of other such fibroids growing again is low. If there were a large number of small fibroids and some of them were not taken out during myomectomy, they can just continue growing as if no surgery ever happened.

(This of course begs the question -- why were not those small fibroids taken out as well? In abdominal myomectomy, the surgeon can actually see and feel under his fingertips the entire uterus. If he can detect them, he can can take them out. However, in a procedure such as laparascopy, the fibroids that are near the surface of the uterus are taken out, while the other parts are simply not taken into account, so smaller fibroids can remain there, unseen and untouched... That is why it is important to diagnose the fibroids entirely and completely, usually with ultrasound, MRI, hysteroscopy etc.)

It is possible to misdiagnose adenomyosis for fibroids and then a wrong kind of surgery may be undertaken.

The Position of the Fibroids

The preferred methods will depend on the place the fibroids occupy. The types of fibroids are:

Intracavitary myomas -- inside the uterine cavity. Will usually produce metrorrhagia (bleeding between periods) and/or severe cramping. This type of myomas can be successfuly eliminated by a procedure called hysteroscopic resection, through the cervix and with no incision.

Submucous myomas -- one part in the cavity and the rest in the wall of the uterus. Usually produces menorrhagia (heavy menstrual bleeding) as well as bleeding between periods. For some of these myomas, hysteroscopic resection may be a method of choice.

Intramural myomas -- in the wall of the uterus. Can be very small up to large as a grapefruit. There are several fibroid treatments for this group, but -- best of all -- this type of fibroids may not call for a surgery at all.

Subserous myomas -- on the outer wall of the uterus. Can be destroyed by laparoscopy.

Pedunculated myoma -- an outside myoma on the stalk. Best eliminated by laparoscopy.

Various Forms of Myomectomy

There is not one technique good in all cases, rather it is a body of evolving techniques, such as:

Abdominal myomectomy

Laparoscopic myomectomy

Laparoscopic myomectomy videos

Hysteroscopic resection (hysteroscopic myomectomy)

The Risks of Myomectomy

If the surgeon is properly trained, the risks will be minimal. Still, note the following list of possible problems:

. blood loss,

. bowel obstruction,

. anemia,

. pain,

. late intestinal obstruction,

. infertility,

. possible conversion to hysterectomy during myomectomy, and

. subsequent surgery.

Pregnancy after myomectomy is not impossible, but some parts of the uterine wall may become weaker because of the myomectomy, with possible complications in pregnancy such as ruptures of the uterine wall, and cesarean section.

Fibroids are benign tumors, but in 1% of all cases there is a possibility that they will become malign. If that is not discovered before the operation, the surgeon may convert the myomectomy to a hysterectomy, in order to prevent spreading cancer to the other parts of the body.

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