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Myomectomy
Myomectomy Risks and complications

Myomectomy Risks and Complications

Myomectomy refers to the surgical removal of uterine fibroids. Like all surgical procedures, it comes with risks and complications. While it is important to understand the risks before undergoing surgery, many of these are unlikely to happen when the procedure is performed minimally invasively by a highly skilled GYN surgeon. 

Risks for the myomectomy procedure include excessive blood loss, problems with maintaining fertility and the development of adhesions and scar tissue. Many of these risks can be mitigated with the CIGC-exclusive Laparoscopic Assisted Abdominal Myomectomy (LAAM) procedure. LAAM has a much lower rate1 of complications both during and after surgery compared to an open myomectomy, standard laparoscopic myomectomy and robotic myomectomy. This is due to the surgeon’s ability to control blood loss and remove uterine fibroids through tiny incisions that heal quickly after surgery. LAAM also has the lowest probability1 of the surgeon needing to convert to an open procedure, meaning the risks and complications associated with a larger incision and longer recovery time are much more unlikely to occur.

After undergoing a myomectomy, you may experience changes in your body as the uterus heals. Understanding postoperative risks can help you know what to look for and ease your mind as you recover.

Common Risks and Complications

Potential risks and complications after undergoing a myomectomy include:

  • Excessive blood loss: While blood loss is typically well controlled during a myomectomy, it’s important to pay attention to bleeding after the procedure. Patients that undergo fibroid removal surgery have the potential to bleed from the uterine incisions after the procedure. This may lead to blood loss that can cause lightheadedness, dizziness, nausea, and generalized malaise. Always contact your physician if you experience these symptoms following myomectomy, as you may need to be seen at a local hospital for evaluation. CIGC travel patients must stay within a certain distance from the surgery center so that CIGC surgeons can admit you to a hospital for which they have privileges to continue any necessary care. For most patients, all that is needed is a hospital evaluation, sometimes with a blood transfusion necessary. Always be sure to contact the physician on call before going to the hospital, so that appropriate instructions can be given. 
  • Infertility: The risk of infertility is inherent to any myomectomy procedure performed using any technique and is dependent on the size, location and number of fibroids removed. The goal of a myomectomy is often to preserve fertility, but the ability to carry a pregnancy to term is never guaranteed after surgery. In some cases, the uterus may be too damaged due to fibroid growth to proceed with fertility goals.
  • Tubal scarring: This can happen with fibroids that directly involve the fallopian tubes. Even when they are successfully removed, large fibroids can damage the fallopian tubes,2 causing them to heal abnormally. Abnormal healing can also result in tubal and uterine wall defects if many fibroids needed to be removed.
  • Adhesions: One of the longer-term complications after a myomectomy is the development of pelvic adhesions, which are thick bands of scar tissue. Adhesions can cause pain and problems with fertility over time. The risk of adhesions is higher with the larger incision used in an open myomectomy and if the surgeon performing the myomectomy is not a highly skilled expert in GYN surgeries.3
  • Pregnancy or childbirth complications: These can include uterine rupture, abnormal placental development and intrauterine growth problems. Many patients who become pregnant will need to undergo a cesarean section for delivery due to weakening of the uterine muscle after removal of fibroids. While these kinds of complications are rare, it’s important to be closely monitored by your doctor throughout your pregnancy to catch any potential problems early.
  • Infection: In rare cases, some patients may develop an infection at the incision sites. When caught early, infections are easily treated with antibiotics.
  • Hysterectomy: If bleeding is uncontrollable or other life-threatening abnormalities are found, a hysterectomy may be necessary. This is very rare with the LAAM approach to myomectomy. 
  • Spreading of cancerous tumors: This is an extremely rare complication but, in some cases, cancerous tumors may be present in the uterus at the time of fibroid removal. When these tumors are broken into small pieces to be removed, a process known as morcellation, cancerous cells can spread throughout the pelvic cavity. CIGC surgeons do not perform morcellation with a power morcellator during any LAAM procedure. 

Factors That Increase Risks and Complications

There are certain factors that may increase the probability of experiencing risks and complications after gynecological surgery. These factors include having a medical comorbidity such as coronary artery disease and having a marker of frailty such as unintentional weight loss.

How to Prevent Risks and Complications

Your doctor may recommend a few ways to minimize the potential for risks and complications. Some of these treatments may include:

  • Pre-surgery anemia treatment: Because uterine fibroids often cause heavy bleeding, they can also lead to anemia. Your doctor may recommend a blood transfusion before surgery to ensure you have enough healthy red blood cells circulating in your body to protect against blood loss.
  • Iron supplements: For patients who have a diminished red blood cell count that has not progressed all the way to anemia, iron supplements may help to replenish the blood before surgery. Iron is necessary to make new red blood cells.
  • Hormone treatment: In order to decrease heavy bleeding before surgery, your doctor may prescribe birth control or another medication to temporarily stop your menstrual cycle. If you tend to lose a lot of blood during periods, this can be a good way to prevent extreme blood loss leading up to surgery.
  • A highly skilled surgeon: Nothing is going to help prevent risks and complications as much as a highly skilled surgeon. CIGC’s myomectomy specialists have perfected the LAAM technique to minimize complications both during and after surgery. 

How to Treat and Manage Risks and Complications

If you do experience one of the rare complications after a myomectomy, there are ways to treat and manage it, including:

  • Antibiotics: If you develop an infection, your doctor can prescribe an antibiotic to treat it. In most cases, infections will resolve within a week with antibiotic treatment.
  • Blood transfusion: If you experience excessive blood loss during surgery, you may need a blood transfusion to replenish your body with healthy red blood cells.
  • Resection of pelvic adhesions: If you develop adhesions after surgery, they can be surgically resected or removed in a minimally invasive procedure.
  • Fertility treatments: Even after a successful myomectomy, infertility may still be an issue. Treatments like in vitro fertilization (IVF) can help move your fertility goals forward.

When to Call a Doctor

Serious postoperative surgical complications are unlikely, but if you experience any of the following symptoms after undergoing a myomectomy, you should call your doctor:

  • Heavy bleeding
  • Fever
  • Severe pain
  • Trouble breathing

The CIGC Difference

LAAM is a safe myomectomy procedure with a low rate of complications both during and after the operation. Even more importantly, every myomectomy is performed by an advanced GYN specialist, meaning your surgery is in the best possible hands.

If you are considering a minimally invasive myomectomy for relief from uterine fibroids, our specialists are ready to evaluate your symptoms and condition and recommend the solution that puts you on the path toward relief.

References:

    1. MacKoul P, Baxi R, Danilyants N, van der Does LQ, Haworth LR, Kazi N. Laparoscopic-Assisted Myomectomy with Bilateral Uterine Artery Occlusion/Ligation. J Minim Invasive Gynecol. 2019;26(5):856-864. doi:10.1016/j.jmig.2018.08.016
    2. Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39(4):521-533. doi:10.1016/j.ogc.2012.09.005
    3. Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. Biomed Res Int. 2018;2018:8250952. Published 2018 Mar 5. doi:10.1155/2018/8250952
    4. Erekson EA, Yip SO, Ciarleglio MM, Fried TR. Postoperative complications after gynecologic surgery. Obstet Gynecol. 2011;118(4):785-793. doi:10.1097/AOG.0b013e31822dac5d