Myomectomy—Open Surgery Overview

This surgery involves removing fibroids from the wall of the uterus (womb). Fibroids are noncancerous tumors in the muscle of the uterus.

Uterine Fibroid © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor may do the following:

• Physical exam
• Blood tests
• Review your medicines
• Dilation and curettage (D&C) —a procedure to remove tissue from the lining of the uterus (endometrium)
• Ultrasound—shows images of pelvic organs
• Intravenous pyelogram —x-rays taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein (done if the fibroids are affecting the ureters)

You should discuss with your doctor:

• Whether you should have hormone treatment for 2-4 months before the procedure—This treatment shrinks fibroids. It makes them small and reduces the risk of excess blood loss during the procedure.
• If cancer is found in the uterus—One option is to remove the uterus during the myomectomy.
• Whether you should donate your own blood for the procedure

Leading up to your procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners such as warfarin (Coumadin)
• clopidogrel (Plavix)
• Arrange for a ride home from the hospital. Also, arrange for help at home.
• Do not eat or drink for at least eight hours before the procedure.

Anesthesia

General anesthesia is used most often. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

The doctor will make an incision in the lower abdomen. Muscles will be separated, and tissue will be cut to expose the uterus. Next, the doctor will remove the fibroids. In some cases, you will be given a drug called Pitressin before the fibroid is removed. This drug will reduce the amount of blood loss.

After removing the fibroids, the doctor will stitch each layer of tissue in the uterus. This will prevent blood clots, excess bleeding, and infection. Lastly, the doctor will use stitches to close the incision area.

Immediately After Procedure

After the procedure, you will be:

• Taken to the postoperative area
• Watched for complications
• Given IV fluids and medicines

How Long Will It Take?

1-2 hours

Will It Hurt?

You will have abdominal pain and discomfort for 7-10 days. Your doctor will give you pain medicine to help control the pain.

Average Hospital Stay

2-3 days

Post-procedure Care

Full recovery will take about 4-6 weeks. When you return home, do the following to help ensure a smooth recovery:

• Be sure to follow your doctor's instructions .
• Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
• Try to walk often. This will decrease the risk of blood clots.
• Take medicines as prescribed by your doctor. If you had to stop medicines before the procedure, ask your doctor when you can start again.
• Bathe or shower as normal. Gently wash the incision area gently with mild soap.
• Ask your doctor when you will be able to:

• Return to work and drive
• Resume sexual activity
• Resume strenuous activity (You may need to wait 2-6 weeks.)

RESOURCES:

National Uterine Fibroids Foundation
http://www.nuff.org/

Women's Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Myomectomy. Duke University Medical Center Reproductive Endocrinology and Infertility website. Available at: http://www.dukehealth.org/Services/Fertility/Programs/Surgery/Myomectomy?search_highlight=myomectomy . Accessed June 1, 2008.

Uterine fibroid treatment options. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patPub/uterineTreatments.shtml#my . Accessed June 1, 2008.