Our Summary

Intraligamental myomas (IMs) are a type of uterine fibroid that grow from the wall of the uterus into the broad ligament, a piece of tissue connecting the uterus to the pelvis. They make up about 6%-10% of all uterine fibroids and often go unnoticed because they do not usually cause symptoms. However, when they become large, they can be difficult to remove due to their location and the risk of injuring nearby structures like the ureter and uterine artery.

In this study, researchers looked back at the medical records of 83 patients who had these fibroids removed at a hospital in Taiwan between 2007 and 2015. They divided the fibroids into three types based on their location: anterior (front), posterior (back), and lateral (side).

They found that the most common symptoms were frequent urination and a noticeable mass in the abdomen. The fibroids were most commonly on the side of the uterus, followed by the back, and then the front. The side fibroids were also the largest and heaviest, leading to more blood loss during surgery.

The only complication was one case of late bleeding after the operation in a patient with a side fibroid. All the removed fibroids were found to be benign (non-cancerous) when examined under a microscope. Following surgery, three patients were able to conceive naturally and had successful pregnancies and deliveries by cesarean section.

The researchers concluded that removing these fibroids can be challenging and that surgeons need to consider the fibroid’s location, size, and shape when planning surgery. They also found that all types of fibroids had similar symptoms, but that the most blood loss occurred when removing side fibroids.

FAQs

  1. What are intraligamental myomas (IMs) and how common are they?
  2. What were the most common symptoms and locations of intraligamental myomas found in the study?
  3. What considerations need to be taken into account when planning surgery for intraligamental myomas?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy for intraligamental myomas is to discuss the risks and benefits of surgery, including the potential for blood loss, injury to nearby structures, and the possibility of successful pregnancy after the procedure. It is important for the patient to have a thorough understanding of their specific case and to work closely with their healthcare team to ensure the best possible outcome.

Suitable For

Patients who are typically recommended myomectomy for intraligamental myomas include those experiencing symptoms such as frequent urination and a noticeable mass in the abdomen. Additionally, patients with large fibroids that are difficult to remove due to their location and the risk of injuring nearby structures may benefit from myomectomy. It is important for surgeons to consider the fibroid’s location, size, and shape when planning surgery for these patients.

Timeline

  • Before myomectomy:
  1. Patient may experience symptoms such as frequent urination and a noticeable mass in the abdomen.
  2. Fibroids are diagnosed through imaging tests like ultrasound or MRI.
  3. Surgeons plan the surgery based on the location, size, and shape of the fibroids.
  • During myomectomy:
  1. Surgery is performed to remove the fibroids, either through traditional open surgery or minimally invasive techniques like laparoscopy or hysteroscopy.
  2. The type of surgery and approach used depend on the size and location of the fibroids.
  • After myomectomy:
  1. Patients may experience some pain and discomfort after surgery, which can be managed with pain medications.
  2. Recovery time varies depending on the type of surgery performed, but most patients can return to normal activities within a few weeks.
  3. Follow-up appointments are scheduled to monitor recovery and address any complications that may arise.
  4. In some cases, patients may be able to conceive naturally and have successful pregnancies after myomectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy for intraligamental myomas include:

  1. What are the risks and benefits of removing intraligamental myomas compared to leaving them untreated?
  2. How will the location, size, and shape of my fibroids affect the surgical procedure and potential complications?
  3. What are the possible long-term effects of having intraligamental myomas removed, such as impact on fertility or future pregnancies?
  4. What is the expected recovery time and post-operative care after a myomectomy for intraligamental myomas?
  5. Are there any alternative treatment options for intraligamental myomas that should be considered before undergoing surgery?
  6. How often will I need follow-up appointments or monitoring after the myomectomy procedure?
  7. Are there any lifestyle changes or precautions I should take to prevent recurrence of intraligamental myomas in the future?
  8. Will the removal of intraligamental myomas affect my overall hormonal balance or menstrual cycle?
  9. What is the experience and success rate of the surgical team in performing myomectomies for intraligamental myomas?
  10. Are there any specific pre-operative tests or preparations I should undergo before the myomectomy procedure?

Reference

Authors: Huang PS, Sheu BC, Huang SC, Chang WC. Journal: J Minim Invasive Gynecol. 2016 Sep-Oct;23(6):954-61. doi: 10.1016/j.jmig.2016.06.007. Epub 2016 Jun 18. PMID: 27327965