Fibroid surgery refers to the surgical procedure to remove fibroids from the uterus. Fibroids (also known as uterine fibroids) are benign tumors consisting of muscle and connective tissue. These growths are hormone-dependent and often grow under the influence of estrogen. While many fibroids cause no symptoms, in some cases they can trigger severe symptoms such as pain, heavy bleeding or pressure on neighboring organs. In such cases, surgery may be necessary. Fibroids are usually discovered by chance when new ones develop over time or symptoms arise.
Surgical removal of a fibroid: a precise surgical technique to preserve the uterus and relieve fibroid-related symptoms
Depending on their location, fibroids may lie within the uterine wall, protrude into the uterine cavity or grow on the outside of the uterus. Fibroid surgery is usually recommended if:
- Heavy bleeding occurs, leading to anemia.
- There is pain or a feeling of pressure in the lower abdomen.
- The desire to have children is affected, as fibroids can interfere with fertility.
- Fibroids grow so large that they press on surrounding organs such as the bladder or bowel.
- Other treatment options, such as medication or drug therapy, as well as minimally invasive procedures, do not bring about any improvement.
In some cases, fibroids during pregnancy may also require surgical treatment if they cause severe symptoms or interfere with the baby’s development. It is important to assess on an individual basis whether surgery is necessary. The best treatment strategy can be determined in consultation with a specialist in gynecology or obstetrics.
There are various procedures for the surgical removal of fibroids, depending on their size, location and number. These include intramural fibroids, which lie within the muscular wall of the uterus; submucosal fibroids, which grow toward the uterine cavity; and pedunculated fibroids, which are attached to the uterus by a stalk of tissue. The most common methods are:
- Myomectomy: In this procedure, the fibroids are removed without removing the uterus itself. This is a preferred option, particularly for women who wish to have children. There are various approaches, including laparoscopic myomectomy (keyhole surgery), hysteroscopic myomectomy (through the vagina) or an abdominal incision (laparotomy). The choice of approach depends on the location and size of the fibroids, as well as their number and size. In many cases, the aim of myomectomy is to preserve the uterus.
- Hysterectomy: This involves removing the entire uterus. This method is used when there are many or very large fibroids and other treatment options are not feasible. A hysterectomy is a permanent solution, as no further fibroids can develop after the procedure. It is primarily recommended when surgical removal of tissue is necessary and other procedures are no longer sufficient. However, pregnancy is no longer possible after a hysterectomy.
- Minimally invasive procedures: These include uterine artery embolisation and focused ultrasound. In embolisation, the blood vessels supplying the fibroids are blocked, causing the growths to shrink. Focused ultrasound uses heat to destroy the fibroids.
The procedure for a fibroid operation depends on the chosen method. As a rule, myomectomy is performed either under general anesthesia or regional anesthesia. In a laparoscopic myomectomy, a form of keyhole surgery, several small incisions are made in the abdomen through which an endoscope and surgical instruments are inserted; in suitable cases, the procedure can also be performed on an outpatient basis. The fibroids are removed through these incisions, and the uterus is preserved.
Hysteroscopic myomectomy is performed via the vagina as a hysteroscopy, without any external incisions. In this procedure, a special instrument (hysteroscope) is inserted through the vagina and the cervix into the uterus to remove the fibroids.
A hysterectomy involves either an incision in the abdomen or laparoscopic removal of the uterus. This procedure usually takes longer and involves a longer recovery time.
Aftercare following fibroid surgery depends on the type of procedure. After a laparoscopic or hysteroscopic myomectomy, most women can go home after a few days. The healing process usually takes several weeks. Patients should bear the following in mind:
- Avoid physical exertion and lifting heavy loads in the first few weeks after the operation.
- Be alert to possible complications such as fever, severe pain or unusual bleeding, and consult a doctor if in doubt.
- Regular follow-up appointments are important to monitor the healing process and ensure that no new fibroids develop.
With a hysterectomy, the recovery time is longer, and it can take several weeks for the patient to be fully fit again. Here too, taking it easy is crucial.
As with any surgical procedure, there are certain risks associated with fibroid surgery. Possible complications include:
- Infections
- Bleeding
- Injury to neighboring organs such as the bladder or bowel
- Scarring in the uterus, which in rare cases can affect fertility
Despite these risks, fibroid surgery is a widely used and generally safe method for treating fibroids. Most women experience a significant improvement in their symptoms after the operation. Bleeding decreases, pain subsides, and pressure on the surrounding organs is reduced.
The prognosis following surgery depends on various factors, such as the number of fibroids and the type of procedure. After a myomectomy, there is a possibility that new fibroids may grow, particularly in younger women. Furthermore, fibroids may develop again over the years, especially if hormonal influences persist. However, a complete cure is achieved in most cases, and many women are able to lead a symptom-free life after the operation.
Fibroid surgery offers women with symptomatic fibroids an effective way to relieve their symptoms and improve their quality of life. Whether surgery is necessary and which method is chosen depends on individual circumstances. It is important to seek detailed advice from a specialist gynecologist. Modern surgical techniques often allow for a quick recovery and minimally invasive treatments that are gentle on the body.
For patients wishing to have children, myomectomy is a good option in most cases, while hysterectomy provides a permanent solution if pregnancy is no longer planned. Speak to your doctor to find the best treatment option for you and to relieve your symptoms.
1. What happens during laparoscopic fibroid surgery?
In laparoscopic surgery, fibroids are removed through small incisions in the abdomen without opening the uterus. The method is particularly gentle and is suitable for many fibroids.
2. When is an abdominal incision necessary?
An abdominal incision is mainly used when there are many or very large fibroids, or when the size, location and number of fibroids do not allow for a minimally invasive technique.
3. Can fibroids cause symptoms?
Yes, existing fibroids can cause symptoms such as bleeding, a feeling of pressure, or problems with neighboring organs such as the bladder or bowel.
4. Is the uterus preserved during fibroid surgery?
In many cases, the uterus can be preserved, for example during a myomectomy or hysteroscopic removal. Only if there are large or numerous fibroids may it be necessary to remove the uterus.
