Complex Myomectomy Expert Care

Risk Factors

Risk factors for multiple or large fibroids:

• Family history of uterine fibroids
• High estrogen states including obesity
• African ethnic background
• Vitamin D deficiency
• Diet high in red meat and low in green vegetables

Who is at Risk

Women of reproductive age, particularly those of African descent, with a family history of fibroids, or those who have never been pregnant, are most commonly affected by multiple or large uterine fibroids.

Diagnosis

Diagnosis involves:

• Pelvic ultrasound for fibroid mapping
• 3D ultrasound or saline infusion sonography for cavity assessment
• MRI for large uterus with multiple fibroids
• Hysteroscopy for submucosal fibroid evaluation
• Complete blood count for anemia assessment

Treatment Options

Complex myomectomy can be performed laparoscopically or via open laparotomy. Intraoperative blood loss reduction with vasopressin, controlled hypotension, and tourniquet technique is essential. Cell saver technology and pre-operative GnRH agonist therapy reduce surgical risk.

The Procedure

Complex myomectomy involves:

• Pre-operative iron supplementation and GnRH agonist to shrink fibroids
• Laparoscopic or open surgical access to the uterus
• Vasopressin injection to minimize blood loss
• Systematic enucleation of all accessible fibroids
• Careful multilayer closure of uterine defects
• Morcellation within containment bag for specimen extraction if required
• Thorough hemostasis and post-operative monitoring

After the Surgery

Post-operative recovery includes:

• Hospital stay of 2 to 4 days
• Iron supplementation for anemia recovery
• Activity restriction for 4 to 6 weeks
• Pelvic ultrasound at 6 weeks to assess uterus
• Contraception advice for 6 to 12 months before attempting conception
• Follow-up for any recurrent fibroid symptoms

Possible Complications of Complex Myomectomy

Potential complications include:

• Significant intraoperative blood loss requiring transfusion
• Conversion to hysterectomy in uncontrolled bleeding
• Uterine adhesion formation affecting fertility
• Fibroid recurrence over time
• Wound infection or haematoma
• Risk of uterine rupture in future pregnancy