A Myomectomy (myoma = fibroid, ectomy = to remove) is where fibroids (benign, non cancerous tumours of the muscle and fibre of the womb) are removed, but the uterus, cervix, fallopian tubes, ovaries and vagina all remain.
Fibroids or myomas are benign, non cancerous tumours of the muscle and fibre of the womb or uterus. They can cause heavy periods (menstrual bleeding ) and unpredictable irregular bleeding. They can also cause pain, become big enough to become a lump in the abdomen (tummy), and can affect a woman’s chance of becoming pregnant. We do not know why fibroids occur, but they are more common as women get older and in Afro-Caribbean women. They rarely become cancerous.
The Myomectomy operation
The myomectomy operation can be performed laparoscopically or for bigger fibroids as open surgery. The open operation can be performed under general (asleep) or regional (awake) anaesthetic and takes about 1 hour. The abdomen is opened so that the fibroids and the uterus can be visualised. The bladder and bowel are then dissected free of the uterus. The fibroids are then excised from the uterus and the defect in the uterus (womb) is then sutured (stitched) to prevent bleeding. The fibroid sent to the laboratory for microscopic investigation.
In some cases the myomectomy is performed with a hysteroscope or with a laparoscope.
During the myomectomy operation, a catheter will be passed into the bladder to drain off the urine (so the bladder doesn’t get in the way of the operation). A plastic tube may also be inserted into the wound to remove any slight bleeding. These tubes will be left in place for 24 – 48 hours. Although there will be some discomfort following the surgery, this will be controlled with pain killers. The average length of stay in hospital is 3- 5 days and normal activities can be resumed within 6 – 8 weeks.
Patients may develop a temperature immediately after the operation, but this is quite normal. Although there will be some discomfort following a myomectomy, this will be controlled with pain killers. Vaginal bleeding may also occur, but is usually light.
There should be no problems with sexual intercourse once recovered from the myomectomy operation.
As with all surgery, there are risks, and the benefits of having the operation must always be balanced against the potential harm from the operation. The vast majority of women who have myomectomy surgery will have very few problems and the operation will result in a great improvement in the quality of the patient’s life. However there are potential complications that you should know about.
The common complications of a myomectomy are infection (bladder infection, wound infection), bleeding (blood transfusion may be required), and bladder damage. Antibiotics are given at the time of the surgery to reduce the risk of infection. If the bladder damage is repaired at the time of surgery, there should be no long term problems. Anticoagulants (thin the blood) are usually given to reduce the chance of a clot forming in the leg (we also use special stockings and get you mobilised out of bed early to reduce the risk).
Fortunately the number of serious complications associated with myomectomy are uncommon, but can include life threatening haemorrhage, bowel damage and a clot on the lung. Where a patient has fasted (nothing to eat or drink for 6 – 8 hours before surgery), the risk of an accident with the anaesthetic are very low. The risk of dying as a result of having a myomectomy is approximately 10,000:1.