What is Myomectomy?
This is a surgical procedure that removes fibroids and leaves the uterus (womb) intact.
Why would I have a Myomectomy?
Surgery may be considered if your fibroid symptoms are particularly severe and all forms of medication have proved ineffective. You should discuss the reasons for your myomectomy and the different treatment options with Mr Chattopadhyay who will be happy to explain these in more detail and answer any questions you may have.
How is the Myomectomy performed?
There are different ways to perform the myomectomy and Mr Chattopadhyay will discuss with you the most appropriate method for your individual case:
Abdominal Myomectomy
In an abdominal myomectomy, an incision is made in your abdomen (which may be around 12 cm or less). This enables the doctor to reach the uterus so that the uterine fibroids can be removed from the wall of the womb (intramural) and the outer layer of the womb (subserous). Once the fibroids have been removed the uterus and abdomen are stitched up. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 3-4 days.
Laparoscopic Myomectomy
We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is called a laparoscopic myomectomy or laparoscopic resection. A laparoscope (a narrow tube with a fibre optic light) is inserted into the womb through a tiny cut in the abdomen. Other small cuts are made in the same area to insert instruments that can dissect and remove the fibroids. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 1-2 days.
Hysteroscopic Myomectomy
A hysteroscopic myomectomy (or hysteroscopic resection) is where a small hysteroscope is inserted through the vagina and the cervix, so that one or more fibroids can be removed. This procedure can only be done where there are small fibroids which are just underneath the uterine lining (submucous fibroids). You will be given a local or general anaesthetic and will probably be able to go home the same day.
What are the complications of a Myomectomy?
Most women will not experience any problems following a myomectomy. As with any surgery, there is a slight risk from the general anaesthetic. Other risks may include some blood loss, infection and perforation of any of the organs of the pelvis, mainly the uterus, bowel, bladder or blood vessels. Mr Chattopadhyay will discuss the risks with you.
Will my fibroids grow back?
Once fibroids are removed those particular fibroids cannot grow back. But fibroids are caused by genetic mutations within uterine muscle cells. This process can over time create new fibroids. In addition, there can be tiny fibroids that cannot be seen or felt, and therefore cannot be removed. This is most likely to happen in someone who has many little fibroids. Recurrence is least likely in women with one or a few large fibroids than with multiple small ones.
Do I need any special preparation?
In preparation for your operation, ensure that you fully understand the procedure by asking any questions or sharing any worries. You may wish to use to write down your questions and take with you on your admission to hospital so that you can discuss any of your concern.
It is advisable that you arrange for any help at home, such as with daily chores and childcare arrangements, until such time as you feel able to undertake these tasks without help. You will also need to ensure that someone is available to collect you from hospital when you are discharged and take you home by car or taxi (not public transport). It is advisable that you bring an overnight bag for your hospital stay. Prior to coming into hospital you should have a bath or shower. Please remove any body piercings and nail varnish from fingers and toes. Valuables and jewellery should be left at home.
What can I expect immediately after the operation?
To perform a successful laparoscopy your abdomen will be inflated with air. This can cause lower abdominal, upper leg and commonly shoulder tip pain. You will also have 2-4 incision sites where the laparoscope and instruments were inserted. These may be tender immediately after your operation and for the next 10-14 days.
If you are having an abdominal myomectomy you may return to the ward with a Patient Controlled Analgesia System (PCA). This will allow you to control your own pain relief. The PCA will remain with you for 1-2 days following your operation and can be topped up with oral and/or rectal analgesia (pain relief). Once the PCA is discontinued you will receive regular oral pain relief.
If you are having an abdominal myomectomy, you may have a catheter placed in your bladder during your operation whilst you are asleep. Catheters stay in place until you are drinking normally and the catheter bag is filling with normal amounts of urine. It may be removed the day following your surgery.
How will my wound be closed?
Your incision sites may either be closed with very small sutures (stitches) if having a laparoscopy or with surgical glue. If you are having an abdominal myomectomy your wound will be slightly bigger. Stitches, surgical glue, clips or staples may be used.
Sutures usually dissolve within 10-14 days for a laparoscopy. If they do not and are causing discomfort please seek advice from your GP or practice nurse. If necessary they should be able to remove them for you. Glued sites may be left to heal, no intervention is required.
If you are having an abdominal myomectomy, your stitches, clips or staples are normally removed between 7-10 days. The hospital will arrange for the district nurse or practice nurse to remove these for you. You may choose to come in to the hospital to have them removed as well.
Will I have any vaginal bleeding?
It is common to have some mild vaginal bleeding for up to seven days after your operation. Do not use tampons during this period, only sanitary towels. Tampons may increase your risk of developing a mild infection. If you feel your bleeding is prolonged or becomes offensive, please seek advice from the hospital or from your GP. The hospital will be able to contact Mr Chattopadhyay for further advice. Please note that in case of any emergency you may need to attend the local NHS hospital A&E. Excessive or prolonged menstrual bleeding is one of the most common symptoms of fibroids. Treatment of your fibroids should now stop this.
How should I care for my wound?
Some oozing from the site(s) may be noted for the first 24 hours after your operation and a dry dressing may be applied. After this time the site should be left clean, dry and exposed. (Please do not use any perfumed products on your wound).
Should oozing continue and/or the areas become inflamed/red/ smelly, when you are at home, please seek advice from your GP, as you may have developed a mild infection.
You may bathe and/or shower as normal, it does not matter if you get the sutures or glue wet. Do not use any perfumed products on your wound when bathing/showering. Please ensure that you dry your wound with a clean towel after personal cleansing.
Will I have a scar?
Laparoscopic scarring is minimal as the incision sites are very small and any scarring will fade with time. If you are having an abdominal myomectomy you may have a slightly bigger scar but, again, this will fade with time.
When can I return to my normal activities?
You will feel tired in the first few days following your operation. Rest and recover and resume your normal activities when you feel ready to. However, avoid heavy lifting, housework and strenuous exercise for 10-14 days. Following laparoscopic surgery you can normally return to work within 7-14 days. After an abdominal myomectomy this might be 4-6 weeks.
Do not attempt to drive until you can wear your seatbelt comfortably and feel confident that you would be able to perform an emergency stop without any abdominal discomfort.
Mr Chattopadhyay will be able to provide you with a sick note at discharge from the hospital, for your employer, if you are working.
Mr Chattopadhyay would like to see you in four to six weeks, to give you the results of tissue testing from the operation, to ensure you are well and to ensure you do not have any further questions.
When can I have sex again?
Do not resume having sexual intercourse until vaginal bleeding has stopped and you feel able and comfortable to have sex.
Will my periods be affected?
Your periods can be affected by your operation. They may be heavier, lighter or delayed.
Will I have constipation following surgery?
This is avoidable. Eat a high fibre diet and drink plenty of water (approximately eight glasses per day) and gradually increase your exercise. If constipation becomes a problem whilst you are in hospital, discuss this with your nurse. If at home, ensure you discuss it with your GP or District/Practice Nurse and they will give you further advice.
