Myomectomy (Fibroid Removal Surgery)

Fibroids are typically benign tumors that arise from the muscular layer of the uterus (the myometrium). They can range in size from a few millimeters to several centimeters and may occur in multiple numbers. Fibroids are hormone-sensitive, are most commonly seen in women of reproductive age, and tend to shrink after menopause.

Types of fibroids include:

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

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

Subserosal Fibroids: These grow toward the outer surface of the uterus and protrude into the pelvic cavity. By pressing on neighboring organs, they can cause pain and pressure symptoms.

Pedunculated Fibroids: These occur when a subserosal fibroid is attached to the outer surface of the uterus by a stalk. They can cause pain due to the risk of the stalk twisting.

When Is Myomectomy Performed?

Myomectomy may be necessary in the following situations:

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

Heavy Menstrual Bleeding: Submucosal fibroids can cause heavy menstrual bleeding (menorrhagia) and, as a result, anemia.

Infertility: Fibroids, particularly submucosal ones, can prevent pregnancy from occurring or increase the risk of miscarriage.

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

Rapid Growth: Rapid growth of fibroids may require evaluation to rule out an underlying malignancy (cancer) risk.

How Is Myomectomy Performed?

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

Open Myomectomy (Laparotomy):
How It's Done: The uterus is accessed through a horizontal or vertical incision in the abdomen. The surgeon removes the fibroids one by one, and the layers of the uterus are then repaired with sutures.
When It's Used: Preferred for large, numerous, or deeply located fibroids.
Advantages: The surgeon can see and remove the fibroids directly and can manage complications more easily.
Disadvantages: Recovery time is longer and postoperative pain is greater.

Laparoscopic Myomectomy:
How It's Done: Several small incisions are made in the abdomen, through which a laparoscope and surgical instruments are inserted. The laparoscope allows visualization inside the abdomen, and the fibroids are broken into smaller pieces and removed.
When It's Used: Suitable for removing medium-sized fibroids in limited numbers.
Advantages: A minimally invasive method that offers a faster recovery process and less postoperative pain.
Disadvantages: May not be suitable for large or numerous fibroids.

Hysteroscopic Myomectomy:
How It's Done: Performed using a thin instrument called a hysteroscope, inserted into the uterus through the vagina. The fibroids are cut and removed from within the uterine cavity.
When It's Used: Used to treat submucosal fibroids.
Advantages: Requires no incisions, offers a fast recovery process, and carries minimal risk of complications.
Disadvantages: Only suitable for fibroids that grow into the uterine cavity.

Recovery Process and Complications After Myomectomy

The recovery process after myomectomy varies depending on the surgical method used and the patient's overall health.

Open Myomectomy: Full recovery generally takes 4-6 weeks. A hospital stay of a few days may be required at first.

Laparoscopic Myomectomy: Recovery time generally ranges from 2-4 weeks, with a shorter hospital stay.

Hysteroscopic Myomectomy: Recovery is completed within 1-2 weeks, and patients can usually be discharged from the hospital the same day.

Possible Complications:

Bleeding: Bleeding may occur during or after myomectomy. A blood transfusion may be required, particularly when large fibroids are removed.

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

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

Adhesions: Adhesions may develop within the abdomen or uterus, which can lead to pain and infertility.

Recurrence of Fibroids: There is a risk that fibroids may develop again after removal, especially in younger patients.

Pregnancy and Fertility After Myomectomy

Since myomectomy is a uterus-preserving surgical procedure, it is an important treatment option for women who wish to maintain their fertility. The chance of pregnancy after myomectomy may improve depending on the location and number of fibroids removed and the surgeon's experience.

Pregnancy Planning: Women planning a pregnancy after myomectomy are generally advised to wait at least 3-6 months to allow the uterine wall to heal.

Mode of Delivery: A cesarean delivery may be recommended after myomectomy because of the incisions in the uterine wall. If the uterine wall has been weakened, the risk of uterine rupture increases during a vaginal delivery.

Myomectomy is an effective surgical method for relieving the symptoms of uterine fibroids while preserving fertility. The choice of surgical technique is determined by factors such as the patient's overall condition and the location and size of the fibroids. The recovery process after myomectomy varies according to the surgical method used, but thanks to modern surgical techniques this process can generally be managed more comfortably and quickly. Pregnancy after myomectomy is possible, but it should be monitored closely and the surgeon's recommendations should be followed.