Myomectomy: Procedure, Recovery, Cost, Risk & Complication

Myomectomy refers to a surgical procedure for removing leiomyomas (uterine fibroids), which are non-cancerous growths that appears in the uterus. Generally, these tend to occur during the childbearing years, but it is possible for them to occur at any age.

In the process of myomectomy, the doctor will take out the fibroids and try to reconstruct the uterus. Unlike hysterectomy, this process removes only the fibroids, keeping the uterus intact. It is the preferred fibroid treatment in case of women who wish to get pregnant. It can also relieve symptoms related to fibroids, such as heavy bleeding during menstruation and pelvic pressure.

A patient may have to undergo myomectomy in the following circumstances:

• If the fibroids are resulting in symptoms that are bothersome or interfering with your regular normal activities
• You are planning for pregnancy and the uterine fibroids may be interfering with your fertility
• For improving the chances of pregnancy before an IVF (in-vitro fertilization) treatment
• If you are anaemic, or suffering from pain that does not seem to improve with medications

Pre Procedure

The following pre-procedure guidelines need to be followed before undergoing a myomectomy:

• Discuss with your doctor about the procedure and get an idea about how it will be conducted. You can also ask about the anaesthesia that you will be administered; whether general or spinal.
• Inform your doctor about all the medications that you need to take on a regular basis. You may have to stop taking some medicines a week prior to the surgery. Consult your doctor about the same and follow the instructions.
• You will have to stop eating or drinking anything a few hours before the surgery. In case you have to take any medicines during that time, have it with a minimum sip of water.

During Procedure

Depending on the number, location and size of the fibroids, any of the following ways of myomectomy may be approached by the surgeon:

• Abdominal myomectomy – In this procedure, the surgeon makes an open incision in the abdomen to get access to the uterus and then removes the fibroids. It can be a horizontal incision along the bikini line or a vertical incision.
• Laparoscopic myomectomy – A small incision is made in or near the navel, and a laparoscope is inserted in the abdomen. The surgeon performs the operation by inserting the surgical instruments through the other small incisions that are made in the abdominal wall.
• Hysteroscopic myomectomy – In this process, a lighted viewing instrument is inserted in the uterus through the vagina. A sterile solution is then passed on to the uterus. The surgeon will shave out the pieces of the fibroid that will be washed out along with the liquid that was previously inserted.

Post Procedure

You may only have to stay overnight at the hospital and then get discharged after undergoing a myomectomy. You will be given oral medications for relieving you from the pain. Consult with your doctor if you experience any side effects of the medication. Also, follow the restrictions that are suggested by the doctor regarding your diet and activities. It is normal to experience vaginal staining or spotting, ranging from a few days to a few weeks, depending on the procedure that you have undergone. The pain medicines may make you feel drowsy or dizzy, so be careful when you are getting up from a sitting or sleeping position.

Undergoing a myomectomy may have the following complications:

• Loss of excessive blood. Women who are suffering from anaemia due to excessive bleeding during menstruation are at a higher risk of developing problems in case of blood loss during the procedure
• Incisions that are made in the uterus for removing the fibroids may lead to a formation of a band of scar tissues. They may tangle the nearby structures of the uterus, blocking the fallopian tube.
• In case the bleeding cannot be stopped, the uterus may have to be removed completely.
• In rare conditions, if a cancerous tumor is mistaken for a fibroid and removed by breaking them in small pieces during a myomectomy, it can lead to the spread of cancer in other parts.

You may have to undergo a pelvic exam and ultrasound after the surgery so that the doctor can examine the status of your condition. Removing the submucosal fibroids improves your chances of fertility and pregnancy. Wait for 3 months after undergoing myomectomy before trying for conception, so that the uterus gets adequate time for healing. You may do simple leg movements and stretches to prevent the formation of blood clots, but ensure that you do not do any intense cardiovascular exercises unless you have the approval of your doctor. After a period of 4-6 weeks, you can resume your exercise routine. Make sure to keep an eye in the area of incision, any type of redness or drainage must be reported to the doctor at once.

The price of myomectomy could be approximately Rs. 2,00,000 – Rs. 3,00,000.