Surgical options for fibroid removal
Tea fibroid treatment it mainly depends on the number of problems caused by its presence. Many women are not even aware of the presence of fibroids unless they undergo some medical control.
oIf the fibroids are not causing problems and discomfort, there is no need for any other treatment other than regular medical check-ups.
oIf fibroids cause pain, prolonged or heavy menstrual bleeding, or other pregnancy-related problems, surgery may be required. The two most commonly performed types of surgery are hysterectomy and myomectomy.
o If fibroids appear just before menopause, then medications or simple surgery can be used to shrink them, as they shrink naturally during menopause.
There are many treatment options available depending on the patient’s particular condition and age:
1.Hysterectomy
2.Myomectomy
3. hysteroscopic resection
4.Embolization
5.laparoscopic surgery
6.medication
Hysterectomy
Hysterectomy is a surgical procedure to remove the uterus, usually along with the cervix. This is the most common and permanent cure for fibroids. But a big drawback of this surgery is that a woman cannot get pregnant or have a baby after this surgery. This option is only considered if the fibroids are too large. Hysterectomy is done by making an incision in the abdomen. Sometimes the ovaries are also removed along with the uterus and cervix. The decision to remove the ovaries depends on how close the woman is to menopause or if the ovaries are diseased.
Vaginal hysterectomy or laparoscopic vaginal hysterectomy may be performed if the fibroids are smaller. The uterus can be removed through the vagina instead of the abdomen. The hospital stay for the hysterectomy is 2 to 5 days. The patient fully recovers after 6 weeks. For six weeks it is advisable to avoid driving, heavy lifting, sexual intercourse, and vigorous exercise. Complications after surgery can be infection, internal bleeding (hemorrhage) requiring a blood transfusion, or injury to other pelvic organs such as the bladder, bowel, or ureters.
Myomectomy
Myomectomy is a method of removing fibroids without removing the uterus. This surgery allows the woman to have children, but only 50% of women can have a successful pregnancy after a myomectomy. Myomectomy is performed through an incision in the abdomen with the help of a laparoscope or
hysteroscope.
Risks after surgery include:
o Severe bleeding may occur. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy.
o Scarring can occur covering the ovaries or blocking one or both fallopian tubes, preventing the tubes from collecting eggs after ovulation.
o Surgery weakens the walls of the uterus. For the delivery of a baby, the patient must go through a cesarean section as the contraction of labor could tear or break the wall.
o Infection
o Blood clots in the legs.
o Recurrence of fibroids
New types of surgeries are available for the removal of small fibroids. The benefits of these options are
These options do not require abdominal surgery.
oMay require an overnight hospital stay, but most of the time no stay is necessary.
o They are cheaper and the recovery is quick and less painful.
o They also show better aesthetic results since hardly any stitches are made.
o Patients fully recover in a week or up to two
Hysteroscopic resection
A thin telescope or hysteroscope is inserted through the cervix. Because it allows the surgeon to see inside the uterus, fibroids can be removed with a laser, an electric knife, or a wire. It does not require any incision.
The procedure is performed under general or local anesthesia.
Embolization
With this procedure, the fibroids are made to shrink as the blood supply is cut off. Using an X-ray image, a small catheter is inserted through a small incision in the groin into the main arteries that supply blood to the uterus. Small plastic particles are inserted through the catheter to block these blood vessels. Because the smaller arteries continue to be connected to the uterus, no damage occurs. All of this is done under local or general anesthesia. The procedure takes one hour and you need to lie on your back for 6-7 hours after surgery to stop bleeding from the incision. It would take a week to fully recover during which some patients have a fever.
Laparoscopic surgery
Under this form of surgery, a pencil-thin surgical telescope called a laparoscope is inserted through one or more tiny incisions in the abdomen to remove fibroids.
o Laparoscopic myomectomy is used for small, easy-to-reach fibroids and an incision is made in the uterus to remove them.
o Laparoscopic myolysis is a procedure used for larger or hard-to-reach fibroids. A laser or electric needle is used to destroy or shrink them.
Medicine
1. Certain medications called gonadotropin-releasing hormone agonists (GnRH agonists) can also be used to treat fibroids, as they indirectly block the production of estrogen that shrinks them. Once the size of the
fibroids are reduced to a third, it is easier to remove them by vaginal hysterectomy or laparoscopic surgery, instead of abdominal surgery which is more complicated. It can also be used for women near menopause, as fibroids naturally shrink after menopause. It is available as Lupron (leuprolide), Synarel (nafarelin), and Zoladex (goserelin).
The disadvantages and side effects of these drugs are: –
oIf these drugs are taken for more than 6 months, it causes bone loss leading to osteoporosis or joint pain.
o Once drug use is stopped, fibroids grow back.
oMost women stop having menstrual periods during the drug use period.
oThis drug has a menopausal-like effect, causing all the problems seen during menopause, such as hot flashes, vaginal dryness, irregular vaginal bleeding, mood swings, and low sex drive.
2. To reduce heavy bleeding due to fibroids, progestogens or androgens are also given as synthetic hormones. But fibroids don’t shrink. Sometimes the GnRH agonist is prescribed in combination with a low dose of estrogen or progestogen, which reduces the side effects of the GnRH agonists.