Uterine myomectomy

Uterine Myomectomy is a surgical procedure aimed at removing fibroids from the uterus. Fibroids, also known as uterine leiomyomas or myomas, are benign (non-cancerous) tumors that arise from the muscle layer of the uterus. They are the most common pelvic tumors in women and can lead to symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms affecting the bladder and rectum. Uterine myomectomy is considered when these symptoms become bothersome or if the fibroids interfere with fertility.

Indications

Uterine myomectomy is indicated for women who experience symptomatic fibroids and wish to retain their uterus, which is particularly important for women of reproductive age who desire future pregnancies. The procedure is recommended when:

• Fibroids cause heavy menstrual bleeding that leads to anemia.
• Fibroids lead to significant pelvic pain or pressure symptoms.
• There is a suspicion that fibroids interfere with fertility or are a cause of recurrent miscarriages.
• A rapid growth of fibroids is observed, which might indicate a rare transformation into a malignant form.

Types of Myomectomy

There are several surgical approaches to perform a myomectomy, and the choice depends on the size, number, and location of the fibroids:

• Laparoscopic Myomectomy: A minimally invasive procedure where small incisions are made in the abdomen, and fibroids are removed using specialized instruments.
• Hysteroscopic Myomectomy: This approach is used for fibroids that are located within the uterine cavity. It involves the insertion of a hysteroscope through the vagina and cervix into the uterus, allowing the surgeon to remove the fibroids without any incisions.
• Abdominal Myomectomy: Also known as an open myomectomy, this procedure involves a larger incision in the abdomen to access and remove the fibroids. It is typically reserved for women with large, numerous, or deeply embedded fibroids.

Risks and Complications

As with any surgical procedure, uterine myomectomy carries potential risks and complications, including:

• Bleeding
• Infection
• Damage to surrounding organs
• Scar tissue formation, which may affect fertility
• Potential need for a hysterectomy if complications arise during surgery
• Recurrence of fibroids

Recovery

Recovery from a myomectomy varies depending on the type of surgery performed. Laparoscopic and hysteroscopic myomectomies generally have shorter recovery times and less postoperative pain compared to abdominal myomectomy. Patients can usually return to normal activities within a few weeks, although they are advised to avoid heavy lifting and strenuous exercise for a specified period.

Fertility and Pregnancy Outcomes

Uterine myomectomy can improve fertility rates and pregnancy outcomes for women whose fibroids are implicated as a cause of infertility. However, the type of myomectomy performed may influence future pregnancy recommendations. For example, women who undergo an abdominal myomectomy may be advised to deliver future pregnancies via cesarean section to avoid uterine rupture.

Conclusion

Uterine myomectomy offers a fertility-preserving option for women suffering from symptomatic fibroids. The choice of surgical approach depends on individual patient factors, including the size, number, and location of fibroids. Women considering myomectomy should discuss the potential risks and benefits with their healthcare provider to make an informed decision.