First: When should uterine fibroids be removed?
Myofibroma is recommended when it causes troublesome symptoms or complications, for example, when the doctor suspects that these tumors affect fertility and the woman wants to have children, and if you want to preserve the uterus.
It has been found that after myomectomy, most women get rid of bothersome signs and symptoms, such as profuse menstrual bleeding, pelvic pain and pressure, and fertility improves. After having a myomectomy, wait three months before trying to conceive to give your uterus time to heal
Second: Methods for myomectomy:
1- Abdominal myomectomy
The surgeon makes an incision in the abdomen to access the uterus and remove the fibroids, and the surgeon enters the pelvic cavity through one of two incisions:
A horizontal incision in the pubic area
Extending approximately one inch (about 2.5 centimeters) above the pubic bone, this incision follows the natural lines of the skin, so it usually produces a smaller scar and causes less pain than a vertical fissure.
Vertical incision
It starts in the middle of the abdomen, and extends from the bottom of the navel to just above the pubic bone. This method gives the surgeon better access to the uterus than at the horizontal incision. It also reduces bleeding, but it is rare to use, unless the uterus is large enough that it extends upwards until it passes the navel.
2- Laparoscopic or robot-assisted myomectomy
The surgeon accesses the fibroids and removes them through several small incisions in the abdomen. During a laparoscopic myomectomy, your surgeon makes a small incision in or near your navel, and then inserts a laparoscope into your abdomen. The fibroid is cut into smaller pieces and removed through these small incisions in the abdominal wall, or through an incision in the vagina.
3- Transvaginal uterine fibroidectomy
The surgeon inserts a small, illuminated instrument, known as a resectoscope because it cuts (excises) tissue using electricity or a laser beam, through the vagina and cervix and into the uterus. A clear fluid, usually sterile saline, is inserted into the uterus to expand the uterine cavity, allowing the uterine walls to be examined.
Using a resectoscope, the surgeon then scrapes off portions of the fibroid until it aligns with the surface of the uterine cavity, and the removed tissue is disposed of using the clear fluid that was used to expand the uterus during the operation.
Third: After myomectomy:
It is recommended to avoid certain activities, such as driving, lifting heavy objects, climbing stairs, or doing vigorous exercise until recovery. Also, the doctor may advise against using tampons and to avoid sexual intercourse during the recovery period. You can expect to have some vaginal blood spots for a few days up to six weeks, depending on the type of procedure you had.
Fourth: complications of the surgical procedure:
1- Iron supplements.
If you have iron deficiency anemia due to heavy menstrual periods, your doctor may recommend iron supplements, which allow your blood cell count to increase before surgery.
2- Hormone therapy.
Hormone therapy before surgery is another strategy for treating anemia. Your doctor may prescribe a Gn-RH agonist, birth control pills, or other hormonal medications to prevent or reduce menstrual flow.
In addition, some hormonal treatments, such as treatment with a gonadotropin-releasing hormone (Gn-RH) agonist, can shrink fibroids in the womb, allowing the surgeon to use a minimally invasive method - such as making a smaller horizontal incision instead of Vertical incision or laparoscopic surgery rather than open surgery.
Fifth: Risks arising from myomectomy surgery?
Myomectomy has a low risk of complications. However, some challenges may occur, such as:
1- Heavy bleeding:
And heavy bleeding may be a result of a woman's infection as a result of menorrhagia. During myomectomy, surgeons take some additional steps to avoid heavy bleeding, including blocking uterine arteries and injecting drugs around fibroids to relax the blood vessels.
2- Adhesions:
Incisions made inside the uterus to remove fibroids can cause adhesions, which are a collection of scar tissue that may appear after surgery. Outside the uterus, adhesions can overlap with adjacent synthetic structures, causing a fallopian tube to become blocked or a loop of intestine blocked. Rarely, adhesions may form inside the uterus and lead to light menstrual periods and feelings of some difficulties during fertility (Asherman's syndrome). Laparoscopic myomectomy may lead to fewer adhesions than is removed through the abdomen (abdominal incision).
3- Rare and dangerous complications:
If your surgeon has to make a deep incision in the uterine wall, your doctor following your subsequent pregnancy may recommend a cesarean delivery to avoid rupture of the uterus during labor, which is a very rare complication of pregnancy. Rarely, the surgeon will have to remove the uterus if he is unable to control the bleeding or if other abnormalities are found in addition to the fibroids.
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