An open myomectomy (or abdominal myomectomy) involves making a cut on the skin of the abdomen to gain access to the uterus in order to remove the fibroids.
It is done when there are multiple fibroids, or if the fibroids are of large sizes and cannot be removed by other less invasive methods.
Before the surgery, some tests will be done to check your blood level, heart and kidney functions, blood group, and blood clotting function. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery. If your blood level is low, you will be placed some tablets or injections to raise the blood level, or to prevent you from having another period, so that your blood level doesn’t drop. Once everything is satisfactory, a date can be fixed.
For this Open Myomectomy surgery, you will have the choice of either being put to sleep (general anaesthesia), or being numbed from the waist down (spinal anaesthesia), as long as there are no other medical contraindications involved.
The cut on the skin is usually made on the lower abdomen; below the bikini line. The good thing about this is that the scar formed on this part of the skin is smaller and less obvious. However, a cut can also be made from the umbilicus down to the lower abdomen if the fibroids are very big or if the person already has a scar there from a previous surgery. The fibroids are then carefully separated from the uterus and removed, and the uterus is repaired before closing the skin back.
The procedure lasts for an average of two to three hours, and the challenges faced postoperatively include pain and abdominal discomfort. There is a higher risk for blood transfusion with an open myomectomy than with any other type of myomectomy. However, with a thorough preoperative assessment and some surgical techniques, this risk is greatly reduced.
If, during the surgery, there was a need to remove fibroids from the inside of the cavity itself, you might have something inserted into the uterus (either a Copper IUCD or a uterine balloon) to prevent scar tissue from forming inside the uterus. This will be removed at a clinic visit, a few weeks after the surgery.
You will be on admission for about four days, after which recuperation continues at home, and your next visit is scheduled for two to four weeks after discharge.
It takes about four to six weeks to recover fully and resume regular activities. If you intend to get pregnant, you will be asked to wait for about three months before you start trying again, in order to enable the uterus heal completely.