Fibroids – Surgical Options
The type of surgery will depend on many factors such as the size, location, and number of fibroids present, and the need to retain the uterus for child bearing.
The current surgical treatments for fibroids are mainly removal of the fibroid and removal of the uterus.
Removal of Fibroids / Myomectomy
Sub mucous Fibroid (the fibroid is projecting into the cavity of the uterus). It is removed through the hysteroscope (telescope is inserted into the uterus and the fibroid is removed by using an instrument to cut it or core it out).
If the fibroid is mainly sub-serosal or intramural then it is removed laparoscopically. This is major surgery, requires admission and anaesthesia. The telescope is inserted in to the abdomen. small cut is made usually in the belly button. Two or three other cuts will be required on the abdomen to insert the instruments that are required. The fibroid is separated from the uterus. It is then placed in a bag inside the abdomen and morcellated. This is then removed through the abdomen. The procedure allows removal of multiple and huge fibroids and retain the uterus.
The fibroids can recur. There are many drugs that may be used preoperatively to shrink the fibroids, to stop the bleeding and help build up the haemoglobin thereby making the surgery feasible and sometimes easier.
Pregnancy can happen naturally after the removal of fibroids. It is important to note that in case the cavity of the uterus was opened during the fibroid removal then the patient will need a planned caesarean section.
Removal of Uterus / Hysterectomy
In some cases, removal of the uterus will be the only option to manage the fibroids. This is the option for women who finished childbearing and have large / multiple or symptomatic fibroids.
Uterus can be removed in several ways.
It can be removed through a cut in the abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy) or through a telescope (laparoscopic hysterectomy)
In either case it requires hospitalization, and anaesthesia and is a major surgery. The pros and cons of each method depend on various factors. The route of surgery can only be decided after considering all factors in each individual case.