Myomectomy (Fibroid Tumor Removal, Uterine Fibroid Removal)

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Definition

A myomectomy is the removal of fibroids, which are noncancerous tumors, from the wall of the uterus.

Uterine Fibroid

Uterine Fibroids

2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Uterus

Reasons for Procedure

A myomectomy is done to relieve problems caused by fibroids without having to perform a hysterectomy (removal of the uterus). These problems include:

  • Pelvic pain
  • Back pain
  • Pressure on the bladder
  • Abnormal uterine bleeding (often leading to anemia)
  • Difficulty becoming pregnant
  • Discomfort during sexual intercourse

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Review of medications
  • Blood studies
  • Dilation and curettage (D&C)removal of tissue from the lining of the uterus (endometrium)
  • X-rays of abdomen
  • Barium enemaa series of x-rays taken after a barium-containing substance is injected through the rectum
  • Intravenous pyelogramx-rays taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein

You should discuss the following with your doctor:

The possibility that signs of malignant cancer may be found in the uterus during surgery and what action you would like the doctor to take if this is the caseOne option is removal of the uterus during this procedure. (Approximately 1 in 200 women with fibroids are found to have malignant uterine cancer.) If you should consider hormone treatment for 2-4 months before surgeryThis treatment shrinks fibroids, making removal easier and reducing the risk of excess blood loss during surgery.If you should consider banking your own blood before surgery, due to the risk of excess blood loss during surgery In the days leading up to your procedure: Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure.Arrange for a ride to and from the hospital.Do not eat or drink for at least eight hours before the procedure. Anesthesia Open surgeryGeneral anesthesia given by injection and inhalation Laparoscopic surgeryGeneral anesthesia given by injection and inhalation or local anesthesia Description of the ProcedureThere are different ways of removing fibroid tumors from the uterus. The two most commonly used are open surgery and laparoscopic surgery.
Open SurgeryA catheter is inserted into the uterus, and a blue dye is injected to stain the uterine cavity and help make locating the fibroid(s) easier. One or more incisions are made in the lower abdomen. Muscles are separated and connective tissue is cut to expose the uterus. When a fibroid is located, it is surgically removed. In some cases, Pitressin, a drug that causes the blood supply to stop for up to 20 minutes, is first injected into the fibroid to reduce bleeding when it is removed.After each fibroid is removed, special care is taken to stitch each layer of tissue in the uterus to prevent blood clots, excessive bleeding, and infection. After the fibroids are removed, surgical tools are removed, the abdominal muscles are sewn together with heavy stitches, and the incision is closed either with stitches or clamps. Laparoscopic SurgeryA catheter is inserted into the uterus, and a blue dye is injected to stain the uterine cavity and help make locating the fibroid(s) easier. A small incision is made in the navel, and a laparoscope is inserted into the uterus. A laparoscope is a specialized endoscope, which is a fiberoptic tube attached to a viewing device, used to examine the abdomen.Two or three additional small incisions are made in the abdomen through which special laparoscopic tools are inserted. Using the laparoscope, the surgeon locates each fibroid and surgically removes it. In some cases, Pitressin, a drug that causes the blood supply to stop for up to 20 minutes, is first injected into the fibroid to reduce bleeding when it is removed. After removal of each fibroid, special care is taken to stitch each layer of tissue in the uterus to prevent blood clots, excessive bleeding, and infection. Once removal of fibroids is completed, the tools are removed and the incision is closed with stitches or clamps.
After ProcedureYou will be taken to the postoperative area, watched for complications, and given intravenous fluids and medications. Once your vital signs are normal (usually within 2-3 hours) you will be moved to a hospital room, or, if laparoscopic surgery was performed, you may be sent home. How Long Will It Take?1-2 hours Will It Hurt?Anesthesia prevents pain during the procedure. However, you can expect abdominal pain or discomfort for 7-10 days after open surgery, and less time (likely 3-4 days) after laparoscopic surgery. Possible Complications Complications from a myomectomy are rare. They include: Excessive bleeding Anemia and/or need for blood transfusions due to excess blood loss Surgical wound infectionRecurrence of fibroid tumorsOpening of the uterus or bowel during surgeryWall of the uterus may be weakened if a large fibroid is removed leaving a deep wound Adverse reactions to anesthesia Need for special precautions in pregnancy (for example, may need to deliver by cesarean section) Pelvic adhesions that can cause pain and/or bowel blockageEvidence of cancer found during surgery, making removal of the uterus necessary Severe scarring, resulting in infertility Average Hospital StayOpen surgery2-3 days Laparoscopic surgeryovernight Postoperative CareWear sanitary pads or napkins to absorb blood (unless told otherwise by your surgeon).Move and elevate legs while resting in bed to decrease the risk of deep vein blood clots.Do not take prescription pain medication for more than seven days; after seven days, take non-prescription pain relievers such as ibuprofen.Bathe or shower as normal, and wash the incision area gently with mild soap until it heals fully.Do not drive for two weeks after open surgery, and 4-7 days after laparoscopic surgery.Avoid strenuous exercise for six weeks after open surgery and two weeks after laparoscopic surgery.Do not resume sexual activity until your doctor says it is safe.To help speed healing and recovery, resume normal activities (including work) as soon as you feel able. OutcomeFull recovery from surgery will take about 4-6 weeks after open surgery, and 2-4 weeks after laparoscopic surgery. The first menstruation after surgery may be heavier than normal.
Eighty percent of the time, the symptoms caused by fibroid tumors are successfully controlled with this procedure. This may include a return to a normal menstrual cycle and the ability to become pregnant, unless the uterus was removed. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteExcessive vaginal bleeding (soaking more than one pad per hour) after surgeryExcessive vaginal discharge that continues beyond one month after surgeryVaginal discharge has a foul odorSevere abdominal painHeadaches, muscle aches, dizziness, or general ill feelingNausea, constipation, or abdominal swellingFibroid tumor symptoms return after surgeryCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency, or frequency of urination or persistent bleeding in the urineNew, unexplained symptoms RESOURCES: National Uterine Fibroids Foundationhttp://www.nuff.org/ Society of Interventional Radiologyhttp://www.sirweb.org/ CANADIAN RESOURCES: The Society of Obstetricians and Gynaecologists of Canadahttp://www.sogc.org/ Women's Health Mattershttp://www.womenshealthmatters.ca/ References: Myomectomy. Duke University Medical Center Reproductive Endocrinology and Infertility website. Available at: http://www.dukehealth.org/Services/Fertility/Programs/Surgery/Myomectomy?search_highlight=myomectomy. Accessed June 1, 2008.
Uterine fibroid treatment options. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patPub/uterineTreatments.shtml#my. Accessed June 1, 2008. Last reviewed January 2008 by Jeff Andrews, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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