An abdominal myomectomy is a surgery to remove uterine fibroids (non-cancerous growths in the uterus) while preserving the uterus. It is often chosen by women who wish to retain fertility or avoid a hysterectomy (uterus removal).
Key Facts:
- Not a cure for fibroids – new fibroids may develop over time.
- Suitable for large, numerous, or hard-to-reach fibroids.
- Involves a larger incision and longer recovery than minimally invasive options (e.g., laparoscopic or hysteroscopic myomectomy).
Why is it Performed?
Your gynaecologist may recommend this surgery if you have:
- Symptomatic fibroids causing heavy menstrual bleeding, pelvic pain, or pressure.
- Infertility or recurrent miscarriages linked to fibroids.
- Fibroids that are too large or numerous for less invasive treatments.
Before Surgery
- Pre-operative tests:
- Pelvic ultrasound or MRI to map fibroids.
- Blood tests (e.g., check for anaemia).
- Preparation:
- Fasting: No food/drink for 6–12 hours before surgery.
- Bowel prep: May be required to empty the bowel (your doctor will advise).
- Medications: Adjust blood thinners (e.g., aspirin) as instructed.
- Arrange support: Plan for someone to drive you home and assist with daily tasks for 1–2 weeks.
During the Procedure
- Anaesthesia: General anaesthesia (you’ll be asleep).
- Incision:
- A horizontal (bikini-line) or vertical incision (4–6 inches) is made in the abdomen.
- Surgery:
Fibroids are carefully removed; the uterus is repaired with stitches.
Blood loss is minimized, and a blood transfusion may be arranged if needed. - Closure: The incision is closed with stitches or staples.
- Duration: 1–3 hours (depends on fibroid size/number).
Risks and Complications
- Common (temporary):
- Pain, bloating, or bruising at the incision site.
- Fatigue and light vaginal bleeding (1–2 weeks).
- Serious (rare):
- Heavy bleeding requiring transfusion.
- Infection, blood clots, or damage to nearby organs (bladder, bowel).
- Scar tissue (adhesions) causing future pain or fertility issues.
- Fibroid recurrence (15–30% of cases).
Recovery
In the hospital:
- Stay for 1–3 days (varies with recovery).
- Pain relief and monitoring for complications.
At home:
- Rest: Avoid lifting >5kg, driving, or strenuous activity for 6–8 weeks.
- Wound care:
- Keep the incision clean/dry, report redness or discharge.
- Staples/stitches removed at 7–14 days post-surgery.
- Activity:
- Gentle walks to aid healing and prevent blood clots.
- Gradually resume normal tasks over 4–6 weeks.
- Return to work: Typically, 4–8 weeks (depends on job demands).
Long-Term Effects
- Fertility: Many women conceive after recovery but discuss timing with your gynaecologist.
- Pregnancy risks: Increased chance of caesarean delivery due to uterine scarring.
- Fibroid recurrence: Regular follow-ups (ultrasounds) to monitor regrowth.
Alternatives
- Medications: Hormonal therapies (e.g., GnRH agonists) to shrink fibroids.
- Minimally invasive options:
- Laparoscopic/ hysteroscopic myomectomy (smaller incisions).
- Uterine artery embolization (blocks blood flow to fibroids).
- Hysterectomy: Removes the uterus (only if future pregnancy is not desired).
Frequently Asked Questions
Q: Will I have a visible scar?
A: Yes, but it will fade over 6–12 months. Horizontal scars are often less noticeable.
Q: How soon can I try to get pregnant?
A: Typically, after 3–6 months, depending on healing. Discuss with your doctor.
Q: Can fibroids grow back?
A: Yes – recurrence rates are 15–30%, but symptoms may not return.
Q: Is recovery longer than a hysterectomy?
A: Similar timeline, but myomectomy preserves the uterus.
eGynaecologist Advice:
- You should consider annual check-up for fibroids if you are diagnosed with fibroids in uterus and take preventive actions in consultation with your gynaecologist to avoid long-term consequences.
- You should seek gynaecological help if you have severe pain, fever, or chills after myomectomy procedure or notice heavy bleeding or foul-smelling discharge from incisions
- You must seek urgent gynaecological review if you develop chest pain, shortness of breath, or calf swelling after while you are recovering from surgical procedure
