Understanding Myomectomy
What Is a Myomectomy Operation?
Myomectomy Operation is a surgical procedure designed to remove fibroids from the uterus. Fibroids, also known as leiomyomas, are benign growths that can cause significant discomfort, fertility challenges, and other health issues. Unlike a hysterectomy, which removes the entire uterus, a myomectomy focuses on preserving the uterus, making it a preferred choice for women who wish to conceive in the future.
Types of Myomectomy Procedures
Hysteroscopic Myomectomy
Hysteroscopic myomectomy is a minimally invasive procedure performed through the vaginal canal using a hysteroscope. It is ideal for removing submucosal fibroids that protrude into the uterine cavity.
Laparoscopic Myomectomy
Laparoscopic myomectomy involves making small incisions in the abdomen and using a laparoscope to excise fibroids. This method ensures minimal scarring and quicker recovery compared to traditional open surgery.
Abdominal Myomectomy
Abdominal myomectomy, also known as an open myomectomy, requires a larger incision in the abdominal wall. It is typically recommended for larger or multiple fibroids that cannot be removed through less invasive methods.
When Is Fibroid Surgery Recommended?
Indications for Fibroid Removal
Fibroid surgery is often recommended when fibroids cause severe symptoms, such as heavy menstrual bleeding, pelvic pain, or pressure. It is also indicated if fibroids interfere with fertility or pregnancy.
Impact of Fibroids on Pregnancy and Fertility
Fibroids can distort the uterine cavity, making implantation difficult and increasing the risk of miscarriage. Addressing these growths through myomectomy can significantly improve reproductive outcomes.
Fibroid Removal and Pregnancy
Fibroids of the uterus affect between two and ten percent of pregnant women. They are often asymptomatic, but there is a possibility that they are related to difficulties during pregnancy. Fibroid removal and pregnancy is something that should be avoided as much as possible during the prenatal period; nonetheless, it has been described in cases of symptomatic myomectomy that did not respond to conservative care. In addition to providing a summary of the previously published literature, the purpose of this study was to describe the outcomes that were reported as well as the dangers that were connected with this technique.
Pregnancy After Myomectomy
How Myomectomy Improves Fertility
By removing fibroids, myomectomy restores the normal structure of the uterus, enhancing the chances of implantation and a healthy pregnancy. Many women experience a significant improvement in fertility post-surgery.
Timeframe to Conceive Post-Surgery
Doctors generally recommend waiting three to six months after a myomectomy before attempting conception. This allows the uterus sufficient time to heal and reduces the risk of complications during pregnancy.
Success Stories: Achieving Pregnancy After Myomectomy
Countless women have achieved successful pregnancies after undergoing myomectomy. These real-life success stories highlight the transformative impact of the procedure on fertility and quality of life.
Myomectomy and ART result
Previous research showed that fibroid size before ART may affect implantation rates. In individuals with intramural fibroids > 50 mm, myomectomy before IVF improves pregnancy outcomes. studied that myomectomy before ART may increase pregnancy outcomes in infertile patients with submucosal and intramural fibroids > 5 cm. Prior to ART, myomectomy for subserosal fibroids did not alter pregnancy outcomes.
Myomectomy during pregnancy
We need substantial, randomised, and controlled research on myomectomies' safety and effectiveness during pregnancy and caesarean sections. Myomectomy during pregnancy may be effective only early in pregnancy and when fibroids are big, developing fast, and causing recurring discomfort. However, miscarriage and foetal loss are major concerns.
Recurrence and Reintervention after Myomectomy
Up to five years following myomectomy, 15-51% of people had fibroids reappear. The ethnic variety of the research groups and diverse recurrence criteria and techniques likely caused this considerable heterogeneity. Parity may impact the risk of a second operation more than age during the initial myomectomy since the cumulative probability of recurrence (CPR) is lowered if a woman has children following myomectomy.
Pre-Myomectomy GnRHa therapy
GnRHa therapy before myomectomy may reduce fibroid volume and improve removal while lowering complications. Vercellini et al. found no effect of GnRHa pre-treatment on blood loss, surgical morbidity, hospital stay, or operating time. Others worry that GnRHa pre-treatment may promote recurrence.
The FDA authorised Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) for leiomyoma therapy in 2004. Early symptom management findings are promising, and GnRHa pre-treatment may improve outcomes. Rabinovici et al. reported 54 pregnancies in 51 women after MRgFUS, with a mean conception time of 8 months and a 41% live birth rate. Women who conceived had 28% spontaneous abortions and 64% vaginal births. There were 6.7% (1/15) preterm births, 2 placenta previa instances (9%), and 93% term births. While first findings are promising, women who become pregnant following MRgFUS should be closely monitored.
UAE, also known as Uterine Fibroid Embolisation (UFE), is a minimally invasive surgery that cuts off the fibroids' blood supply. UAE results are equivalent to surgery. The UAE has low major consequences and fast procedure and recovery timeframes. Early trials showed 80-95% symptom alleviation. Reportedly, fibroids reduce 44% after 3 months. In August 2008, the American College of Gynaecology (ACOG) declared UFE safe and effective in adequately chosen women with “level A evidence.”.
Pregnancy rates and obstetrical outcomes after UAE are not advised for women with fibroids seeking future fertility due to transitory and persistent amenorrhoea. Endometrial damage from diminished menstrual flow may cause improper placentation and ovarian failure. However, amenorrhoea occurs in less than 5% of patients and is worsened by advanced age or perimenopause.
Goldberg et al. found that UAE-affected pregnancies are more likely to result in malpresentation, preterm delivery, caesarean section, and postpartum haemorrhage than those without fibroids. UFE increased miscarriage, caesarean section, and postpartum haemorrhage rates compared to fibroid-free pregnancies, according to Homer and Sarodigan. Mara et al. used hysteroscopy to evaluate 127 UAE patients 3-9 months after UAE (mean age 35.1 years) and found that 59.8% had abnormal endometrium with tissue necrosis (40.9%), intracavitary myoma protrusion (35.4%), endometrium “spots” (22.1%), intrauterine synechiae (10.2%), and “fistula” between the uterine cavity and intramural fibroid. Despite 78% asymptomatic, 35.4% had necrosis and/or hyalinization. The high prevalence of intrauterine diseases following UAE may explain the higher risk of early pregnancy loss. The UAE is new; thus, further study with bigger cohorts from several centres is needed to determine its long-term impact on fertility and conception.
After UAE, recurrence and intervention
REST and EMMY were big randomised experiments on UAE safety. UK patients who had myomectomy, hysterectomy, and UAE participated in the REST experiment. Both surgery and UAE patients improved after 5 years; however, UAE had a 32% fibroid recurrence rate, making repeat intervention more likely. The Dutch EMMY study found that UAE and hysterectomy alleviate symptoms similarly. UAE patients had a 28% reintervention rate after 5 years.
Uterine fibroids
The most prevalent gynaecological condition, uterine fibroids, require surgery when symptomatic. Progestins and oestrogen–progestin combos were first used, but their efficacy is unclear. When GnRH peptide analogues with superagonist and antagonist characteristics were developed, a tremendous advance was made. Initially, adverse effects prevented their routine use, but cetrorelix solved this problem. Due to hypoestrogenism, both types of analogues may only be used for 6 months. Today, they are used as adjuvant treatments before surgery with favourable outcomes. New, nonpeptidic, orally active GnRH-receptor blockers have been synthesised in the previous decade. Elagolix is being tested in fibroid patients. Another important discovery is the use of selective progesterone receptor modulators, or 'antiprogestins'.
Benefits of Fibroid Removal
Restoring Uterine Health
Removing fibroids through myomectomy helps restore the natural shape and function of the uterus, reducing complications associated with abnormal growths.
Reducing Symptoms and Improving Quality of Life
Patients often report a marked reduction in symptoms such as heavy bleeding, pain, and discomfort. This improvement translates into better overall health and well-being.
Risks and Recovery After Myomectomy
Potential Complications
As with any surgery, myomectomy carries risks, including infection, blood loss, and uterine scarring. However, advances in surgical techniques have minimised these risks.
Recovery Time and Care Post-Surgery
Recovery time varies depending on the type of myomectomy. While laparoscopic and hysteroscopic myomectomies typically require a few weeks of recovery, abdominal myomectomy may necessitate a longer healing period. Post-surgical care involves rest, a balanced diet, and follow-up appointments to ensure optimal recovery.
Myomectomy and Alternative Treatments
Comparing Myomectomy with Other Fibroid Treatments
Alternative treatments such as medications and uterine artery embolisation (UAE) offer non-surgical options for managing fibroids. However, these may not be suitable for women seeking to preserve fertility, making myomectomy the preferred choice in such cases.
Medications, Uterine Artery Embolisation, and Their Role: Medications can manage symptoms temporarily, while UAE reduces blood supply to fibroids, causing them to shrink. Both options have limitations, especially for women planning future pregnancies.
Hysteroscopic Myomectomy
Procedure Overview
Hysteroscopic myomectomy involves inserting a hysteroscope through the vaginal canal to remove fibroids within the uterine cavity. This outpatient procedure is minimally invasive and allows quick recovery.
Who Is an Ideal Candidate for Hysteroscopic Myomectomy?
Women with submucosal fibroids that are accessible via the uterine cavity are ideal candidates for this procedure. A thorough evaluation is essential to determine suitability.
Preparing for Myomectomy Surgery
A chest X-ray, echocardiogram, biochemical blood test, and pelvic magnetic resonance imaging (MRI) are required to determine the number, size, and features of the target fibroids. The MRI number of fibroids is simply a reference since certain little fibroids cannot be spotted.
Informed Consent
Patients must be informed about laparoscopic surgery risks and hazards before the operation. LM, we must also discuss patient surgical difficulties. For instance, all myomectomy patients must have a caesarean section at delivery. Unexpected cancer is another serious concern. Tumour cell dispersion may reduce survival.
Although rare, uterine rupture during pregnancy is possible. If there are many fibroids or they are in hard-to-reach regions, haemostasis may fail, and hysterectomy may be necessary.
We control bleeding using diluted vasopressin. This is injected into the uterus locally. Off-label usage must be notified to the patient. No compensation mechanism protects individuals who suffer uncommon severe complications like heart failure, cardiac arrest, or shock. Patients must understand the hazards and consent to diluted vasopressin.
Pre-Surgical Assessment and Planning
Before surgery, patients undergo a series of tests, including imaging and blood work, to assess overall health and plan the procedure effectively.
Dietary and Lifestyle Adjustments
Maintaining a healthy diet, avoiding smoking, and managing stress are critical steps in preparing for surgery. These adjustments aid in optimal recovery and surgical outcomes.
Conclusion
Myomectomy is a life-changing procedure for women struggling with fibroids and fertility challenges. By understanding the different types of myomectomy, indications for surgery, and the recovery process, patients can make informed decisions. With advancements in medical science, myomectomy continues to offer hope, improved health, and restored fertility to countless women worldwide. If any patient or the patient's family wants to know more about it or to get proper nourishing healthcare, it is suggested to visit Ovum Hospitals.
FAQs
1.What are the main types of myomectomy procedures?
The main types are hysteroscopic, laparoscopic, and abdominal myomectomy, each suited to specific fibroid conditions.
2.How does myomectomy improve fertility?
By removing fibroids and restoring uterine health, myomectomy enhances implantation and reduces miscarriage risks.
3.What is the recovery time after a myomectomy?
Recovery time varies: 1-2 weeks for hysteroscopic, 2-4 weeks for laparoscopic, and 6-8 weeks for abdominal myomectomy.
4.Are there non-surgical alternatives to myomectomy?
Yes, options include medications and uterine artery embolisation, but they may not be ideal for women seeking to conceive.
5.When can I try to conceive after myomectomy?
Doctors recommend waiting 3-6 months post-surgery to allow the uterus to heal fully.