Fibroid surgery, specifically myomectomy, is a surgical procedure to remove uterine fibroids (also known as leiomyomas). Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Myomectomy is the preferred treatment for women who wish to preserve their uterus and maintain fertility.

Types of Myomectomy

1. Hysteroscopic Myomectomy:

   • Indication: Suitable for submucosal fibroids (those that protrude into the uterine cavity).

   • Procedure: The surgeon inserts a hysteroscope through the vagina and cervix into the uterus. Using special instruments, the fibroids are removed through the hysteroscope.

   • Recovery: Generally quick, with patients often returning to normal activities within a few days.

2. Laparoscopic Myomectomy:

   • Indication: Suitable for subserosal (fibroids on the outer wall of the uterus) and intramural (fibroids within the uterine wall) fibroids.

   • Procedure: Minimally invasive surgery using small incisions in the abdomen. A laparoscope (a thin, lighted tube) is used to view the uterus and remove the fibroids.

   • Recovery: Faster than open surgery, with a typical recovery time of 1-2 weeks.

3. Abdominal Myomectomy (Laparotomy):

   • Indication: Recommended for large or numerous fibroids, or if the uterus is extensively enlarged.

   • Procedure: Open surgery with a larger abdominal incision to access and remove the fibroids.

   • Recovery: Longer recovery period, usually around 4-6 weeks.

Indications for Myomectomy

• Heavy menstrual bleeding

• Pelvic pain or pressure

• Frequent urination due to bladder pressure

• Difficulty with bowel movements due to rectal pressure

• Infertility or recurrent pregnancy loss

• Rapid growth of fibroids

• Suspicion of malignancy

Risks and Complications

• Infection

• Excessive bleeding (may require a blood transfusion)

• Scar tissue formation (adhesions)

• Injury to surrounding organs (e.g., bladder, intestines)

• Uterine rupture in future pregnancies (especially with deep intramural fibroids)

• Need for hysterectomy if uncontrollable bleeding occurs during surgery

Post-Surgery Care

• Pain Management: Prescribed pain medications to manage post-operative discomfort.

• Activity Restrictions: Avoiding heavy lifting and strenuous activities for the recommended period.

• Follow-Up Visits: Regular check-ups to monitor healing and detect any complications.

• Fertility Monitoring: For those desiring future pregnancies, monitoring by a fertility specialist may be advised.

Conclusion

Myomectomy is an effective treatment for symptomatic uterine fibroids, particularly for women who wish to preserve their uterus and maintain fertility. The choice of surgical method depends on the size, number, and location of the fibroids, as well as the patient’s overall health and reproductive goals. Consulting with a gynecologist or a reproductive specialist can help determine the best approach for each individual case.