Uterine fibroid (myoma) is the commonest benign tumour of the uterus. It can be solitary or more commonly, multiple, and affects women of all ages. However, it is often associated with women who have not given birth.
Uterine fibroids are often symptomless, and are discovered on routine gynaecological examination.
Otherwise, presenting symptoms are heavy menstruation, painful menstruation, abdominal pain not associated with the period, distension of the abdomen, and less frequently, disturbance of urinary and bowel function.
Asymptomatic fibroids less than 4.0cm do not require surgery.
Symptomic fibroids require active management, irrespective of size. For example, a fibroid of 1.0cm in the uterine cavity causing heavy menstruation will need to be resected.
- Hysteroscopic Resection of fibroids in the uterine cavity.
- Myomectomy Removal of the fibroids with conservation of the uterus. This may be carried out via laparotomy (abdominal incision) or laparoscopic (key-hole surgery).
- Hysterectomy This surgery involves removal of the entire womb, and is usually indicated in the older women who have completed her family and the fibroids are multiple and large. The ovaries need not be removed at surgery. Again, the surgery can be carried out by laparatomy or laparoscopic.
Hysteroscopic procedures do not usually require admission, except when the submucous myoma is big, and bleeding excessive.
Laparoscopic myomectomy, in simple cases, may also be day surgical procedures or at most an overnight stay, while myomectomy, carried out by conventional surgery, requires at least 3 days hospitalisation.
Laparoscopic hysterectomy usually entails 2 nights of hospital stay, compared to 4-5 days, in the case of conventional laparatomy.
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