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What is Myomectomy?
Myomectomy is a surgical procedure in which fibroids are removed from the uterus wall.
Gonadotropin Releasing Hormone Analogue (GnRH-a) therapy may be used before myomectomy to reduce the size of the fibroids. This helps in reducing blood loss during a surgery. The GnRH-a therapy decreases the estrogen amounts in the body.
What are the different methods of performing Myomectomy?
Myomectomy may be performed by various surgical methods; choosing the method depends on the size, number and location of the fibroids.
- Hysteroscopy
Fibroids that are located on the inner wall of the uterus but have not grown deep into the wall of the uterus is removed by hysteroscopy. A hysteroscope is inserted through the cervix into the uterus and the fibroids are removed.
- Laparoscopy
Fibroids that measure approximately 2 inches and are located outside the uterus is removed by laparoscopy. This method uses a laparoscope which is inserted through a small abdominal incision and the fibroids are located and removed.
- Laparotomy
Fibroids that are large in size or those that have grown deep into the wall of the uterus are removed by laparotomy. This is the traditional method of performing a myomectomy. During a laparotomy, a full abdominal incision is made horizontally or vertically. A few incisions are made in the muscles of the uterus and the fibroid is removed.
How to prepare for Myomectomy?
- The patient may be required to go through a hormone treatment 2 to 6 months before myomectomy to reduce the size of the fibroids.
- The patient needs to go through a thorough physical examination.
- The doctor should be informed if the patient is:
- Taking any medication
- Allergic to any medication
- Treated for any pelvic, uterine, cervical or vaginal infection 6 weeks prior to the procedure.
- Suffering from heart or lung ailments
- Pregnant
- Arrangements should be made for someone to drive the patient home.
Days admitted:- Hysteroscopy: is done as an outpatient procedure.
- Laparoscopy: may be done as an outpatient procedure. However, sometimes patients may require a stay of 1 day in the hospital.
- Laparotomy: 1 to 4 days at the hospital
Anesthesia:General Anesthesia
Recovery:- Patients will be able to recover in a couple of weeks after myomectomy using laparoscopy and hysteroscopy.
- Patients who have had a laparotomy may need 4 to 6 weeks to recover.
- Patients’ symptoms of bleeding and pain caused by fibroids are cured after myomectomy.
- In many cases of patients with the problem of infertility, chances of pregnancy are known to be improved after myomectomy.
Risks:Risks involved in myomectomy are rare. They include:
- Infection
- Bleeding
- Uterine wall weakening
- Risks of anesthesia
- Severe bleeding that may lead to the removal of the whole uterus
- Uterine scarring may lead to infertility
- Rupture of uterine scars during pregnancy and delivery
After care:- The patient should follow the doctor’s instructions carefully.
- Patients trying to get pregnant may try to conceive 4 to 6 months after myomectomy because fibroids may grow back later.
- Patients may be required to do a hysterosalpingogram 4 months after myomectomy.
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