Uterine Fibroids

INTERVENTIONAL RADIOLOGY

               Minimally Invasive Alternatives to Surgery

abdominal hysterectomy for fibroid uterus (note graphic detail)

Abdominal hysterectomy for fibroid uterus

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Copyright © 2008, Joel Garris MD, FACR. All rights reserved.

Surgical Treatments

Hysterectomy

• Surgical removal of the uterus which may be total or partial (cervix left in place)
  

• Major abdominal surgery under general anesthesia
  

• Performed through an abdominal or vaginal approach depending on the size of the uterus and a variety of other factors
  

• Requires a several-day hospital stay and 4 to 6 weeks of recovery time
  

• Performed if future fertility not an issue
  

• If you have your ovaries removed you will go through menopause regardless of your age and may experience hot flashes, vaginal dryness, sweating, mood swings and osteoporosis.
  

• Hormone Replacement Therapy (HRT) may be required for menopausal symptoms you should understand the pros and cons of HRT.
  

• Should be performed when there are multiple or large fibroids and when all other non-surgical treatment has failed to control the fibroid symptoms.
  

• Advantage: fibroid symptoms completely resolve.
  

Abdominal hysterectomy remains the most commonly performed operation to remove

the enlarged fibroid uterus.  600,000 hysterectomies are done in the US each year, over 200,000 for uterine fibroids.  Hysterectomy is the 2nd most common operation performed in the US, caesarian section is #1. 

Myomectomy

• Involves the cutting out of the biggest fibroid(s) or collection of fibroids and then stitching the uterus back together.  Thus the uterus is not removed
  
  
  

• Major abdominal surgery under general anesthesia
  

• This is a more challenging operation than a hysterectomy. Since fibroids have a rich blood supply, significant bleeding must be controlled during the operation.
  

• Most women have multiple fibroids and it is not surgically possible to remove all of them
  

• While symptoms may be controlled initially, fibroids may grow back requiring additional operations
  

• Sometimes the procedure can be done laproscopically but more commonly abdominal myomectomy is required through a horizontal (bikini) incision
  

• Abdominal myomectomy requires a 4-6 week recovery
  

• Primarily performed in younger patients whose primary concern is preserving their fertility
  

• Post operative complications
  

-internal hemorrhage

-infection, e.g., abscess

• The procedure may cause extensive pelvic scarring, making subsequent myomectomy or other abdominal surgery more difficult
  

• Myomectomy can contribute to future fertility problems or cause adhesions leading to intestinal obstructions
  

• Advantage: recommended for women in whom preservation of fertility is the highest priority although fertility decreases progressively after each myomectomy operation due to scar formation around the ovaries and tubes.
  

Endoscopic resection of fibroids

• A type of myomectomy for fibroids inside the uterine cavity
  

• A hysteroscope is placed through the vagina to remove submucosal fibroids within the endometrial cavity, if they are 5 centimeters and smaller.
  

• Complications include hemorrhage and uterine perforation.
  

• Limited application since most fibroids cannot be treated with this method.
  

• Advantage: this is not major surgery and recovery is very rapid.