Complications of Surgery - Adhesions following Myomectomy by Dr Sylvia.
"Dear Doctor, how does one deal with adhesions forming in the womb and tubes following Myomectomy ?"
What is Myomectomy?
Very simply, it's the surgery that removes a fibroid from the womb.
For decades, it has probably been one of the commonest methods for treating Fibroids although recently, several alternatives have become more widely available.
Fibroids are among the commonest health problems affecting women - up to 1/3 of women globally could have Fibroids.
While many women may not have significant symptoms of fibroids, a large number do.
This was a question I got from a client recently and I thought its great way to demonstrate that women do not just struggle with the challenge of Fibroid symptoms, the right treatments - but also the complications that could arise following said treatment.
Dealing with Complications following Myomectomy - Adhesions.
One of the complications of surgery following myomectomy is *adhesions*.
This is when tissues within the abdomen and pelvis can get *stuck together*after surgery.
The reason it happens is because after an operation, the body will start to heal and in doing so, it creates new tissues over the operated areas.
Imagine if you had a scratch or wound on your knee after a fall.
Within some days, your body naturally forms scar tissue to cover up the knee injury.
This is part of the healing process.
It’s very similar to what happens internally - the body makes new tissue to heal after surgery; this tissue is like scar tissue and can cause some parts of the organs like the tubes or womb or even the bowels to get stuck together.
So this is *how* it happens. Why, though?
Sometimes, we think adhesions following myomectomy arise from excessive handling of the tissues during surgery.
For instance, the surgeon has to handle the womb several times to locate the fibroids.
Or they have to move the organs within the abdomen round to reach the fibroids.
Any of these could make adhesions more likely to develop.
Why are Adhesions following Myomectomy a problem?
They can get quite serious or they could be minimal.
When severe, they can be additional distress to women who have already suffered problems from Fibroids prior to treatment via Myomectomy.
In some people, they may cause a blockage to the bowels or bladder preventing the free flow of urine or faeces.
They could cause pelvic pain, pain during periods and pain during sex.
They could (because they have changed) the structure of the womb and tubes even more following the fibroids, worsen a woman's chance of getting pregnant.
How are Adhesions Treated?
Finally, the treatment will usually be surgery again - to try and carefully separate the scars and free the organs.
This is a process called adhesiolysis.
Some people suggest castor oil packs or massage could be used for treating adhesions - there is limited evidence for the effectiveness of this treatment.
While using castor oil for skin scars has shown some benefits - this is not the same with internal/abdominal adhesions.
Currently, the better ways to treat these conditions - Fibroids; and the complications like adhesions is using *laparoscopy* guided by ultrasound.
Laparoscopy simply is using instruments to enter the abdomen (tummy); with very small cuts in the skin, using cameras to explore the inside of the body.
Instead of making large cuts into the abdomen that has been the common practice.
With laparoscopy and ultrasound, the surgeon introduces instruments with cameras attached to the ultrasound so they look at the machine while operating the instruments in the body.
It minimises the direct handling of the organs but they target the necessary areas for surgery easier and recovery time is better.
So having fibroids removed using this method - laparotomy - allows for fewer complications, for example, developing adhesions following myomectomy.
Learn more about Fibroids here.
More Doc's Corner questions:
Here's a useful article for adhesions following surgery.
Subscribe to our youtube channel for health information videos, too.
Comment below with your points or questions, and see you soon.
Editing by AskAwayHealth Team
All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through firstname.lastname@example.org
Image Source Canva