Fibroids of the uterus

Fibroids are growths made up of connective tissue and muscle cells of the uterus(your womb). They are typically non-cancerous and can present as a single or multiple growth in and around your uterus. Fibroids are very common and most do not require treatment. Depending on your symptoms, the location, size and number of the fibroids, different treatment can be offered. Myomectomy is a surgery in which the fibroids are removed without removing the uterus. This may be recommended if you have severe symptoms like heavy menses, heavy pelvic sensation, urinary problems due to the fibroid etc.

Surgery can be performed in 2 ways:

• Laparotomy(open): a cut of about 10-15cm is made on the abdomen. This can be horizontal or vertical
• Laparoscopy(minimally invasive): Small cuts made on the abdomen (about 1cm). Carbon dioxide is released into your abdomen to facilitate the surgery and a scope is inserted for viewing. Instruments are then placed through the small cuts to perform the surgery. The fibroids are then cut or morcellated into smaller pieces to allow removal through the small cuts

The choice of surgery depends on a few factors including the size and number of fibroids, the location of the fibroids, complexity as well as patient factors and surgeon expertise.

As with all surgeries, complications can sometimes occur even with the best effort of the surgical and nursing teams. Some of these are inherent in any operative procedure. If complications do occur, recovery may take a longer period of time and further procedures may be necessary.

Risks and complications

Here are some risks and complications that may occur and this list is not exhaustive:

Common complications include bleeding and infection, wound complications(infection, breakdown, delayed healing, keloid formation), pain or numbness over the wound site

Other less common complications include injury to the surrounding organs(e.g. urinary bladder, bowels, blood vessels etc), formation of clots in the deep veins, scar tissue formation etc.

In certain circumstances, if a laparoscopic surgery was planned, it may be converted to an open surgery due to technical difficulties or complications encountered.

Even when myomectomy is successful and the fibroids are removed, new fibroids may grow. There is a risk of recurrence of 15-30% in 10 years.

In some cases, a Caesarean Section for delivery in future pregnancies will be advised if there is a concern regarding the scar on your uterus weakening and opening up during labour. Your doctor will discuss this with you after surgery.