Myoma Surgery (Myomectomy)
Purpose of This Article
This article was written to draw special attention to the fact that in cases where surgical removal of the uterus is not desired due to fibroids, only fibroids can be removed and the uterus can be preserved instead of complete removal of the uterus.
myomectomy, It means the surgical removal of lumps (fibroids) called fibroids from the uterine wall. Approximately one-third of women with fibroids cause symptoms such as groin pain and excessive bleeding that do not respond to medication during menstruation. complete removal of the uterusmeaning hysterechromia operation is done. Women of childbearing age who have been diagnosed with myoma and who do not want their uterus to be surgically removed should be treated with myomectomy to preserve the uterus.
Treatment Before Operation
Treatment with GnRH analogues once a month, starting three months before the operation, allows the fibroids to shrink, so the operation is performed with a smaller incision and less blood loss. During this treatment, menstruation is interrupted and bleeding does not occur. Thus, since the bleeding due to myoma will stop until the operation, the patient’s anemia will also improve, and there will be no need for blood transfusion from the outside. However, using this drug is at the physician’s discretion. Because GnRH analogs cause temporary menopausal symptoms and cause unwanted side effects such as night sweats and hot flashes. In addition, these drugs make the small fibroids in the uterus invisible, so these small fibroids may grow and require a second operation in the future, since these fibroids cannot be removed during the operation. If myomectomy is not performed after this three-month treatment, the fibroids will regain their former size in a short time.
Myomectomy Surgery Risks
As with any surgical operation, myomectomy operation can bring a wide variety of risks, especially when performed in inexperienced hands.
However, these complications are extremely rare when performed by experienced and appropriately trained physicians. Women should be warned about the risks that may occur in myomectomy operation.
Possible complications in myomectomy:
Pain, late bowel obstruction, anemia, infertility (infertility), pelvic adhesion (adhesion), possibility of conversion to hysterectomy during the operation and need for reoperation later, possibility of cesarean section when pregnancy occurs after the operation, and although more than 99% of myomas are benign As there is a very rare possibility of cancer, the risks should be known in advance by the patients who will undergo the operation.
Myomectomy complication rate 3%-9%
Myoma recurrence rate is 15%
Pelvic adhesion rate 15%-53%
Myomectomy Operation Techniques
Although small fibroids can be removed through a small incision by laparoscopy or hysteroscopy, large fibroids are removed either through an abdominal (abdominal) or vaginal incision, depending on their location in the uterus.
Hysteroscopic Myomectomy:Myomas on the inner wall of the uterus are removed by entering the uterus through the cervix with a suitable hysteroscope instrument.
Laparoscopic Myomectomy: Pediculum fibroids on the outer surface of the uterus are eliminated in this way. The pelvic cavity is entered through a small incision made under the navel.
Abdominal Myomectomy (laparotomy myomectomy): It is performed under either general, spinal or epidural anaesthesia. The abdominal method is preferred for the removal of fibroids that cause compression symptoms that are located close to the vessels where bleeding may be excessive and in a dangerous position, or excessively large fibroids that put pressure on the uterine cavity. in this case either ”bikini cut”called horizontal incisionor below the navel vertical incision the abdomen is opened. Fibroids embedded in the uterine wall are caught and each one is removed one by one. Each opening is closed one by one to prevent bleeding and infection in the uterine wall.
Myomectomy operation should be performed as soon as possible in order for women who cannot become pregnant or have miscarriage due to myoma to become pregnant. Because it is inconvenient to get pregnant for at least one year after the operation, like a patient who had a cesarean section.
It takes four to six weeks for patients to return to their normal activities after the standard operation. If myomectomy was performed with laparoscopy or hysteroscopy, the recovery period is shorter and takes one to two weeks.
Alternatives to Myomectomy Operation
– Total hysterectomy:Complete removal of the uterus.
-Subtotal hysterectomy:Removal of the corpus of the uterus, leaving the cervix.
-Fibroid embolization: It is a relatively new and invasive technique, based on the principle of reducing the fibroids and improving the symptoms by blocking the blood vessels feeding the fibroid. Through a catheter inserted into the femoral artery, the blood vessel is reached and fine particles are injected into this vessel, which cuts off the blood flow.
It is very important for women who want their uterus to be preserved and who do not want to experience postoperative complications (shortening of the vagina, scarring on the vagina cuff, urinary incontinence, sagging of the bladder, etc.) due to the removal of the uterus, to be aware of the fact that they can apply to an alternative such as myomectomy operation before removing the entire uterus due to myoma.