What Is Open Myomectomy? Surgical Removal of Uterine Fibroids via Open Surgery

The uterus is a vital organ at the center of women’s health where pregnancy develops. However, in some women, masses called fibroids (benign tumors arising from the uterine muscle layer) may occur within this tissue. Fibroids often cause no symptoms; however, if they lead to complaints such as heavy menstrual bleeding, anemia, abdominal pain, bloating, and fertility problems, surgical treatment may be required.

At this point, open myomectomy (removal of fibroids via laparotomy) comes into play. This surgery is a safe and effective method that aims to remove only the fibroids while preserving the uterus. It is especially preferred in patients with large or numerous fibroids.

What Is Myomectomy? (Surgical Removal of Fibroids from the Uterus)

Myomectomy is the procedure of removing fibroids from the uterus. “Open myomectomy” refers to performing this procedure through an incision made in the abdomen (usually along the bikini line).
With this method, the surgeon reaches the uterine tissue directly, carefully removes the fibroids, reconstructs the uterus, and preserves the patient’s fertility potential.

In summary:
• Purpose: Remove only the fibroids while preserving the uterus
• Method: Open surgery through an abdominal incision
• Advantage: More effective results in large or multiple fibroids

Who Is Open Myomectomy Suitable For?

According to statistics, 1 in 4 women has fibroids, and not every fibroid requires surgery. However, in some situations, surgery becomes inevitable.

Open myomectomy is generally recommended for the following patients:

1. Those with fibroids larger than5 cm or deeply embedded in the uterine wall
2. Those withmultiple fibroids
3. Those whoplan pregnancy but cannot conceive due to fibroids
4. Patientsnot suitable for laparoscopic surgery
5. Those experiencingheavy menstrual bleeding (menorrhagia) and anemia

The most important goal in this method is both to preserve the uterus and to maintain the woman’s chance of having children in the future.

Preoperative Preparation

A detailed evaluation is performed before surgery.
• Ultrasound or MRI is used to determine the number, location, and size of the fibroids.
• Blood tests are performed to assess the risk of anemia or infection.
• The patient is informed in detail about the surgical process and the postoperative period.

In some cases, hormone therapy (GnRH analogs) may be used preoperatively to shrink the fibroids. This can facilitate the operation and reduce blood loss.

How Is Open Myomectomy Performed?

The surgery is performed under general anesthesia.
The surgeon typically makes an incision of approximately 10–15 cm in the lower abdomen (at the level of the bikini line).

The steps are as follows:

1. Access to the uterus:The abdominal wall and peritoneum are opened to expose the uterus.
2. Removal of fibroids:The fibroids are removed one by one; special medications are used to reduce bleeding during this step.
3. Repair of uterine tissue:The areas where the fibroids were removed are meticulously sutured, and the uterus is restored to its integrity.
4. Closure:The layers are closed in sequence, completing the operation.

The duration of the operation varies between 1–2 hours, depending on the number and size of the fibroids.

Postoperative Course and Recovery

The recovery period after open myomectomy is somewhat longer than with minimally invasive (laparoscopic) methods. However, with proper care, patients can generally return to daily life in a short time.

Regarding the recovery process:
• Hospital stay: 1–3 days
• Full recovery: 4–6 weeks
• First menstruation: Usually occurs 4–8 weeks later

Points to consider:

• Avoid heavy lifting and sudden movements for the first 4 weeks.
• Keep the incision area clean and monitor for signs of infection.
• Do not resume sexual intercourse without medical clearance (generally after 6 weeks).
• A diet rich in iron and protein is recommended.

Advantages of Open Myomectomy

• The uterus is preserved:Fertility potential continues.
  • Direct access to all fibroids is possible.
  • It is the most effective method in large and multiple fibroids.
  • It is a safe surgical option due to the low risk of malignancy.

Disadvantages and Possible Risks

As with any surgical procedure, open myomectomy has certain risks:
• Risk of bleeding: Higher in large fibroids.
• Adhesions (intra-abdominal adhesions): Tissue adhesions may occur postoperatively.
• Infection: Rare; controlled with antibiotic therapy.
• Cesarean requirement: In some patients, cesarean delivery may be preferred in future pregnancies.

When performed by an experienced gynecologic surgeon, the complication rate is quite low.

Pregnancy After Open Myomectomy

Open myomectomy is a safe option for women who wish to preserve their fertility.
Pregnancy can be planned after the uterus has completely healed (generally 6 months after surgery).

Becoming pregnant before the recommended interval may lead to pregnancy when the uterine wall has not yet regained sufficient strength; this can increase risks such as uterine rupture. Therefore, the post-myomectomy pregnancy plan must be made under medical supervision.

Alternative Surgical Methods

Depending on the size and location of the fibroid and the patient’s desire for fertility, different methods can be applied:
• Laparoscopic Myomectomy: Minimally invasive surgery performed with small incisions using a camera.
• Hysteroscopic Myomectomy: Fibroids located on the inner uterine wall are removed via the vaginal route.
• Hysterectomy: Complete removal of the uterus (preferred in patients who do not desire fertility and have large fibroids).

The most appropriate method for each patient is decided jointly by the physician and the patient.

Follow-Up After Open Myomectomy

In the first year after surgery, patients should attend regular gynecologic check-ups.
The probability of fibroid recurrence is 10–20%. Therefore:
• Annual ultrasound examinations are important.
• One should avoid factors such as excessive stress, hormonal imbalance, and obesity.
• Regular exercise and a balanced diet help maintain hormonal balance.

Frequently Asked Questions (FAQ)

1. When can I return to work after open myomectomy?
   It is generally possible to return to light-duty work after4–6 weeks. However, for physically demanding jobs, medical clearance should be awaited.
2. Do fibroids recur after surgery?
   Especially in those with a genetic predisposition or ongoing hormonal imbalance, fibroids may redevelop. Therefore, regular follow-up is important.
3. Will my menstrual pattern change after open myomectomy?
   Menstrual delays or irregularities may occur in the first few months; however, as the uterus heals, the cycle returns to normal. Most patients experience less painful and better-controlled periods.
4. Is open myomectomy or the minimally invasive method better?
   This depends entirely on the size and number of fibroids and the patient’s fertility goals. In large fibroids, the open method may be preferred.
5. When can sexual intercourse be resumed after surgery?
   Generally after6 weeks, once the uterus and incision tissue have completely healed.