Uterine Fibroids and Hysterectomy - Other Procedures

Complications and Postoperative Factors. Any procedure for myomectomy is very complex. To reduce the risk for complication, patients should seek a surgeon experienced in myomectomies. Complications that occur during a myomectomy from any procedure include the following:

Excessive blood loss (higher incidence in laparotomy).
Uterine weakening and rupture during pregnancy. (This has been more of a concern with laparoscopy.)
Subsequent development of scar tissue (called adhesions). There is a higher incidence of adhesions in laparotomy. Lubricating gels (Intergel) or patches made of animal tissue sewn over the uterus are under investigation to reduce this risk. More studies are needed.
Infection.
Damage to the bowel or bladder (higher incidence in laparotomy).

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Pregnancies After Myomectomy. Studies are finding that pregnancy can be restored in more than half of women after the procedure. In appropriate candidates, there appear to be no differences in fertility rates and pregnancy complications between laparotomy or laparoscopy. The best candidates for retaining fertility include women with pedunculated and superficial serosal fibroids (stalk-like fibroids that grow out from the uterine surface). Women with deep intramural fibroids, for example, are at higher risk for infertility after myomectomy.

It should be noted that although studies indicate that between 40% and 58% of women become pregnant after myomectomy, only about a quarter of the women carry their babies to term. Women who become pregnant subsequently face a higher risk for cesarean section or miscarriage. It is still unresolved whether laparoscopic myomectomy weakens the uterine walls and poses a higher risk for rupture during pregnancy than laparotomy.

Recurrence of Fibroids and Recurrent Surgeries. The recurrence rate for fibroid growth after myomectomy is high. Between 11% and 26% of patients will have recurring fibroids that are severe enough to need additional treatment. One study suggested that women who had uteruses that were less than the equivalent size of 12 weeks of pregnancy and women who were overweight had a higher risk for needing repeat surgery.

Uterine Artery Embolization

Uterine Artery Embolization (UAE), also called uterine fibroid embolization, is a very promising nonsurgical therapy. It destroys fibroids by depriving them of their blood supply. It is less invasive than hysterectomy and myomectomy, and involves a shorter recovery time than the other procedures.

The procedure is typically performed in the following manner:

Specialists insert a catheter (a thin tube) into a uterine artery.
Small particles are injected at the point where the artery feeds the blood vessels leading to the uterine fibroid. They can be made of organic compounds (e.g., polyvinyl alcohol particles) or acrylic materials (e.g., Embosphere microspheres). The particles block the blood supply to the tiny arteries that feed abnormal fibroid cells and the tissue eventually dies. Circulation to normal uterine tissue, however, is usually restored.
Patients can expect to stay in the hospital overnight after UAE, but studies are underway to see if the procedure can be done on an outpatient basis.