What you need to know about:

Myomectomy

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Recovery Period:
2 to 6 weeks
Permanence:
Permanent
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Time it takes:
2-4 hours
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Anesthetize:
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Overview of

Myomectomy

in Thailand

A myomectomy is a surgical procedure that removes the uterine fibroids, also known as myomas or uterine leiomyomas. This treatment option operates in contrast to a hysterectomy, which is a full removal of the uterus.

Myomectomies are ideal for patients who wish to leave the uterus intact or to still have the ability to conceive after the surgery is over.

Like any other structure of the body, the uterus is vulnerable to an abnormal growth of cell tissue. These are known as uterine fibroids, benign tumors made up of muscle cells and fibrous connective tissue within the uterus.

It's estimated that about 20 to 70 percent of women will develop uterine fibroids during their reproductive years. While the cause behind fibroid growth is still being researched, the tumors can be removed through the right medical treatment.

Myomectomy is a popular form of surgery for this problem, so today we'll be exploring what a myomectomy is and how it's delivered.

Goals of

Myomectomy

This surgery is typically performed in order to relieve the symptoms that come with fibroid growth. These symptoms include heavy menstrual bleeding, long-lasting periods, pelvic pain, frequent urination, constipation, and difficulty with emptying the bladder.

A woman with uterine fibroids might experience pain in the abdomen, the lower back, or the pelvis region. Some fibroids result in weight gain and infertility. If you're displaying any of these symptoms on a regular basis, seek a trusted doctor who specializes in this field of care.

The goal of a myomectomy is to reduce these symptoms and to raise the quality of life for the patient. Once a removal is done, the fibroid symptoms tend to lessen within the patient.

Before undergoing surgery, it's important for the patient to discuss her options with the doctor. Hysterectomy may be brought up as an alternative to myomectomy. However, with a hysterectomy, the woman will no longer able to conceive or menstruate.

The patient will need to weigh out the advantages and disadvantages of each procedure.

Price of

Myomectomy

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Pros and cons of

Myomectomy

Pros

  • This surgery preserves your uterus, leaving you with the ability to become pregnant.
  • This procedure tends to have less blood loss compared to hysterectomy.
  • The outcome of this surgery usually relieves the pain, discomfort, and bloating that come with a heavy menstrual cycle.

Cons

  • This procedure may not completely remove all of the uterine fibroids.
  • There's still a risk of significant bleeding.
  • The procedure could weaken the walls of your uterus, resulting in long-term effects.
  • This procedure isn't the most definitive treatment in the permanent fibroid removal. There's still a likely chance of fibroid recurrence.

How it works:

Myomectomy

During myomectomy, the surgeon will insert a small instrument into the uterus, usually through the vagina. A sterile salt solution may be applied to expand the uterine cavity for close examination. A camera can be inserted for better visualization of the inside region.

The surgeon will work toward separating the muscles of the uterus for navigation. Then the procedure will go toward removing the fibroids from the front end while avoiding impact to the fallopian tubes and the intestines. This requires special instrumentation, sometimes from a wire loop resectoscope or a hysteroscopic morcellator.

The type of myomectomy you undergo will be decided by the doctor.

A vaginal myomectomy involves the removal of fibroids through the vagina, while an abdominal myomectomy is performed through an abdomen incision.

A hysteroscopic myomectomy uses a hysteroscopic resectoscope to remove submucous fibroids found in the uterine cavity.

In a robotic-assisted myomectomy, a robotic device is used to cut the fibroids into small pieces for easier removal. Ask your doctor about which surgery type would work best for you.

Preparation before

Myomectomy

Pre - treatment

Before the surgery can be performed, an appointment needs to be scheduled between the doctor and the patient. Typically, the doctor will guide the patient through the pre-surgery preparation. You should receive a set of instructions on the following:

  • When to arrive at the hospital and where to wait for the surgery. This often involves a four hour waiting period.
  • Whether to avoid consuming food or water at least eight hours before surgery. Food avoidance is done to prevent aspiration while under anesthesia.
  • Sleeping advice. The staff will want you to get enough sleep to avoid stress or drowsiness throughout the day.
  • Whether to avoid wearing makeup or jewelry. It's easier for some staff to visually evaluate you without these distractions.
  • When to remove dentures or contact lenses before entering the operating room.
  • What medication to take or to avoid. Some medications can interfere with the results of a surgery, like aspirin or blood-thinning drugs.  
  • Whether to avoid smoking or drinking alcohol. Smoking can increase the risk of infection, with the act of coughing having an impact on the abdomen's incision.
  • Whether to bring a friend or a family member to the surgery. This is especially relevant if your visit involves the use of anesthesia.

 

If you can, ask for printed instructions as well as verbal guidance; that way, you won't forget anything.

Once you've been prepped on how to ask before surgery, the doctor will begin pre-surgical testing. This could involve blood tests or computational imaging to examine the body.

X-rays and electrocardiograms (EKGs) are sometimes done before the day of the surgery.

Procedural Care

Listen to your healthcare providers carefully and follow their instructions. It's common for the patient to wear a urinary catheter during the procedure. Constipation can become a side effect of abdominal surgery, so the patient will be instructed on how to move bowels during this period.

Recovery after

Myomectomy

Post - treatment

After the myomectomy is over, the patient will be moved to a recovery room while waiting for the anesthesia to wear off. It's normal to have the patient stay in the hospital for two days after the myomectomy, or to stay four or five days after an open procedure.

While recovering from the procedure, ask the nurse for help in managing after-effects such as fatigue, headaches, nausea, or vomiting. Try to get plenty of rest during the recovery process.

Once released from the hospital, avoid lifting heavy objects or having sexual intercourse. The full recovery period could take six weeks, and for many people, it takes six months to feel fully recovered from surgery.

Risks & side effects

  • A myomectomy, just like any other surgery, comes with the risk of infection, excessive bleeding, and trauma.
  • In some rare cases (<1%), patients may suffer from reopening of the wound in the uterus post-surgery.
  • Under very rare conditions, patients who experienced uncontrolled bleeding post-surgery may require a hysterectomy.
  • Before embarking on a myomectomy, it's important to talk to your doctor to address all your concerns and questions about the procedure.

FAQs:

Myomectomy

How do I know if I have uterine fibroids?

You should pay attention to your menstruation cycle. Do you have any of the symptoms related to uterine fibroids? If so, get checked in with your doctor for a diagnostic screening.

Why do uterine fibroids develop?

The fibroids start out as benign growths from the uterine's muscle tissue. The fibroids vary by size, shape, and location. They can attach to the outer surface of the uterus, the uterine wall, or to the stem-like structure. Fibroids are often the result of estrogen and progesterone. These hormones fuel the menstrual cycle, but an excess of hormone receptors can create fibroids.

 

How can I manage symptoms before a myomectomy?

It's normal for patients to experience symptoms such as heavy bleeding, painful crams, anemia, abdominal pain, rectal pain, aching during sex, or frequent urination. Some fibroids don't have any visible symptoms. To manage the more painful symptoms, it's recommended that you visit a doctor for routine pelvic exams and checkups. The doctor can provide advice for pain relief management.


What if the procedure is not performed?

Then the symptoms will persist, potentially lowering the quality of life for the patient.

Can I travel after the procedure?

You should avoid driving or airplane travel for at least one month post-surgery. Ask your doctor about making travel arrangements.

What is the likelihood of success?

This procedure has a 90 to 95 percent success rate. The outcome will depend on many factors, including the patient's current health and the severity of the condition. This treatment will need to be performed by a safe and certified surgeon to ensure success.

Can fibroids turn cancerous?

Less than 1 out of 1,000 fibroids turn cancerous, so it's a rare likelihood.

What are the other treatment options for uterine fibroids?

Aside from myomectomy and hysterectomy, patients can also choose to undergo endometrial ablation using laser therapy. There’s also myolysis, which uses a needle insertion to destroy the fibroids. Uterine fibroid embolization (UFE) is another treatment option for this condition.

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