Our Summary

This research paper discusses a study carried out in a teaching hospital between May 2009 and June 2014. The study focused on women aged between 18 and 45 who had undergone a specific type of surgery called laparotomic myomectomy, which is often performed to remove large or multiple fibroids in women who still want to have children. The study aimed to understand the rate at which uterine adhesions, which are scar tissues that can cause complications, occur after this surgery.

The study involved 98 women who had the surgery and were later examined using a procedure called hysteroscopy. The researchers found that about a quarter of these women developed uterine adhesions after the surgery. Almost half of these adhesions were complex, meaning they were particularly problematic. The researchers found that opening the uterine cavity during the surgery significantly increased the risk of these complex adhesions. The study suggests that an office hysteroscopy can be performed after the surgery to detect such cases.

FAQs

  1. What is laparotomic myomectomy and who typically undergoes this surgery?
  2. What was the main finding of the study regarding the risk of uterine adhesions after laparotomic myomectomy?
  3. Why is an office hysteroscopy suggested after the surgery and what does it help detect?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the risk of developing uterine adhesions after the surgery. It is important for patients to be aware of this potential complication and to follow up with their doctor for regular check-ups to monitor for any signs of adhesions forming. Additionally, discussing the option of an office hysteroscopy post-surgery to detect any adhesions early on can be beneficial in preventing complications. It is important for patients to have open communication with their healthcare provider and to ask any questions or concerns they may have about the surgery and potential complications.

Suitable For

Patients who are typically recommended myomectomy are women who have symptomatic fibroids that are causing significant discomfort or interfering with their quality of life. Myomectomy may be recommended for women who still want to have children, as it is a fertility-preserving surgery that can improve their chances of conceiving and carrying a pregnancy to term. Additionally, myomectomy may be recommended for women who have fibroids that are causing heavy menstrual bleeding, pelvic pain, or pressure on other organs.

In the study mentioned above, laparotomic myomectomy was performed on women with large or multiple fibroids who wanted to preserve their fertility. These patients were at a higher risk of developing uterine adhesions after the surgery, particularly if the uterine cavity was opened during the procedure. Therefore, patients who are considering myomectomy should discuss the potential risks and benefits with their healthcare provider to determine if it is the best option for their individual situation.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of fibroids such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient consults with a gynecologist who recommends a myomectomy to remove the fibroids.
  3. Patient undergoes pre-operative tests and evaluations to assess their overall health and suitability for surgery.
  4. Surgery date is scheduled and patient is advised on pre-operative instructions such as fasting and medication management.

After myomectomy:

  1. Patient undergoes laparotomic myomectomy surgery to remove the fibroids.
  2. Patient is closely monitored in the hospital post-surgery for any complications or adverse reactions.
  3. Patient is discharged from the hospital with instructions on post-operative care, including pain management and wound care.
  4. Patient follows up with their gynecologist for post-operative appointments to monitor healing and recovery.
  5. Patient may experience temporary side effects such as pain, bloating, and fatigue.
  6. Patient may undergo a hysteroscopy to check for uterine adhesions, which can occur after myomectomy.
  7. Patient continues to follow up with their gynecologist for long-term monitoring and management of any potential complications or recurring fibroids.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with myomectomy surgery, including the development of uterine adhesions?
  2. How common are uterine adhesions after myomectomy, and what factors might increase my risk of developing them?
  3. How will uterine adhesions be diagnosed and treated if they occur after myomectomy?
  4. What are the symptoms of uterine adhesions, and when should I seek medical attention if I experience them?
  5. Are there any preventive measures or steps I can take to reduce my risk of developing uterine adhesions after myomectomy?
  6. What follow-up appointments or tests will be necessary to monitor for the development of uterine adhesions post-surgery?
  7. Are there any alternative treatments or surgical techniques that may lower the risk of uterine adhesions during myomectomy?
  8. How will uterine adhesions affect my fertility or future pregnancy plans, and what steps can be taken to address any potential issues?
  9. Can you provide more information about the study mentioned in this research paper and how its findings may impact my own myomectomy surgery?

Reference

Authors: Capmas P, Pourcelot AG, Fernandez H. Journal: Reprod Biomed Online. 2018 Apr;36(4):450-454. doi: 10.1016/j.rbmo.2018.01.010. Epub 2018 Feb 2. PMID: 29454580