Abdominal Myomectomy

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

1. Anaesthesia: General anaesthesia (you’ll be asleep).
2. Incision:
   1. A horizontal (bikini-line) or vertical incision (4–6 inches) is made in the abdomen.
3. Surgery:
   1. Fibroids are carefully removed; the uterus is repaired with stitches.
   1. Blood loss is minimized, and a blood transfusion may be arranged if needed.
4. Closure: The incision is closed with stitches or staples.
5. 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