Prof Saim Yılmaz, MD
"In fibroids with a stalk, the ideal treatment method is myomectomy"
In myomectomy, each uterine fibroid is removed individually with a surgical operation. In this way, fibroids can be treated without removing the uterus, and fertility potential can be preserved, especially in young women. Myomectomy is usually performed as open surgery on the abdomen, but can also be performed laparoscopically or hysteroscopically (through the vagina). Myomectomy is the ideal treatment method for small fibroids protruding into the uterus and fibroids with stems attached to the outer surface of the uterus. However, in large, multiple fibroids especially in intramural fibroids, the operation becomes difficult, surgical risks increase, it may be necessary to remove the uterus during surgery, and the probability of recurrence of fibroids increases even if the surgery is successful.
Myomectomy is not an appropriate method, especially in patients with multiple uterine fibroids, because the operation takes longer, blood loss is greater, and pain and other complications are more common after surgery. The hospital stay after surgery may be even longer than a hysterectomy. In patients with multiple fibroids, it is often not possible to surgically remove all fibroids, and it is difficult to identify which fibroid is causing the patient's complaints. For this reason, in such patients, even if the myomectomy is performed successfully, approximately 60% of the patients have relapses and the surgery needs to be repeated. These patients have multiple myomectomies or eventually have the uterus completely removed (hysterectomy). However, in such patients, if fibroids are seen to be multiple on MRI, embolization can be applied from the very beginning and the fibroids can be permanently treated in a single session. We regret to say that we have seen many patients who underwent myomectomy many times (sometimes 6-7 times) for multiple fibroids, and the fibroids recur each time. However, we must emphasize that such patients are still suitable for embolization therapy no matter how many times they have undergone myomectomy, and that these patients can permanently get rid of the remaining fibroids in one session with embolization.
In conclusion, myomectomy is a good treatment method for small submucous fibroids and pedunculated subserous fibroids regardless of size and number. However, it should not be preferred in other types of fibroids, especially multiple intramural and sessile subserous fibroids and large submucous fibroids. Embolization is more appropriate in such fibroids. In order to understand which patient is suitable for myomectomy and which is suitable for embolization, MRI should be taken in all myoma patients for whom treatment is considered.
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