What is a Myomectomy?

Written by: Mr Chellappah Gnanachandran
Published:
Edited by: Kalum Alleyne

Laparoscopic surgeon and gynaecology ultrasound specialist, Mr Gnanachandran explains why a myomectomy is often the best option for relieving fibroid problems for patients who want to conceive.

 

A woman who has been liberated after a myomectomy

 

What is a Myomectomy?

A myomectomy is a surgical procedure that is performed to remove fibroids. There are many methods for performing this procedure, ranging from keyhole to open surgery and hysteroscopic approach.

 

Why might someone need a Myomectomy?

Although fibroids are quite common and usually benign, they can sometimes cause a number of health problems. These can include heavy and/or painful periods, causing disturbances in lifestyle and anaemia, tiredness.

 

Fibroids can be a reason for the difficulty in conceiving and pregnancy complications like pre-term deliveries or abnormal presentations, subfertility and infertility. In a small number of cases a myomectomy may also be performed in order to solve bladder functionality issues Women experiencing these issues usually seek a myomectomy to alleviate pain and facilitate pregnancy.

 

What are the risks?

As with any surgery, myomectomy procedures do carry an element of risk for potential patients.

 

Some of the risks are standard for operations of this type, such as heavy bleeding, potential damage to other organs and prolonged surgery and blood transfusion.

 

Risks unique to myomectomy is the risk of hysterectomy (1- 4%) needing to be performed due to excessive bleeding, although this is an extremely rare occurrence at first myomectomy and selected cases. Also, other risks are recurrence of fibroids and scarring of the womb cavity. Possible post-surgery problems include persistent pain, haematoma (bruising), infection and blood clots.

 

The resultant scarring means it is essential that patients avoid any type of pregnancy. Including IVF, for up to 3-6 months after surgery.

 

What happens after surgery?

The amount of time spent in the hospital after surgery varies, with the type of surgery and the amounts of fibroids removed as being the main factors. If key-hole surgery is performed, the patient may be allowed to leave the same day or, if not the next, whereas patients are kept for at least 48 hours to 72 hours after open surgery. The patient´s heart rate will be monitored in both cases, while fluid and antibiotics are usually administered via IV for 24 hours. A catheter may also need to be fitted in order to drain urine.

 

Are there alternatives to a myomectomy?

While this type of surgery has a very high success rate, there are many reasons why a patient may choose not to go ahead with it. One of the alternatives is GNRH or Esmya medications that aim to decrease the fibroid size; although this method is only effective for smaller fibroids, larger growths may still require surgery. It has also been known to cause menopausal symptoms.

 

Hormonal treatments are another option but they’re not ideal when the fibroid affects the womb cavity or if the fibroids are more than 4cm in length.

 

Other alternatives include a hysterectomy or uterine artery embolization but are generally only recommended to those who have completed their families due to potential fertility issues.

 

Mr Gnanachandran has extensive experience in scanning in gynaecology, especially for fibroids and ovarian cysts. In addition, he is an accredited IOTA scanner for ovarian mass and participates in ovarian cancer studies. Please visit his profile to book a consultation.

By Mr Chellappah Gnanachandran
Obstetrics & gynaecology

Mr Chellappah Gnanachandran (Mr Gnana) is a leading laparoscopic surgeon and a consultant gynaecologist based in Northampton, UK.

He scans all his gynaecology patients himself.  He is one of the few gynaecologists who has a trained degree in scanning.

He currently sees private patients at BMI Three Shires Hospital and Northampton General Hospital. He provides a range of treatments for patients with gynaecology conditions including fibroids, ovarian cysts, and endometriosis.

Mr Gnanachandran specialises particularly in gynaecology scanning and has advanced knowledge in ovarian cyst pathology and endometrial assessment. He also treats young women for early indications of cancer and conditions affecting fertility. Part of his responsibility as a consultant gynaecologist is to help patients avoid unnecessary interventions and allow them to access appropriate early surgery if necessary.

He often carries out ultrasound scans and laparoscopic surgery for patients with subfertility, endometriosis, fibroids and early gynaecology malignancies.

Mr Gnanachandran has given training and lectures nationally on scanning for endometrium, fibroid and IOTA scanning for ovarian cysts.

Mr Gnanachandran graduated from the University of Colombo in Sri Lanka in 2002 before joining the NHS training programme in 2004. In 2005, he began his training in obstetrics and gynaecology and started working in several hospitals throughout Wales and the West Midlands.

Mr Gnanachandran gained a master of science in gynaecology ultrasound at the University of Derby.

In 2016 he was appointed as a consultant at Northampton General Hospital to develop fertility services

He is the current lead for gynaecology rapid access care service which provides tall patients with suspected gynaecological cancers are seen within 2weeks time from referrals.

He completed training in several different aspects of gynaecology including 

1) Ultrasound scan for the pelvic and transvaginal scan.

2) Laparoscopic and hysteroscopic surgeries for benign gynaecological conditions such as fibroids, adenomyosis, and endometriosis

3) Surgery for patients with infertility including hysteroscopic resection of fibroid, polyps and uterine septum

4) Colposcopy and treatment of cervical precancers

5) Gynaecology oncology referrals and early gynaecology cancers such as endometrial cancer early stage.  All cancer patients will need to go through MDT.

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