Fibroid Surgery

Fibroids are a benign tumor of the uterus. They may exist singly or they may be in multiples and they can be present in different layers/sites of the uterus. Fibroids may or may not be symptomatic.

Their cause is largely unknown; however statistically there are certain common factors that are seen in women with fibroids, which mean that these women have a predisposition towards fibroids.

The definitive treatment for fibroids is surgery, although there are some treatment options for women reluctant to undergo fibroid surgery for one reason or the other.  Surgery is recommended for women with heavy bleeding per vagina leading to Anemia, intractable pain, menstrual irregularities, and/or difficulty in conceiving.

There are two options for fibroid surgery. They are Hysterectomy which is removal of the uterus in total or Myomectomy which means removal of the fibroid(s) only, preserving the uterus.

Myomectomy is an option offered to or preferred by those women who are in the child -bearing period, or those women who have not completed their family and are desirous of having more children.

Hysterectomy on the other hand is the more commonly performed operation for fibroids. It is done on women who have deep seated tumors, multiple tumors, tumors which are difficult to remove from the uterus and for those women who have crossed the child bearing age or have completed their family.
Surgery is usually performed under General Anesthesia but may be done under Spinal anesthesia as well.

The various types of surgical procedures being done are:

-Abdominal Hysterectomy
-Laparoscopic Hysterectomy
-Vaginal Hysterectomy
-Abdominal Myomectomy
-Laparoscopic Myomectomy
-Hysteroscopic Myomectomy
-Uterine artery occlusion
-Endometrial ablation

Hysterectomy and myomectomy both are major surgeries with their concomitant risks and complications. After myomectomy there is a chance that the fibroids may reoccur. Prior to surgery, the patient needs to undergo certain tests which include blood tests and an EKG (especially in older patients).

As with any other major surgery the risks in case of fibroid surgery are,
 
- Bleeding
Quite a few women undergo fibroid surgery as they have excessive vaginal bleeding leading to Anemia and are therefore anemic before surgery. In such cases their Hemoglobin level needs to be corrected before surgery and adequate arrangements for blood transfusions should be ready before starting the operation.

- Infection
Strict precaution should be undertaken to ensure that the instruments, etc. used are well and thoroughly sterilized. This will minimize chances of infection. Also a good antibiotic cover should be given pre as well as post-operatively.

- Pain
There are several medicines which give good protection from pain; however some degree of pain postoperatively is almost inevitable.

- Injury to surrounding structures.
The surgeon has to be very careful that surrounding structures are not damaged. The bladder is catheterized prior to starting surgery to keep it empty and the intestines are packed away with sterile surgical towels to keep them away from the site of fibroid surgery.

- Thromboembolism, which means traveling of a blood clot and its getting lodged in some major blood vessel.

In addition the cost factors for fibroid surgery need to be considered.

So although surgery remains a popular method for its treatment, with the new developments more and morepeople are looking for alternatives. They are searching for other methods to avoid the risks and costs involved in surgical treatment.