Fibroid surgery (laparoscopic and open myomectomy)

Symptoms of fibroids

Many fibroids cause no symptoms and are found during a routine examination. When they do cause symptoms, the most common are:

• Heavy or prolonged periods and resulting anaemia
• Pelvic pain, pressure or a feeling of fullness in the abdomen
• Frequent urination or constipation
• Difficulty getting pregnant or recurrent miscarriage (especially with fibroids growing into the uterine cavity)

Which fibroids need treatment?

The decision to treat depends not on the size of the fibroid but on the symptoms it causes, its location, how fast it grows and your plans for pregnancy. Small fibroids that cause no symptoms are usually monitored with regular ultrasound scans.

Treatment options

Who is suited to keyhole and who to open surgery?

Whether uterus-preserving fibroid surgery is done by keyhole or open surgery is decided after the number, size and location of the fibroids have been mapped by ultrasound or MRI.

For women planning a future pregnancy, a secure, layered repair of the uterine wall is the priority, and the approach is chosen to allow this safe repair. An operation started by keyhole surgery can be converted to open surgery if this proves necessary during the operation.

Both approaches are effective and safe in the right patient; neither is better than the other in every situation. The choice is individual and depends on the size, number and location of the fibroids, your general health, your expectations and pregnancy plans, and your surgeon's assessment.

How is fibroid surgery performed?

Fibroid surgery that preserves the uterus is called myomectomy. In both approaches the aim is to remove the fibroids and repair the uterine wall securely in layers. The operation is performed under general anaesthesia.

Laparoscopic (keyhole) myomectomy

Usually 3–4 small incisions are made at the navel and in the lower abdomen. Guided by the camera image, the fibroid is separated from the uterine wall and the wall is stitched closed. The fibroid is reduced in size inside a special bag that prevents spread within the abdomen and removed through one of the small incisions or through the vagina.

• Most patients go home within 1 or 2 days.
• There is less pain and the scars are small.
• Return to daily activities is usually within 1–2 weeks.

Open (abdominal) myomectomy

The uterus is reached through a horizontal incision in the lower abdomen, usually along the bikini line. Because the surgeon can find fibroids by touch, removing all fibroids lying deep in the uterine wall or present in large numbers, and repairing the wall, may be easier with this approach.

As the incision usually lies along the bikini line, it is covered by underwear.

In both approaches various techniques are used to reduce bleeding during the operation.

Recovery

The length of the hospital stay and the time to return to daily life depend on the approach used, the number and size of the fibroids removed, the extent of the operation and your general health. Heavy lifting and strenuous exercise are avoided for a few weeks after surgery. Your personal recovery plan and follow-up appointments are explained when you are discharged.

Pregnancy after surgery

Pregnancy should be avoided for a while after surgery to allow the uterine scar to heal. The waiting time, and the mode of any future delivery, are planned with your doctor according to how much the uterine wall was involved.