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MYOMECTOMY FOR FIBROIDS (PART 2)
The formation of adhesions — a risk of any abdominal surgery — must be avoided if possible because of the associated pain and interference with normal organ function. Tissues that were never meant to be joined can become attached to each other and problems like chronic pelvic pain and infertility may result. To minimise the chances of adhesions forming, tissues must be handled gently, appropriate irrigation solutions or an adhesion barrier used within the abdomen, and blood loss minimised. The extra cost to the patient of taking these precautions is less than $150, a small price to pay for the prevention of potentially serious problems. The use of laser techniques and diathermy also appears to reduce the risk of adhesion formation. Reconstruction of the uterus after removal of fibroids requires skill and care. Recent research suggests that when sutures are avoided during myomectomy, adhesions are less likely to develop. On the other hand, the absence of sutures may lead to weakness of the uterus.
An occasional serious complication of hysteroscopic myomectomy is perforation of the uterus. It may occur if the surgeon cuts deeply into the wall of the uterus to remove parts of an embedded fibroid. To minimise the risk of this happening, some doctors simultaneously perform a laparoscopy, a procedure in which a small incision in the abdomen is used as a porthole to enable visual inspection of the pelvic organs, including the outside wall of the uterus. Others think this is of doubtful value. Most women return home within one to three days of a hysteroscopic or laparoscopic myomectomy and it is usual for surgeons to check on each patient’s progress about six weeks later.
For open myomectomy, the pattern of post-operative illness and time to full recovery is similar to that for abdominal hysterectomy. That is, the average length of hospital stay is four to seven days, pain persists for several weeks and full recovery may take several months.
Women having a hysteroscopic or laparoscopic myomectomy experience less pain and a shorter convalescence (by about two to four weeks) than those having either open myomectomy or abdominal hysterectomy. The cost of these procedures in Australia is considerably less, in the short-term at least, than the cost of an open myomectomy (around $1500 for hysteroscopic myomectomy and $2200 for a laparoscopic myomectomy compared to $3825 for an open myomectomy). Because of the relatively recent introduction of hysteroscopic and laparoscopic techniques to perform myomectomy, it will be some time before we know the extent to which fibroid recurrence and complications alter these costings.
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