Myomectomy

WHAT YOU SHOULD KNOW:

• Myomectomy surgery removes one or more myomas from your uterus (womb). Myomas are also called fibroid tumors (growths of tissue and muscle) or leiomyomas. A woman's uterus is the organ where a fetus (unborn baby) grows during pregnancy. Myomas may cause more bleeding than usual during or between your monthly periods. Your periods also may last longer if you have myomas. If you bleed too much, you may get anemia (a condition where your blood does not have enough iron). Myomas can cause pain and pressure in your lower abdomen, and you may need to urinate more often. Myomas may make it harder to get pregnant or may cause problems during pregnancy. Myomas are usually benign, which means they do not have cancer in them.
  
  
• Myomas are removed using open or laparoscopic surgery. During an open myomectomy, your caregiver will make an incision (cut) into your abdomen to remove your myomas. If you are having laparoscopic surgery, your caregiver will remove the myomas through smaller cuts in your abdomen. After a myomectomy, you may bleed less during or between your periods. You may have less pain in your abdomen. It may be easier for you to get pregnant and to carry your baby full-term.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During surgery, your caregiver may switch to an open myomectomy if your myomas cannot be removed through smaller cuts. You may get an infection in your wound (surgery area). Your bowel, blood vessels, or uterus may be damaged. You may bleed too much and need a blood transfusion or a hysterectomy (surgery to remove your uterus). If you have a hysterectomy, you cannot get pregnant. After surgery, you may have trouble urinating or having a bowel movement (BM). You may get fibroids again. You may have scar tissue that causes pain or makes it harder for you to get pregnant. You may have heart problems and you may die.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without surgery, your myomas may grow bigger. Large myomas can cause pain and pressure in your abdomen and you may have trouble breathing. You may bleed too much from your vagina and get anemia. It may be harder to get pregnant. If you become pregnant, then you may have a miscarriage (lose your baby) or have your baby too early. Talk to your caregiver if you have questions or concerns about your myomectomy, myomas, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Pre-op care: You are taken to the surgery room and put on a table. Caregivers wash your abdomen and put sheets over you to keep the surgery area clean.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• Blood transfusion: You may need a blood transfusion if you have severe (very bad) anemia. You also may need a blood transfusion if you lose a large amount of blood during surgery. During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

• You may have an open or laparoscopic myomectomy. If you are having open myomectomy, your caregiver makes a cut across your abdomen below your belly button. Beneath this cut, your caregiver makes smaller cuts. Through the cuts, your caregiver uses tools to cut into your uterus and the muscles surrounding it. Medicine put on the myomas or nearby tissues may decrease bleeding. Your caregiver also may tie off the blood vessels near your myomas to help stop bleeding. Your caregiver cuts the myomas out of your uterus.
  
  
• With laparoscopic myomectomy, your caregiver makes smaller cuts on your abdomen. Your caregiver puts tools through these cuts to open your uterus and see the myomas. Your caregiver may put heat or medicine on your myomas to help decrease bleeding. Your caregiver cuts the myomas into smaller parts. The myomas are removed through one of the small cuts, or through a larger cut in your abdomen. After open or laparoscopic myomectomy, your caregiver will stitch the cuts closed. Bandages cover your wounds to keep them clean. The myomas may be sent to a lab to check for the cause of your fibroids.

After your surgery:

You are taken to a room to rest until you are awake. Do not try to get out of bed until your caregiver says it is okay. After your caregiver sees that you are okay, you may go home. If you are staying in the hospital, you will be taken to your room.

• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
    
    
  • Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
    
    
  • Iron: Your caregiver may give you iron pills if you have anemia.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Blood transfusion: You may need a blood transfusion if you have severe (very bad) anemia. You also may need a blood transfusion if you lose a large amount of blood during surgery. During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.