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Myomectomy an Alternative to Hysterectomy

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Updated March 30, 2010

Myomectomy for Fibroid Tumors

Fibroid tumors are the justification given for over one-third of the estimated 600,000 hysterectomies performed annually in the United States. Myomectomy surgically removes fibroid tumors while preserving the uterus in women of childbearing age or in women who want to avoid hysterectomy. When performed by an experienced physician, myomectomy is a safe and effective alternative to hysterectomy.

Preoperative therapy often includes a single monthly injection of Lupron during the two to four months preceeding a myomectomy. Lupron stops estrogen production causing fibroids to shrink in size and menstruation usually stops. Lupron is sometimes prescribed for women whose excessive bleeding has caused anemia unresponsive to traditional treatments, including iron supplements.

Conflict exists among physicians about the use of Lupron because it is expensive and causes menopausal symptoms such as hot flashes and night sweats. Some thought is also given that Lupron may shrink some very small fibroids to a point where they are not visible to the physician during a myomectomy and these unseen fibroids are left to grow again and possibly require additional surgery.

Myomectomy is safely performed multiple times but each time surgery is performed, the risk of pelvic adhesions increases and pelvic adhesions can be an additional source of problems for women when they become painful, perhaps cause infertility, and require additional surgery. (Multiple abdominal laser surgeries to remove pelvic adhesions, caused by pelvic inflammatory disease, was the reason for my recent hysterectomy.)

A successful myomectomy should provide complete relief from all symptoms associated with fibroid tumors; however, fibroids often grow back and hysterectomy may need to be reconsidered later.

What risks are associated with myomectomy?

Many physicians who are untrained in performing myomectomy, will opt for a hysterectomy, because their lack of experience increases the risk of complications.

Although complications are rare when myomectomy is performed by a properly trained physician, women considering this procedure should be aware of the possible risks. Possible complications of myomectomy include, blood loss, ileus (bowel obstruction), anemia, pain, late intestinal obstruction, infertility, possible conversion to hysterectomy during myomectomy, and subsequent surgery.

Although pregnancy is still possible after a myomectomy, women who become pregnant following myomectomy face possible cesarean section due to a potential weakening in the uterine wall.

Although more than 99% of fibroids are benign, your physician should also discuss the rare possibility of cancer before your myomectomy.

How is myomectomy performed?

There are several ways to perform a myomectomy; it can be performed vaginally or abdominally using a variety of different methods. The type of myomectomy chosen depends on the size and location of the fibroid tumors.

After a woman is under anesthesia, a catheter is inserted into the bladder to keep the bladder empty during the procedure. Another catheter is then inserted into the uterus and a blue dye is injected to stain the uterine cavity; this staining of the uterine cavity is necessary to help the physician determine the location of the fibroids which often are so large they are indistingushable from the tissue of the uterus.

The blue dye also runs into the fallopian tubes and allows the physician to determine whether the fallopian tubes are blocked (and preventing pregnancy by blocking the sperm from reaching the egg) or open. Repairs to the fallopian tubes can also be made during this procedure.

Next, Pitressin, is injected into the first fibroid the physician has decided to remove. Petressin is a drug which causes the blood supply to stop for twenty minutes and allows the physician to remove the fibroid with less risk of excessive bleeding and transfusion.

Special care must be taken when closing up the defect (space) left where the fibroid was removed. Each layer of tissue must be sutured individually to prevent clots and other complications. As each fibroid is removed this procedure is repeated.

All women undergoing a minimally invasive myomectomy technique, should be aware of the possible need to convert to a traditional abdominal procedure (including the possiblity of hysterectomy), while the myomectomy is in progress.

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