Myoma is the most common benign tumor of the female reproductive system. Myomas, which affect the majority of women of reproductive age, mostly manifest themselves in women with excessive menstrual bleeding, groin pain, pressure symptoms and negative effects on reproduction.
Open myoma surgery or myomectomy is the most commonly recommended surgical method for protecting the uterus and getting rid of myomas. When planning myoma surgery, the size and location of the myoma, the patient's age, clinical symptoms, the patient's desire to protect their fertility and the doctor's experience are important.
In this article, I will answer frequently asked questions such as "What is open myoma surgery and how is it performed? How does recovery occur after open myoma surgery? How long does the surgery take?"
Open myoma surgery is a surgery in which the abdominal layers are cut vertically in the midline of the abdomen or parallel to the groin and the abdominal cavity is entered. In these surgeries, the incision shape and size are decided according to the size of the myoma.
The decision-making process for open myomectomy depends on the correct use of imaging methods such as ultrasound and magnetic resonance (MR). If a mapping is performed and the location, number and position of the myoma to be removed are calculated, the maximum targeted number of myomas and success can be achieved in the surgery.
In recent years, the closed method has been preferred more for myomectomy. Because closed myomectomy surgery is much better for the patient's comfort. However, open myomectomy surgery is preferred instead of closed myomectomy surgery in some patients. If;
In open myomectomy surgery, the skin, subcutaneous tissues and membranes are cut in the incision made in the abdomen. The muscle layer surrounding the abdomen is separated from the midline. Finally, the inner abdominal membrane is cut and the abdominal cavity is entered.
In open myomectomy surgery, after entering the abdomen, the myoma mass is detected in the uterus and the sheath surrounding the myoma is cut using cautery. The myoma core is reached and the myoma is captured. The captured myoma is separated from the uterus. The dead space in the uterus where the myoma emerged is sutured with at least 2 or 3 layers of durable suture material and the wound opening is brought face to face.
Bleeding is controlled between the stitches with bipolar energy cautery. After the myoma is taken out of the abdomen and bleeding is controlled, anti-adhesion liquid and barrier agents are left in the abdomen. Then, the abdominal layers are closed in accordance with the anatomy and open myoma surgery is performed.
One of the most important points in open or closed myoma surgeries is how to control bleeding and what to do if bleeding is encountered. The experience of the team and the decisions they make in this regard are of great importance for the protection of the uterus.
The duration of open myoma surgery varies according to the size and number of myomas. The larger the myoma and the greater the number of myomas, the longer the surgery time. The location of the myoma also affects the surgery time.
The duration of myoma surgery also varies according to the surgical technique. The duration of closed surgery is slightly longer than the duration of open surgery. Of course, the surgeon's experience also affects the duration of surgery.
We complete open myoma surgeries in an average of 1 hour, and closed myoma surgeries in 1.5-2 hours. As I mentioned before, the duration of myoma surgery may be shorter or longer depending on the number and characteristics of the myoma.
More myomas can be removed in open myoma surgery compared to closed myoma surgery. The surgeon's ability to feel the myomas with his hand may allow him to remove more myomas. The recurrence period of myomas after surgery is longer in open surgeries compared to closed surgeries.
Open myoma surgery can be performed without the need for high-tech devices and advanced laparoscopy experience like closed surgeries. Therefore, it can be applied more widely.
Open myoma surgeries can be performed by numbing the waist without the need for general anesthesia. The patient does not experience nausea, vomiting, chills, shivering caused by general anesthesia, and throat pain due to the intubation tube.
Since open myomectomy surgery is performed through incisions in the abdomen, the recovery period is longer than closed surgery. The complaint of not being able to pass gas is more common. There is a possibility of infection and the wound not closing during the incision site healing.
The risk of incision site hernias is increased after open myomectomy surgery. The possibility of intra-abdominal adhesion after surgery is higher in open myomectomy surgery than in closed surgeries.
Since myomectomy surgeries are removed by cutting the uterine wall in all open or closed myomectomy surgeries, it is not desired for the patient to experience labor pain when pregnant. For this reason, a cesarean section is recommended for the patient after myomectomy surgery.
After open myomectomy surgery, it is recommended that the patient avoids heavy lifting for 2 months and avoids sexual intercourse until the pain and vaginal spotting subside.
The methods to be used for bleeding control in open myoma surgery are vasoconstrictor medical agents and constriction of vessels, temporary ligation of uterine arteries, tourniquet applications for uterine arteries, and interventional radiology and arterial embolization applications.
We do not prefer arterial embolization and permanent arterial ligation methods in women of reproductive age because they will disrupt the nutrition of the uterus and ovaries.
Bleeding may occur after open myoma surgery. The most common reason for this is that the uterus loses its ability to contract and takes a loose position. This is briefly called Uterine Atony. The loose structure of the uterus causes bleeding in the form of leakage between the stitches.
Silicone drains are placed in the abdominal cavity for early detection of bleeding after open myoma surgery. In the presence of bleeding, the blood in the abdomen is drawn out through these drains. Depending on the speed of bleeding, the use of medical agents, intravenous fresh blood supplementation, or repeat surgery may be on the agenda.
Since there will be a vertical or horizontal incision in the abdomen in open myomectomy, it takes time for this incision to heal and close. The stitches are closed in approximately 1 week to 10 days and the patient can return to daily life.
It is not recommended for a patient who has had open myomectomy to go into a bathtub or pool. A patient who has had open myomectomy can take a shower and wash 48 hours after the surgery. No loofah or soap is applied to the incision line.
A patient who has had open myomectomy may have difficulty passing gas due to the temporary cessation of bowel movements. In this case, the patient feels discomfort due to the bloating caused by the gas in the intestines. While the patient increases walking, agents that increase bowel movements and relieve spasms may be given. If the patient still cannot pass gas, an enema administered through the rectum will relieve the patient's discomfort.
The time for sexual intercourse after open myomectomy varies depending on bleeding and pain. If there is no bleeding or pain, sexual intercourse can be had 2 weeks after open myomectomy. If bleeding is prolonged, sexual intercourse should be postponed a little longer.
A patient who has undergone open myomectomy may have decreased mobility due to the pain caused by the incision after the surgery, bowel movements may be delayed, and they may use painkillers and antibiotics for a long time.
The most important cause of abdominal swelling after open myomectomy is the inability to release gas and abdominal tension. In open surgeries, the intestines lose their rhythmic movements for a while because they are directly exposed to room temperature and sometimes protrude outside the abdomen, and this causes symptoms of intestinal obstruction.
The day after open myomectomy, the blood and fluid in the abdomen are removed with silicone drains and the drain can be removed. The patient feels a brief momentary pain while the drain is being removed. The pain ends as soon as the drain is removed.
In a person who has undergone open myomectomy, the surgical incision may become infected and may not heal. If the incision site does not close, it may be necessary to clean and stitch the incision again after intravenous antibiotic treatment. The process of stitching the surgical incision again is called secondary suture.
