Myomectomy is a surgical procedure performed to remove fibroids, which are non-cancerous growths that develop in the wall of the uterus. It is a common treatment option for women who have symptomatic fibroids and want to preserve their uterus for future fertility or personal reasons.
During a myomectomy, the fibroids are removed while the uterus is left intact. Depending on the size, location, and number of fibroids, the procedure can be performed through an abdominal incision laparoscopically (using small incisions and a camera), or hysteroscopically (through the vagina and cervix).
Myomectomy is a fertility-preserving surgery, meaning that it can help women who want to become pregnant by removing fibroids that may be affecting fertility. However, it's important to note that fibroids can recur after myomectomy, and there is still a risk of infertility or pregnancy complications even after successful removal of fibroids.
There is a risk of complications such as bleeding, infection, and injury to surrounding organs. Recovery time can also vary depending on the type of myomectomy performed.
What are the complications of myomectomy?
Like any surgery, myomectomy carries some risks and potential complications. The following are some of the most common complications that can occur after a myomectomy:
Infection: Any surgical procedure carries a risk of infection, and myomectomy is no exception. Infection can occur at the site of the incision or in the uterus. Antibiotics may be prescribed before and after surgery to reduce the risk.
Bleeding: Heavy bleeding during or after the procedure is possible particularly if the fibroids are large or multiple. Blood transfusion may be required in some cases and rarely, loss of the uterus may occur if blood loss cannot be controlled.
Damage to other organs: There is a risk of accidentally damaging nearby organs such as the bladder, bowel, or ureters during the surgery, which can lead to complications.
Scar tissue: Formation of scar tissue at the site of the incision can cause pain and discomfort.
Recurrence of fibroids: While myomectomy removes existing fibroids, new fibroids can develop over time and may require additional treatment.
Anaesthesia complications: Complications related to anaesthesia such as allergic reactions, nausea, and vomiting are possible. Reaction to vasopressin – drug used to reduce blood supply to uterus.
Infertility: Myomectomy aims to preserve fertility, but there is still a risk of infertility, especially if the fibroids are large or located in certain areas of the uterus.
Uterine rupture: Rarely, myomectomy can weaken the uterine wall and cause it to rupture during subsequent pregnancies or labor.
What is the actual risk of hysterectomy after a myomectomy ?
The incidence of hysterectomy after myomectomy depends on several factors, such as the type of myomectomy, the size and number of fibroids, and the age and medical history of the patient. However, in general, the incidence of hysterectomy after myomectomy is relatively low.
According to a systematic review and meta-analysis published in the Journal of Minimally Invasive Gynecology in 2020, the overall incidence of hysterectomy after myomectomy was 3.5%. The incidence was higher for women who had multiple fibroids or large fibroids.
It is important to note that myomectomy is generally considered a safe and effective procedure for removing fibroids and preserving fertility. However, in some cases, hysterectomy may be necessary if the fibroids are too large or numerous, or if there are other complications during the procedure.
Recovery from Myomectomy
Recovery from myomectomy can vary depending on the type of surgery performed, the size and location of the fibroids, and the individual patient's overall health. Here are some general guidelines for what to expect during recovery from myomectomy:
Hospital stay: Most patients will need to stay in the hospital for at least one night after the procedure. During this time, the patient will be monitored for any complications and given pain medication as needed.
Pain management: Pain and discomfort are common after myomectomy. You will be provided with appropriate analgesia to manage the pain. Over-the-counter analgesics may also be used.
Activity level: Patients should avoid heavy lifting, strenuous exercise, and sexual intercourse for at least six weeks after the procedure. Walking is encouraged to promote healing and prevent blood clots.
Incision care: Patients will need to keep the incision site clean and dry to prevent infection. The healthcare provider may recommend showering instead of bathing and avoiding swimming until the incision is fully healed.
Follow-up appointments: You will have follow-up appointments scheduled for you to monitor your recovery.
Return to work: Patients can typically return to work and normal activities within two to six weeks after the procedure, depending on the type of surgery performed and the patient's individual recovery.
Pregnancy: We will advise when to start trying to conceive again depending upon the type and location from where the myoma has been removed.
Mode of birth: This also will be advised to you. If the endometrial cavity has been entered when removing the fibroid/s, which can happen quite often, you will be advised to have a planned C section.