Myomectomy—Open Surgery

(Fibroid Tumor Removal; Uterine Fibroid Removal)
  • Definition

    This surgery involves removing fibroids from the wall of the uterus (womb). Fibroids are noncancerous tumors in the muscle of the uterus.
    Uterine Fibroid
    Uterine Fibroids
    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    Myomectomy is done to relieve problems caused by fibroids without doing a hysterectomy (removal of the uterus). These problems can include:
    • Pelvic pain
    • Back pain
    • Pressure on the bladder
    • Abnormal vaginal bleeding
    • Difficulty becoming pregnant
    • Discomfort during sexual intercourse
    The symptoms caused by fibroids are often successfully controlled with this procedure. This may include a return to a normal menstrual cycle and the ability to become pregnant.
  • Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a myomectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Surgical wound infection
    • Recurrence of fibroids
    • Damage to other organs
    • Wall of the uterus may be weakened if a large fibroid is removed
    • Reactions to anesthesia
    • Need for special precautions in pregnancy, such as the need to deliver by cesarean section
    • Pelvic adhesions that can cause pain and/or bowel blockage
    • Problems found during surgery that make removal of the uterus necessary
    • Severe scarring, resulting in infertility
    Factors that may increase the risk of complications include:
    Be sure to discuss these risks with your doctor before the procedure.
  • What to Expect

    Prior to Procedure
    Your doctor may do the following:
    • Physical exam
    • Blood tests
    • Review your medications
    • Dilation and curettage (D&C) —a procedure to remove tissue from the lining of the uterus (endometrium)
    • Ultrasound—shows images of pelvic organs
    • Intravenous pyelogram —x-rays taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein (done if the fibroids are affecting the ureters)
    You should discuss with your doctor:
    • Whether you should have hormone treatment for 2-4 months before the procedure—This treatment shrinks fibroids. It makes them small and reduces the risk of excess blood loss during the procedure.
    • If cancer is found in the uterus—One option is to remove the uterus during the myomectomy.
    • Whether you should donate your own blood for the procedure
    Leading up to your procedure:
    • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
    • Arrange for a ride home from the hospital. Also, arrange for help at home.
    • Do not eat or drink for at least eight hours before the procedure.
    Anesthesia
    General anesthesia is used most often. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.
    Description of the Procedure
    An incision will be made in the lower abdomen. Muscles will be separated, and tissue will be cut to expose the uterus. Next, the fibroids will be removed. In some cases, you will be given a medication to reduce the amount of blood loss.
    After removing the fibroids, the each layer of tissue in the uterus will be stitched. This will prevent blood clots, excess bleeding, and infection. Lastly, the stitches will be used to close the incision area.
    Immediately After Procedure
    After the procedure, you will be:
    • Taken to the postoperative area
    • Watched for complications
    • Given IV fluids and medications
    How Long Will It Take?
    1-2 hours
    Will It Hurt?
    You will have abdominal pain and discomfort for 7-10 days. You will be given medication to help control the pain.
    Average Hospital Stay
    2-3 days
    Post-procedure Care
    Full recovery will take about 4-6 weeks. When you return home, do the following to help ensure a smooth recovery:
    • Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
    • Be sure to follow your doctor's instructions.
  • Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occur:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Excessive vaginal bleeding (soaking more than one pad per hour) after the procedure
    • Excessive vaginal discharge that continues beyond one month after the procedure
    • Vaginal discharge has a foul odor
    • Severe abdominal pain
    • Headaches, muscle aches, lightheadedness, or general ill feeling
    • Nausea and vomiting
    • Constipation
    • Pain and/or swelling in one or both legs
    • Fibroid symptoms return after the procedure
    • Cough , shortness of breath, or chest pain
    • Pain, burning, urgency or frequency of urination, or persistent blood in the urine
    • New, unexplained symptoms
    If you think you have an emergency, call for emergency medical services right away.
  • RESOURCES

    National Uterine Fibroids Foundation http://www.nuff.org

    Women's Health.gov—US Department of Health and Human Services http://www.womenshealth.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    Uterine fibroid symptoms, diagnosis, and treatment. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patients/uterine-fibroids/. Accessed October 29, 2014.

    6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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