Fibroids are benign tumors that occur by feeding on the blood cells of the uterine wall. The most common tumors of the female reproductive system are fibroids. Fibroids, which often progress without symptoms, occur during routine health checks that most women have.
Doctors do not offer any treatment for fibroids that progress without symptoms and do not interfere with the woman's life routine. However, in cases where fibroids cause excessive menstrual bleeding, anemia, infertility and recurrent miscarriages, treatment option for fibroids should now be considered.
WHAT IS MYOMECTOMY?
Fibroids are among the benign tumors that most commonly affect women. These formations take their name from the smooth muscle layer of the uterus called the myometrium. The cells forming the fibroid originate from this smooth muscle layer, and the growth of structures made up of these cells is related to the amount of estrogen in the bloodstream. Some cases of fibroids can become quite large, causing complaints such as abdominal pain or abnormal menstrual bleeding.
The typing of fibroids varies according to the uterine region where they occur:
Intramural fibroids are the most common type of fibroid. These types of fibroids occur within the muscular wall of the uterus. Intramural fibroids can grow over time, causing the uterus to stretch.
Subserosal fibroids arise from the serosa layer in the outer layers of the uterus. Enlarging subserosal fibroids can cause the inside of the uterus to appear larger on one side.
Pedunculated fibroids, another type of myoma, are the form of subserosal fibroids supported by a root or stem-like structure.
Submucosal fibroids occur in the myometrium, which is the middle part of the intrauterine muscle layer. This tumor type is seen more rarely than other fibroids.
The structure, size and number of the tumor formed in various parts of the genital organs of women in myomectomy disease are also of great importance. For this reason, myomectomy in women can only be understood through routine controls. Different changes can be observed in the body as a result of myomectomy formation. According to these changes, the symptoms of myomectomy are as follows;
Difficult menstrual period and heavy menstrual bleeding
Pain in the back and groin areas
Burning and pain during urination
Swelling in the abdomen and lower abdomen
Feeling pain during sexual intercourse
In case of myomectomy symptoms, it is useful to be checked as soon as possible. For the diagnosis of myomectomy, it is necessary to be examined by a specialist gynecologist. This examination is called a pelvic examination. In addition, the patient's medical history is also taken during this process. Afterwards, the final diagnosis process is completed with ultrasound control and Pelvic MRI device. Thus, gynecologists have information about the myomectomy sites and amount in your body.
TYPES OF MYOMECTOMY
Depending on the size and type of fibroid in the patient, the surgeon may choose one of the surgical approaches.
This application is open surgery that everyone knows. With this method, the woman's uterus is reached through an open abdominal incision and the fibroids are removed. This application is done under general anesthesia. The uterine cavity is reached with 1-2 vertical or horizontal incisions made to the patient. This method generally reduces the bleeding rate in myoma surgery. During the operation, the doctor can visually see the uterus, manually examine the fibroids. It opens a suitable incision for the uterine fibroid. After abdominal myomectomy, the patient must stay in the hospital for 2-3 days. The recovery period is 4-6 weeks.
A few small incisions are made in the patient's abdomen and fibroids are removed with special instruments belonging to laparoscopy. Unlike open surgery, there are no large incisions and no large openings in the abdomen. In this application, an incision is made from the belly button of the patient. From this region, the abdomen is inflated with carbon dioxide gas. The laparoscope is inserted into the pelvic cavity to view the ovaries, uterus, and other pelvic organs. Then, the operation is performed by making small incisions in the abdominal wall. The fibroid is removed through a small incision in the uterine wall or a small incision in the vagina.
In this application, fibroids are removed by reaching the cervix and uterus through the vaginal route with special instruments. This method is generally recommended to treat submucosal fibroids, ie those in the uterine cavity. In the procedure performed under general or spinal anesthesia, an instrument called a resectoscope is inserted through the vagina. The tube in the tool releases a liquid to the environment. This expands the uterine cavity. Thus, the walls of the uterus can be examined. The fibroids are removed by smashing with the instrument. The uterus is cleaned by washing it with a liquid.
AFTER THE OPERATION
When you are discharged from the hospital, your doctor prescribes a painkiller you can take by mouth, gives you information about how to take care of yourself, and restrictions on your diet and other activities. Depending on the type of procedure you have had, you can expect some vaginal spotting or light bleeding from a few days to six weeks.
Results from myomectomy may include:
Relief in symptoms. After myomectomy surgery, most women are relieved of uncomfortable signs and symptoms such as excessive menstrual bleeding and pelvic pain and pressure.
Improvement in fertility problems. Women who have had a laparoscopic myomectomy achieve good pregnancy outcomes within about a year after surgery. After a myomectomy, the recommended waiting time is three to six months before trying to conceive to allow your womb time to heal.
Fibroids that your doctor couldn't detect during surgery, or fibroids that weren't completely removed, may eventually grow and cause symptoms. New fibroids may also develop, which may or may not require treatment. Women with only one fibroid have a lower risk of developing new fibroids than women with multiple fibroids. Women who become pregnant after surgery have a lower risk of developing new fibroids than women who do not become pregnant.
FREQUENTLY ASKED QUESTIONS
Is there a risk of recurrence of fibroids?
There is a 20-25 percent risk of recurrence of fibroids within 5 years after the operation. In myomectomy, which is called myomectomy, all visible fibroids can be removed, but since fibroids that are invisible at microscopic level cannot be removed, there is a risk that they will grow and reappear over time and cause complaints.
In whom are fibroids more common?
Fibroids that develop from the smooth muscle fibers of the uterus are more common in women with a family history of fibroids. Due to the increase in the unmet estrogen hormone in women of reproductive age, the incidence of fibroids is between 15-20%. Due to the increase in estrogen during pregnancy, the size of fibroids increases more.
Do fibroids decrease during menopause?
With the decrease in estrogen hormone during menopause, fibroids decrease and become smaller.
Can fibroids turn into cancer?
Although fibroids are usually benign and well-defined masses, their growth and blood flow rates should be checked with ultrasound to evaluate the possibility of being a malignant sarcoma, albeit very rare.
Should all fibroids be surgically removed?
Evaluation of whether fibroids can be surgically removed; It is evaluated according to the patient's condition, the right time and the method to be used. In a fibroid that does not cause any compression or bleeding, there is no need for surgery unless there are signs that raise suspicion of a malignant smooth muscle tumor. On the other hand, fibroids that cause excessive bleeding, prevent the baby from implanting in the uterus, and cause pressure and pain on the bladder and the last intestine should be removed.
How long does the recovery process take in laparoscopic myomectomy?
Laparoscopic myomectomy operation, while the patient stays in the hospital on the day of the operation, he is usually discharged the next day. The recovery period after surgery ranges from a few days to two weeks.
What are the advantages of laparoscopic myomectomy?
Compared to open surgery, in Laparoscopic myomectomy, patients experience less pain, have very small sutures, experience less blood loss, and return to their daily lives faster. It also shortens the hospital stay.
Should estrogen suppressing drugs be used before laparoscopic myomectomy operation?
Routine administration of GNRH analogues, that is, drugs that suppress the woman's natural estrogen, should be avoided before the operation. These agents obscure the line that the fibroid makes to the uterus, making it difficult to separate the fibroid from the uterus. In rare cases, it can be used to stop the patient's bleeding before surgery and raise the patient to the level of blood ready for surgery.
Estrogen-suppressing drugs can be used only at the age close to menopause or in cases where systemic diseases do not allow surgery. Long-term use of these drugs may cause complaints such as osteoporosis, cessation of menstruation, and hot flashes. Treatment methods recommended for fibroids, such as blocking the fibroids feeding the fibroids and reducing their nutrition, are not recommended for young patients due to the risk of damage to the ovary and endometrium layer of the agents used.