Myomectomy (Fibroid Removal Surgery)

Fibroids are benign tumors that originate from the muscular layer of the uterus (myometrium). Their size can range from a few millimeters to several centimeters, and they may be single or multiple. Fibroids are hormone-sensitive and are most commonly seen in women of reproductive age; they tend to shrink after menopause.

Types of fibroids include:

Submucosal Fibroids: Fibroids that grow toward the inner lining of the uterus (endometrium) and protrude into the uterine cavity. They may cause heavy menstrual bleeding and infertility.

Intramural Fibroids: Fibroids that grow within the uterine wall and increase the overall size of the uterus. This is the most common type of fibroid.

Subserosal Fibroids: Fibroids that grow toward the outer surface of the uterus and protrude into the pelvic cavity. They may cause pain and pressure symptoms by compressing nearby organs.

Pedunculated Fibroids: A type of subserosal fibroid that is attached to the uterus by a stalk. They may cause pain due to the risk of twisting.

In Which Cases Is Myomectomy Performed?

Myomectomy may be required in the following situations:

Painful Symptoms: Fibroids may cause pelvic pain, pressure symptoms (such as pressure on the bladder or intestines), and chronic pelvic discomfort.

Heavy Menstrual Bleeding: Submucosal fibroids can lead to excessive menstrual bleeding (menorrhagia), which may result in anemia.

Infertility: Fibroids, especially submucosal ones, may interfere with conception or increase the risk of miscarriage.

Pregnancy Complications: Fibroids may grow during pregnancy and lead to preterm birth or fetal development abnormalities.

Rapid Growth: Rapid enlargement of fibroids may require evaluation to rule out the possibility of an underlying malignancy.

How Is Myomectomy Performed?

Myomectomy can be performed using different surgical techniques. The method chosen depends on the number, size, and location of the fibroids, as well as the patient’s overall health condition.

Open Myomectomy (Laparotomy):
How It Is Performed: The uterus is accessed through a horizontal or vertical incision in the abdomen. Fibroids are removed one by one, and the uterine layers are sutured and repaired.
Indications: Preferred for large, multiple, or deeply located fibroids.
Advantages: Allows the surgeon to directly visualize and remove fibroids and manage complications more easily.
Disadvantages: Longer recovery time and more postoperative pain.

Laparoscopic Myomectomy:
How It Is Performed: Several small incisions are made in the abdomen to insert a laparoscope and surgical instruments. The laparoscope provides visualization of the abdominal cavity, and fibroids are removed by cutting them into smaller pieces.
Indications: Suitable for medium-sized fibroids and a limited number of lesions.
Advantages: Minimally invasive, shorter recovery time, and less postoperative pain.
Disadvantages: May not be suitable for very large or numerous fibroids.

Hysteroscopic Myomectomy:
How It Is Performed: A thin instrument called a hysteroscope is inserted into the uterus through the vagina. Fibroids are removed from within the uterine cavity.
Indications: Used for the treatment of submucosal fibroids.
Advantages: No abdominal incisions, rapid recovery, and minimal risk of complications.
Disadvantages: Suitable only for fibroids that grow into the uterine cavity.

Recovery Process and Complications After Myomectomy

The recovery process after myomectomy varies depending on the surgical technique used and the patient’s general health condition.

Open Myomectomy: Full recovery usually takes 4–6 weeks. Hospitalization for a few days may be required.

Laparoscopic Myomectomy: Recovery generally takes 2–4 weeks, with a shorter hospital stay.

Hysteroscopic Myomectomy: Recovery is usually completed within 1–2 weeks, and patients are often discharged on the same day.

Possible Complications:

Bleeding: Bleeding may occur during or after myomectomy. In cases where large fibroids are removed, blood transfusion may be necessary.

Infection: There is a risk of infection at the surgical site or in the pelvic area.

Weakening of the Uterine Wall: Incisions in the uterine wall may increase the risk of uterine rupture in future pregnancies. For this reason, cesarean delivery may be recommended after myomectomy.

Adhesions: Intra-abdominal or intrauterine adhesions may develop, potentially leading to pain or infertility.

Recurrence of Fibroids: Fibroids may recur after removal, especially in younger patients.

Pregnancy and Fertility After Myomectomy

Since myomectomy preserves the uterus, it is an important treatment option for women who wish to maintain fertility. The chance of pregnancy after myomectomy may increase depending on the location and number of fibroids removed and the surgeon’s experience.

Pregnancy Planning: Women planning pregnancy after myomectomy are usually advised to wait at least 3–6 months to allow the uterine wall to heal properly.

Mode of Delivery: Due to uterine incisions, cesarean delivery may be recommended after myomectomy. If the uterine wall is weakened, the risk of uterine rupture during vaginal delivery may increase.

Myomectomy is an effective surgical method for relieving symptoms caused by uterine fibroids while preserving fertility. The choice of surgical technique depends on factors such as the patient’s overall condition and the size and location of the fibroids. Although the recovery process varies according to the technique used, modern surgical methods generally allow for a faster and more comfortable recovery. Pregnancy after myomectomy is possible, but it requires careful follow-up and adherence to the surgeon’s recommendations.