Myomectomy at The Holly Hospital

What is a myomectomy?

A myomectomy takes out fibroids (non-cancerous growths in the wall of the womb) while leaving the womb itself in place. Unlike a hysterectomy, this means becoming pregnant afterwards remains possible.

What conditions does a myomectomy treat?

Myomectomy tends to be recommended where fibroids are behind:

• heavy periods, or bleeding between periods
• pelvic pain or a feeling of pressure
• trouble conceiving, particularly where fibroids have grown very large
• needing the toilet often, or a tummy that feels swollen and uncomfortable, where fibroids are pressing on the bladder or have grown to a considerable size

Plenty of fibroids never cause a single symptom and need no treatment at all. Myomectomy comes into the picture mainly where fibroids have grown large, or are sitting somewhere causing genuine problems, and keeping the option of pregnancy open matters to you.

What are the benefits of a myomectomy?

Taking out the fibroids alone, rather than the womb along with them, means periods carry on as before and pregnancy stays possible further down the line, something a hysterectomy would rule out entirely.

Are there different types of myomectomy?

• open (abdominal) surgery, through a cut along the bikini line, or a longer up-and-down cut where fibroids are especially large; this fits best where fibroids are at their biggest, giving a surgeon full sight of everything in the pelvis
• keyhole (laparoscopic) or robot-assisted surgery, working through a few small cuts in the tummy with a camera and slim instruments; getting back on your feet tends to happen sooner than with open surgery, though the womb's wall can end up a little weaker afterwards, so open surgery is sometimes favoured instead if pregnancy is on the cards
• a route through the vagina and cervix with no cuts to the skin whatsoever, suited only to fibroids growing inside the cavity of the womb itself, generally the quickest of the three to bounce back from

Which approach fits best comes down to how big your fibroids are, how many there are, how deep they sit, and where exactly they've grown. Surgery is generally carried out under a general anaesthetic, occasionally spinal instead, sometimes combined with a local anaesthetic to help keep bleeding down and ease discomfort once it's over.

What happens before a myomectomy?

Getting ready starts with a nurse-led check, going over your medical history, confirming you're fit for surgery, and noting down what you're currently taking, blood thinners, herbal remedies and anything bought without a prescription.

Going without food or drink for roughly six hours before you're admitted on the day itself is standard, and it's worth telling the team about any chance you might be pregnant. Your surgeon will run through what's involved, along with the likely benefits, risks and alternatives, before asking you to put your consent in writing.

What happens during a myomectomy?

1. You're given anaesthetic, general or spinal depending on which surgery you're having, so nothing hurts while it's happening.
2. A drip goes into your arm or the back of your hand for fluids and medication, while equipment tracks your heartbeat and other key readings throughout.
3. A tube may be fitted to keep your bladder empty for the duration of the operation.
4. Your surgeon then reaches the fibroids, whether through a cut in your tummy, several smaller cuts, or by working through the vagina and neck of the womb depending on the method chosen, and takes them out while keeping your womb intact.
5. Once that's done, everything gets closed back up with stitches, whether that's the wall of the womb itself, or your tummy for open or keyhole surgery.

Timings vary, but most operations of this kind wrap up inside three hours, with the exact length shifting depending on which surgical route is used, and how many fibroids need dealing with.

What does recovery look like?

Waking up happens in a recovery area, with any bladder tube and your drip removed as you come round. Getting up and moving, eating, and using the bathroom again all get encouraged fairly promptly, along with keeping your legs active, all to help ward off blood clots.

How long full recovery takes varies by the type of surgery involved:

• open (abdominal) surgery: several days as an inpatient, then up to 6 weeks at home before feeling entirely back to normal
• keyhole or robot-assisted surgery: same-day discharge is common, with roughly 2 to 4 weeks of recovery once home
• surgery through the vagina and neck of the womb: sometimes just a handful of days to get back on your feet

At home, some light bleeding and discharge for several weeks is normal, alongside soreness that tends to flare up most when you're moving about, which painkillers can help settle. Steer clear of lifting anything heavier than a light bag of shopping during the first week and avoid sex entirely for 6 weeks.

Build activity back up in stages rather than returning to your usual routine all in one go and having someone around to lend a hand at home in that early stretch makes a genuine difference if you can arrange it. You'll be fit to drive again once you're free from pain and confident an emergency stop wouldn't catch you out.

What are the risks and complications?

Possible risks of a myomectomy include:

• bleeding heavy enough to need a blood transfusion
• infection needing a course of antibiotics
• blood clots forming in the leg or lungs; getting moving soon after surgery, plus compression stockings or a blood-thinning injection, help guard against this
• injury to organs nearby, sometimes needing a further operation to put right
• scar tissue building up in the pelvis or inside the womb
• an allergic reaction to the anaesthetic used
• a small chance, roughly 1 in 100, of needing an emergency hysterectomy during the operation, kept as a last resort where bleeding can't be brought under control any other way
• new fibroids appearing later on, more likely the younger you are and the more fibroids were taken out the first time round; studies suggest fresh growths can turn up in as many as 60 out of every 100 people within five years, though not every case needs further treatment