Surgical Removal of Fibroids

The common indications for removal of fibroids are anaemia due to heavy bleeding, pain or pressure symptoms and infertility or miscarriage. Myomectomy is an operation which aims to preserve the uterus and thus fertility if desired. The following surgical methods are used based on the size and location of fibroids:

• Open Surgery/Laparotomy - used to remove fibroids, multiple fibroids, or fibroids that are deep inside the wall (intramural).
• Laparoscpic (key-hole) Myomectomy - preformed for smaller fibroids attached to the uterus in a subserous location (growing on the outside of the uterus). The fibroids are removed through a smaller incision and hence recovery is faster. However, if technically unsafe or difficult, the operation may be deferred to open surgery.
• Hysteroscopic Myomectomy - used to remove small fibroids growing on the inner wall of the uterus (i.e. towards the uterine cavity). These fibroids can be removed vaginally through a telescope and do not require abdominal incision/cut and your hospital stay is therefore shorter.

 

Open Myomectomy

Technically, removing fibroids can be more difficult and slightly more risky than a hysterectomy.  In rare cases, a myomectomy operation may become a hysterectomy if the circumstances arise.  The surgery is usually preformed under general anaesthesia.  An abdominal incision is made which may be horizontal (bikini cut) or vertical (up/down usually below the umbilicus).  The choice of incision depends on the size of the fibroids and technical attachments, taking particular care to avoid injury to the bladder, bowel and ureter.  An incision is made over the fibroid and the fibroid is removed using a blunt and sharp dissection, however, this can lead to heavy bleeding.  If you have multiple fibroids, you will have multiple cuts in the uterus.  After removal, the uterus is sutured in multiple lays for control of the bleeding and to achieve an anatomically normal uterus.  The abdominal wall is closed in multiple lays with absorbable sutures and subcutaneous (under the skin) sutures are applied to the skin.  you mayhave the following attachments/tubes after surgery:

• Urinary catheter
• Intravenous fluid
• PCA (drug infusion to control)
• TED stockings (to prevent clotting)
• Drain (to clear any blood collected in abdomen after surgery)

 

The risks of surgery include

• Bleeding. On rare occasions a hysterectomy may be necessary due to uncontrolled bleeding or if uterus is deformed with multiple fibroids
• Post-operative pelvic infection
• Scar tissue formation leading to weakness of the uterus which may necessitate a caesarean section in future births and may also lead to abnormal placental location. Fibroid surgery can also produce scarring leading to infertility or sub-fertility. However, in most instances, it will improve fertility outcomes.
• Injuries to bladder, bowel, blood vessels and ureter.
• Recurrence
• You would be advised to wait for 6-12 months before conceiving. You may be advised to have a tubal patency test 3-4 months after surgery if the fibroids were in close location to the tubes and cavity.

A separate information sheet for the risks and possible complications related to major gynaecological surgery is provided.

 

Pre-Operative Preparation

• You will have a pre-anaesthetic consultation
• Correction of anaemia and treating heavy bleeding
• Stop smoking
• Reduce weight if overweight and achieve higher fitness levels

 

Post-Operative Period

You will be in the hospital for 2-3 days.  The recovery is usually 4-6 weeks.  You may not be able to drive for 3-4 weeks.  Early mobilization helps.  Generally a myomectomy is as safe as a hysterectomy in terms of risks..  In the case of multiple fibroids, the surgery is slightly more risky.