Myomectomy Health Article

Risks

The risks of a myomectomy performed by a skilled surgeon are about the same as hysterectomy (one of the most common and safest surgeries). Removing multiple fibroids is more difficult and slightly more risky. Possible complications include:

• infection
• blood loss
• weakening of the uterine wall to the degree that future deliveries need to be performed via cesarean section
• adverse reactions to anesthesia
• internal scarring (and possible infertility)
• reappearance of new fibroids

There is a risk that removal of the fibroids may lead to such severe bleeding that the uterus itself will have to be removed. Because of the risk of blood loss during a myomectomy, patients may want to consider banking their own blood before surgery (autologous blood donation).

Normal results

Removal of uterine fibroids will usually improve any side effects that the patient may have been suffering from, including abnormal bleeding and pain. Under normal circumstances, a woman who has had a myomectomy will be able to become pregnant, although she may have to deliver via cesarean section if the uterine wall has been weakened.

Morbidity and mortality rates

Depending on the surgical approach, the rate of complications for myomectomy is about the same as those for hysterectomy (anywhere between 3% and 9%). The rate of fibroid reoccurrence is approximately 15%. Adhesions (bands of scar tissue between organs that can form after surgery or trauma) occur in 15–53% of women postoperatively.

Alternatives

Hysterectomy (partial or full removal of the uterus) is a common alternative to myomectomy. The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of all hysterectomies. A subtotal (or partial) hysterectomy is the preferable procedure because it removes the least amount of tissue (i.e., the opening to the cervix is left in place).

Fibroid embolization is a relatively new, less-invasive procedure in which blood vessels that feed the fibroids are blocked, causing the growths to shrink. The blood vessels are accessed via a catheter inserted into the femoral artery (in the upper thigh) and injected with tiny particles that block the flow of blood. The fibroids subsequently decrease in size and the patient's symptoms improve.

BOOKS

Connolly, Anne Marie and William Droegemueller. "Leiomy omas" In Conn's Current Therapy 2003. Philadelphia: Elsevier Science, 2003.

Ludmir, Jack and Phillip G. Stubblefield. "Surgical Procedures in Pregnancy: Myomectomy" (Chapter 19). In Obstetrics: Normal & Problem Pregnancies. Philadelphia: Churchill Livingstone, 2002.

ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St., SW, P.O. Box 96920, Washington, DC 20090-6920. <http://www.acog.org>.

Center for Uterine Fibroids, Brigham and Women's Hospital. 623 Thorn Building, 20 Shattuck Street, Boston, MA 02115. (800) 722-5520. <http://www.fibroids.net>.

OTHER

de Candolle, G., and D. M. Walker. "Myomectomy." Practical Training and Research in Gynecologic Endoscopy. February 17, 2003 [cited March 13, 2003]. <http://www.gfmer.ch/Books/Endoscopy_book/Ch14_Myomectomy.html>.

"High Efficacy Rate Shown in Minimally Invasive Treatment of Uterine Fibroids." Doctor's Guide. January 13, 2003 [cited March 14, 2003]. <http://www.pslgroup.com/dg/2271BA.htm>.

Indman, Paul D. "Myomectomy: Removal of Uterine Fibroids." All About Myomectomy. 2002 [cited March 14, 2003]. <http://www.myomectomy.net>.

Toaff, Michael E. "Myomectomy." Alternatives to Hysterectomy Page [cited March 14, 2003]. <http://www.netreach.net/~hysterectomyedu/myomecto.htm>.

"Uterine Fibroids: Disproportionate Number of Black Women with More, Larger Tumors." National Institute of Environmental Sciences. March 2001 [cited March 14, 2003]. <http://www.niehs.nih.gov/oc/crntnws/2001mar/fibroids.htm>.

Carol A. Turkington
Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Myomectomies are usually performed in a hospital operating room or an outpatient setting by a gynecologist, a medical doctor who has specialized in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics.

QUESTIONS TO ASK THE DOCTOR

• Why is a myomectomy being recommended?
• How many myomectomies do you perform a year?
• What type of myomectomy will be performed?
• What are the risks if I decide against the myomectomy?
• What alternatives to myomectomy are available to me?