Uterine myomectomy





Myomectomy, refers to the surgical removal of uterine leiomyomas


known as fibroids. 



In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential.



Removal of a fibroid necessary when the fibroid causes pain or pressure, abnormal bleeding, or interferes with reproduction. 



The fibroids that are needed to be removed are typically large in size, or in certain locations such as the endometrial cavity causing significant cavity distortion.



Treatment options for uterine fibroids include observation or medical therapy, such a GnRH agonist, hysterectomy, uterine artery embolization, and high-intensity focused ultrasound ablation.



A myomectomy can be performed either by a general or a spinal anesthesia.



Traditionally a myomectomy is performed via a laparotomy with an  abdominal incision, either vertically or horizontally. 



The open surgical approach is often preferred for larger lesions. 



Incisions in the uterine muscle and are repaired once the fibroid has been removed. 



Myomectomynopen surgery recovery takes six to eight weeks.



Laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy.



Laparoscopic myomectomy is not generally used on very large fibroids. 



A fibroid that protrudes  into the endometrial cavity may be accessible to hysteroscopic removal, and recovery  is a few days.



Myomectomy may be associated with surgical complications, particularly among women who had previous abdominal surgery.



The recovery time is longer after open abdominal myomectomy than  after laparoscopic or hysteroscopic myomectomy, 



Transfusion requirements is higher with abdominal myomectomy  at 16% compared with approximately 7% with hysteroscopic myomectomy and 3% with laparoscopic myomectomy.



Complications of myomectomy.:


blood loss leading to a blood transfusion, adhesion or scar formation around the uterus or within its cavity, and the potential need later to deliver via cesarean section.



Removing all fibroid lesions may not be possible with myomectomy, and the procedure does not prevent new lesions from developing: new fibroids will be seen in 42-55% of patients undergoing a myomectomy.



Myomectomy surgery is associated with a higher risk of uterine rupture in subsequent pregnancy.



Pregnancy following myomectomy should get Cesarean delivery to avoid the risk of uterine rupture that is commonly fatal to the fetus.



The use of misoprostol in the vagina and the injection of vasopressin into the uterine muscle are both effective  to reduce bleeding during the procedure.



Other possible treatments to decrease bleeding include: chemical dissection, vaginal insertion of dinoprostone, a gelatin-thrombin matrix, tranexamic acid, infusion of vitamin C, infiltration of a mixture of bupivacaine and epinephrine into the uterine muscles, or the use of a fibrin sealant patch.








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