Surgical Options For Fibroid Removal

The treatment of fibroids depends primarily on the amount of trouble that is caused due to their presence. Many women do not even get to know the presence of fibroids unless they undergo some medical check up.Most women also carry a pregnancy easily though after most surgical options ,it is more difficult to carry a pregnancy.

If fibroids are not causing problems and discomfort there is no need for any treatment other than regular medical checkups.

If the fibroids cause pain, heavy or lengthy menstrual bleeding, or other pregnancy related problems, a surgery may be required. The two kinds of surgery most commonly performed are hysterectomy and myomectomy.

If the fibroids appear just before menopause then medication or simple surgery can be used to shrink them as they shrink naturally during menopause.

There are many treatment options available depending on the particular patients condition and age:

1.Hysterectomy
2.Myomectomy
3.Hysteroscopic resection
4.Embolization
5.Laparoscopic surgery
6.Medication

Hysterectomy

Hysterectomy is a surgical procedure to remove the uterus,usually along with the cervix.This is the most common and permanent cure of fibroids. But a big drawback of this surgery is that a woman cannot ecome pregnant or carry a baby after this surgery. This option is only considered if the fibroids are too large. A hysterectomy is performed by making an incision in the abdomen. Sometimes the ovaries are also removed along with the uterus and cervix. The decision to remove the ovaries depends on how close the woman is to menopause or if the ovaries are diseased.

Vaginal hysterectomy or Laparoscopic vaginal hysterectomy can be performed if fibroids are smaller in size, The uterus can be removed through the vagina instead of the abdomen. The hospital stay for hysterectomy is 2-5 days. The patient fully recovers after 6 week. For six weeks it is advisable to avoid driving,heavy lifting,sexual intercourse and vigorous exercise. Complications after the surgery could be infection,internal bleeding (hemorrhage) needing blood transfusion or injury to other pelvic organs such as the bladder, bowel, or ureters.

Myomectomy

Myomectomy is a method to remove fibroids without removing the uterus. This surgery allows the woman to bear children, but only 50% women can carry a successful pregnancy after a myomectomy. Myomectomy is performed through an incision in the abdomen with the assistance of a laparoscope or hysteroscope.

Risks after the surgery include:

Heavy bleeding can occur. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy.
Scarring can occur covering the ovaries or blocking one or both of the fallopian tubes which does not allow the tubes to pick up the eggs after ovulation.
The surgery weakens the uterus walls.For delivery of a baby the patient has to go through a cesarean section as labor contraction could tear or rupture the wall.
Infection
Blood clots in the legs.
Reoccurrence of fibroids

For removal of small fibroids newer kinds of surgeries are available. The benefits of these options are

These options do not require abdominal surgery.
They could require an overnight hospital stay but mostly no stay is needed at all.
They are cheaper and recovery is quick and less painful.
They also show better cosmetic results as barely any stitches are made.
Patients recover completely within one week or maximum two

Hysteroscopic resection

A thin telescope or hysteroscope is inserted through the cervix. As it allows the surgeon to see inside the uterus, the fibroids can be removed using a laser, electrical knife or wire. It does not require any incision. The procedure is performed under general or local anesthesia.

Embolization

Under this procedure the fibroids are made to shrink as the blood supply is cut off. Using an X-ray image, a small catheter is threaded through a tiny incision in the groin into the main arteries that supply blood to the uterus. Small particles of plastic are inserted through the catheter to block these blood vessels. Because smaller arteries continue to be connected to the uterus, there is no damage caused. This is all done under local or general anesthesia. The procedure takes an hour.It is necessary to lie flat on the back for 6-7 hours after the surgery to stop the bleeding from the incision. It would take a week to recover completely during which some patients have fever.

Laparoscopic surgery

Under this form of surgery a pencil-thin surgical telescope called laparoscope is inserted through one or more tiny incisions in the abdomen to remove the fibroids.

Laparoscopic myomectomy is used for small and easy to reach fibroids and an incision in the uterus is made to remove them.

Laparoscopic myolysis is a procedure used for bigger or difficult to reach fibroids. A laser or electric needle is used to destroy or shrink them.

Medication

1. Certain drugs called Gonadotropin releasing hormone agonists (GnRH agonists) can also be used to treat fibroids.They indirectly block production of estrogen which shrinks the fibroids. Once the size of the fibroids is reduced to one thirds,it is easier to remove them through vaginal hysterectomy or laparoscopic surgery ,rather than abdominal surgery which is more complicated. It can also be used for women close to menopause as fibroids shrink naturally after menopause. It is available as Lupron (leuprolide),Synarel (nafarelin) and Zoladex (goserelin)

Disadvantages and side effects of these drugs are:-

If these drugs are consumed for more than 6 months, it causes bone loss leading to osteoporosis or joint pain.
Once the drug consumption stops, the fibroids grow back.

2.To reduce heavy bleeding due to fibroids, Progestogen or Androgens are also given as synthetic hormones. But they do not shrink the fibroids. Sometimes GnRH agonist is prescribed in combination with a low dose of estrogen or progestogen, which reduces the side effects of GnRH agonists.

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