Definition of myomectomy :

Myomectomy : Myomectomy is the enucleation of myomata from the uterus leaving behind a potentially functioning organ capable of future reproduction.

Indications of myomectomy:

1. Persistent uterine bleeding despite medical therapy.
2. Excessive pain or pressure symptoms.
3. Size >2 weeks, woman desirous to have a baby
4. Unexplained infertility with distortion of the uterine cavity.
5. Recurrent pregnancy wastage due to fibroid.
6. Rapidly growing myoma during follow-up.
7. Subserous pedunculated fibroid.

Counseling of a patient before myomectomy :

1. About the disease & its fate
2. Proposed treatment : Myomectomy
3. Available treatment options.
4. Complications if not treated
5. Complications of the treatment :

• Risk of recurrence & persistence of fibroid is about 30-50%
• Risk of persistence of menorrhagia is about 1-5%
• Risk of relaparotomy is about 20-25%

  6. Prognosis of the treatment : 

• Pregnancy rate following myomectomy is about 40-60%.
• Pregnancy following myomectomy should have a mandatory hospital delivery, although the chance of scar rupture is rare (little more when the cavity is open).

 7. Post-operative follow-up.

8. Informed written consent.

Prerequisites that should be fulfilled before myomectomy :

1. Hysteroscopy or hysterosalpingography : To exclude any submucous fibroid or a polyp or any tubal block.
2. Hysteroscopy endometrial biopsy : In cases of irregular cycles, not only to remove a polyp but also to exclude endometrial carcinoma.
3. Examination of the husband from fertility point of view (semen analysis).

Complications of myomectomy :

Immediate : 

1. Haemorrhage.
2. Injury to the bladder and the ureter when dealing with cervical or broad ligament fibroids.
3. Injury to the fallopian tubes-interstitial portion is commonly damaged during incision & suturing.
4. Injury to bowel.
5. Febrile morbidity due to tissue reaction or infection.

Remote : 

1. Abdominal distension scar.
2. Adhesion of the small bowel to the scar.
3. Persistent menorrhagia because menorrhagia may be due to causes other than the fibroid or Ix an intra-uterine polyp or leiomyoma was overlooked at operation.
4.  Recurrence of fibroid.
5. Risk of re-laparotomy
6. Endometriosis
7. Rupture of the scar in subsequent pregnancy.