Open myomectomy
Open
myomectomy, that is myomectomy through a laparotomy incision, is the traditional
technique for removing fibroids. This operation has a long history and remains
the only surgical option when the fibroids are numerous
and/or large, and there is a wish to preserve the uterus (e.g. for future child
bearing).
The incision used for open myomectomy depends on a number of factors, the chief of which is the size of the fibroids. It is often possible to use a horizontal "bikini-line" incision as long as the fibroids do not extend beyond the umbilicus (belly button), but a vertical incision usually has to be used if the womb is larger. If the fibroids are very large or you are anaemic (low in iron), we often use drug treatment for 3 months before surgery to reduce the bulk of the fibroids (to facilitate the procedure) and to correct the anaemia (as these drugs stop your periods). In addition, we regularly use "triple tourniquets" (vascular ties around the major blood vesels supplying the uterus) to reduce blood loss during surgery, and therefby reduce your chances of having to have a blood transusion.
Open myomectomy is major surgery and you will probably stay in hospital for 5 days or so. It will then take you a few weeks to get back to your normal activities.