Continuing our discussion about resection of submucous fibroids.
One of the determinants of success of this procedure depends and size of the amount of fibroid in the cavity of in relation to the muscle of the womb.
A simple classification used is:
Type 0= where all the fibroid is in the cavity of the womb
Type I = where most of the cavity is within the cavity of the womb and some within the muscle
Type II = where most of the fibroid is within the muscle of the womb and a little projecting into the cavity.
(Type 0 fibroids are generally easier to remove than type II)
Other factors that determine success are:
1. The size of the fibroids and uterus and
2. The number of fibroids.
In a recent scientific study women with a normal sized womb and no more than 2 fibroids were projected to need additional surgery less than 10% of the time within 5years compared to women who had an enlarged womb and 3 or more fibroids where the risk increased to 35%.
If your gynaecologist feels that your fibroids are too large you may be advised have some medication to shrink the fibroids. The commonest medication used in a GnrH analogue. This may help make the procedure easier and help reduce some complications, reducing the fibroid size by up to 30% after 2-3 injections, reducing the operating time and reducing the amount of fluid absorbed into the body.
The commonest complication of this procedure is tearing of the cervix at the time of entry into the womb. For this reason your surgeon may advise that your cervix be prepared before the operation. Commonly the night before or a few hours before the procedure you may be advised to insert a tablet or two of Misoprostol, which is a tablet that makes the neck of the womb softer and easier to dilate for the procedure.
Another complication that surgeons encounter is fluid overload. This happens when the fluid used to distend the uterus for the operation is absorbed into the body. Special fluid monitoring systems are available to help avoid this complication to ensure that the amount of fluid that goes in is what comes out. Surgeons generally stop the procedure if they notice that the fluid “lost” is more than 1000mls.
Bleeding can also be a complication of this type of surgery and in most cases is put right either by the use of medication or the use of compression during the procedure. Only in extreme cases would a hysterectomy be necessary in cases of intractable bleeding as a life saving measure. The risk of this is generally put at 1:10,000.
If bleeding is encountered or the fibroid found to be too big for some women a
2-stage procedure may be necessary. This is where the procedure is stopped and completion surgery scheduled for another time.
If you have been advised to have a Hysteroscopic resection of your fibroid discuss these issues with your doctor. You should ask whether
- Cervical preparation is necessary and whether is will be used in your case?
- What measures will be taken to avoid fluid overload?
- Will a special pump be used to monitor fluid?
- What their success and complication rates are.