Fibroid surgery is one of several treatment options available to patients with painful or uncomfortable symptoms caused by fibroids. However, do know that surgical removal of fibroids does not guarantee that they won’t manifest again within your uterus. Fortunately, just because you develop fibroids doesn’t automatically mean you need surgery because there are non-invasive alternatives. This article covers fibroid diagnoses, procedures and risks, and options.
What Is Fibroid Surgery?
During fibroid surgery, a surgeon removes fibroids from the wall of your uterus or the entire uterus in some cases. Fibroids, muscular tumors that have grown into the uterine wall, are almost always benign. Most of the time they have been slowly growing for many years. The size and exact position in your uterus determines whether they cause symptoms such as cramps, bleeding, pain, or difficulty with fertility.
Main Types of Surgery for Fibroids
There are two main types of fibroid surgery:
Myomectomy refers to the surgical removal of only your fibroids. Depending on the size, type and location of your fibroids, a myomectomy may be either a robotic laparoscopic or open procedure. An open procedure involves cutting into your abdomen, whereas a robotic laparoscopic procedure only requires several small incisions.
Remember that a laparoscopy is a procedure in which a surgeon inserts a tiny fiber-optic instrument containing a small camera into your abdomen through a tiny incision. This subsequently allows the surgeon to remove your fibroids via several small incisions.
A hysterectomy is the removal of your entire uterus. Since fibroids can grow back after a myomectomy, a hysterectomy is still the most absolute, certain cure for uterine fibroids. Many women who are done having children choose this option.
More and more often, surgeons perform hysterectomies using a laparoscope. This can be done three different ways; laparoscopic-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and robotic laparoscopic hysterectomy. These are other options to discuss with your doctor. Bear in mind that removal of your cervix and ovaries is optional and something to discuss before your hysterectomy.
Other Types of Fibroid Surgery
- Hysteroscopic Endometrial Ablation.
- Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE).
With a hysteroscopic endometrial ablation, a surgeon completely removes or destroys the lining of your uterus by several methods, such as:
- Boiling water.
- Wire loops.
- Electric current.
This procedure is minor and often done on an outpatient basis. This procedure usually only partially removes or seals submucosal fibroids at the center of your uterus in the endometrial lining. It is not able to reach any deeper fibroids. This procedure involves a camera looking through your cervix and up into the endometrial cavity.
During a myolysis procedure, a surgeon inserts a needle into your fibroids, targeting each one by either freezing it or subjecting it to an electrical current. The procedure often involves a laparoscope. This procedure is still in the investigational stages. A recent study showed that twelve months later many women had an improvement in the amount of bleeding during their periods. It is important to also know that on average the fibroids in the study decreased 45% at twelve months after laparoscopic myolysis. The myolysis seems to shrink many of the fibroids, but not remove them.
Here is a valuable link outlined the outpatient procedure for the treatment and relief of symptomatic uterine myomas:
Uterine fibroid embolization (UFE) or uterine artery embolization are either inpatient or outpatient procedures. During this procedure, a surgeon threads a tube through your groin then to the blood vessels supplying your fibroids and injects gel or plastic particles into the vessels. This cuts off the blood to your fibroids, causing them to shrink. This procedure is done by an Interventional Radiologist in the Radiology Department.
Who Needs Fibroid Surgery?
Fibroid surgery is recommended if your quality of life suffers because of fibroid symptoms, such as cramps, pain, heavy bleeding, frequent urination, discomfort from large fibroids pressing against other organs, and difficulty getting pregnant.
Malignant fibroids are must be removed as well as the uterus. Fortunately, malignant fibroids are not very common. Most of the time, fibroids are benign but causing inconvenient, and unmanageable symptoms , In this case, removal or shrinkage of your fibroids may be the best option.
A myomectomy preserves the remaining healthy parts of your uterus so that you can still get pregnant. After a myomectomy, your uterus takes 12 months to completely heal. Therefore, you should not get pregnant until one year later. Additionally, you must have a Cesarean section for any future deliveries. This is because the areas in the uterus where the fibroids used to be could rupture during labor contractions and put the baby in danger.
Risks of Fibroid Surgery
Any form of invasive surgery carries its fair share of risks, including:
- Temporary or permanent nerve damage, causing numbness or tingling.
- Skin breakdown or scarring, which requires further surgery.
- Bleeding, which may require further surgery.
- Subcutaneous (under the skin) fluid buildup.
- Infection around the site of the incision.
- Anesthesia-related complications, such as blood clots, pneumonia, and (although very rarely) death.
If you have a history of obesity, diabetes, lung disease or cardiovascular disease, then you are more likely to develop some of these complications as well as heart attack and stroke. Therefore if you are considering fibroid surgery, talk with your regular medical doctor as well.
Other types of risks are very surgery specific. For example, a myomectomy carries the following risks (some of which are rare but possible):
- Heavy bleeding that necessitates an emergency hysterectomy.
- Uterine scars that later rupture if you try to labor and have a vaginal delivery.
- Inadvertent injuries to the bladder or the bowel, causing bowel obstruction.
- Scar tissue that diminishes fertility.
- Pelvic infection, including of the ovaries, fallopian tubes and uterus.
Abdominal hysterectomies present some of the same risks, in addition to damage to the urinary tract, rectum or bladder as well as other structures within the pelvis.
Hospital stays and recovery times depend on the type of procedure you undergo. Abdominal procedures generally require a hospital stay of one to three days and recovery times of two to six weeks.
Since laparoscopic procedures are usually outpatient, they require a stay of a couple hours to one day.
The average stay is one to four days; average recovery times for laparoscopy and laparotomy are one to two weeks and four to six weeks respectively.
Alternatives to Fibroid Surgery
If you do not require surgery, states the University of Michigan Medical Center, consider these effective alternative treatments:
- Hormones (BCP and Lupron) to shrink fibroids. Unfortunately, while they do reduce the bleeding, it only offers a temporary relief. Furthermore, hormonal treatment only treats the bleeding symptoms and does not reduce the size of the tumor.
- Dilation and curettage (D&C). This method treats treats the symptoms of fibroids by removing the uterine lining. While it reduces the bleeding temporarily, it does not treat the tumor.
- Anti-inflammatory drugs, such as ibuprofen, to manage pain.
- Ablation. This is another treatment option that treats the symptoms but does not help with the tumors. The bleeding may stop but the tumors may continue to grow.
- Get an intrauterine device (IUD) or take birth control hormones to reduce pain and bleeding by reducing the amount of tissue present.
Fibroids are very common, even though they usually are not cancerous, they cause significant symptoms. In some cases, large or painful fibroids require prompt, careful medical attention. Fortunately, advances in medical treatment present a variety of safe, efficacious procedures to deal with fibroids.
From inpatient and outpatient to invasive and non-invasive procedures, there is one ideally suited to your unique circumstances. See a doctor to diagnose your fibroids and help you make the most sound decision about treatment.
Do you have a story, question, or observation about fibroids and fibroid surgery? Please feel free to share.
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