MAKING FIBROID OPERATION SAFE

How Safe is Your Gynaecologist?

Myomectomy is a surgical operation for the enucleation of uterine fibroids. This involves a laparotomy (an incision on the anterior abdominal wall) to open the abdomen. It involves closure of the dead spaces where the fibroids were domiciled and stoppage of bleeding which occurs during the procedure. It also involves suturing of the serosa (peritoneal covering of the uterus) and the anterior abdominal wall in layers

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About the Book

MISSION STATEMENT

This book is on a mission to help surgeons carry out myomectomy successfully no matter the sizes and number of the fibroids. They will benefit from the experience of the author who is pioneering caesarean myomectomy and has successfully removed very large fibroids while retaining the women’s womb and fertility.

By the time all women with huge or many fibroids who wish to retain their reproductive capacities have successful myomectomies the book has fulfilled its mission.

 

 

Making fibroid operation (myomectomy) safe

INTRODUCTION

Myomectomy is a surgical operation for the enucleation of uterine fibroids. This involves a laparotomy (an incision on the anterior abdominal wall) to open the abdomen. It involves closure of the dead spaces where the fibroids were domiciled and stoppage of bleeding which occurs during the procedure. It also involves suturing of the serosa (peritoneal covering of the uterus) and the anterior abdominal wall in layers

Steps that ensure a safe myomectomy include:

  • Haemoglobin estimation which is done to ensure the patient has a normal haemoglobin level

Women who have been bleeding seriously on account of fibroids and have a low haemoglobin level should receive blood to shore up their haemoglobin status prior to the operation

The number of units to be transfused depends on the haemoglobin level. Women with haemoglobin level of 6g% or less can receive three units of blood. Blood level must be up to 10g% or more prior to surgery. At least two units of blood should be grouped and cross-matched for the operation.

  • Infection in the endometrial cavity can be treated prior to the operation to minimize the infection involving the ovaries, fallopian tubes and the uterus. Treatment will also prevent wound infection following the operation. Treatment of infection resident in the pelvis will promote a clean pelvic peritoneum.

It will also make for minimal scar tissue formation in the lower aspect of the uterus, anterior abdominal wall and skin. Women that have extensive scar tissues in the womb or anterior abdominal wall can hardly have a vaginal birth because the scar will prevent descent of the baby’s head to the pelvic floor.

An endometrial swab for microscopy, culture and sensitivity can be done

A urine microscopy, culture and sensitivity should also be done. Organisms  identified should be killed by relevant sensitive antibiotics.

An intravenous urogram can be done to identify clearly the course of the ureters to avoid injuring them during the procedure

  • Counselling of the woman and her spouse and others around her to enable the woman and her people to willingly consent to the operation.
  • Vaginal/pelvic examination

The cervix and cervical opening should be examined to rule out any of the following:

  • Submucous pedunculated fibroid extruding from the cervical os
  • Cervical cancer
  • Prayers for safe surgery and uneventful post-operative period (Refer to Winning the battle against fibroids)
Details
Publisher: SMEEI
Publication Year: 2020
eBook Price: 5
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