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A myomectomy is a medical procedure performed for the purpose of removing uterine fibroids. However, there are three variations to this procedure that are dictated by the size of fibroids and their location. Unlike a laparoscopic myectomy or hysteroscopic myomectomy that involve the insertion of a specialized scope to examine tissue deeper in the pelvic cavity, an abdominal myomectomy is characterized by a vertical or horizontal incision of the abdomen surface. Again, which incision is made depends on the area of the pelvic cavity that needs to be accessed.
The preferred method of entry is the Pfannenstiel incision, which is made horizontally along the “bikini line” above the pubic bone. The reason this incision is desirable is because it goes with the grain of the skin, so to speak, resulting in less pain and scarring. However, if the uterus is significantly enlarged or protruding, the surgeon may need to perform a vertical incision instead. It may also be necessary if a fibroid is embedded in a ligament along the pelvic wall that adjoins the uterus. The plus to this kind of incision is less bleeding, while the downside is a more prominent scar.
While an abdominal myomectomy is a relatively simple procedure, it does require general anesthesia and a few days stay in the hospital. After the surgery, pain medication may be given for a day or two intravenously. Once the patient is able to resume drinking fluids and eating solid foods, medications may then be given by mouth. In addition, the physician may prescribe additional pain medications to be taken at home during the recovery period.
Most women are able to resume normal activities and return to work after four weeks of home rest. However, most patients are advised to refrain from strenuous exercise or sexual activity for at least six weeks. The use of tampons is also discouraged during the recovery period.
There are certain risks to having an abdominal myomectomy that should be considered. While this procedure can relieve pain and discomfort caused by fibroids, it does not prevent the recurrence of fibroids. In addition, the surgery can lead to the formation of adhesions that can interfere with conception and carrying future pregnancies. In fact, if the uterine wall has been compromised to a certain degree as a result of having an abdominal myomectomy, there is an increased risk of the uterus rupturing during labor and delivery. If this is the case, the patient is usually advised to deliver via Caesarean section. However, if fertility is not an issue, abdominal myomectomy is often preferable to complete hysterectomy since the woman’s uterus is left intact.