Uterine Fibroid Surgeries and Risks of Recurrence

Recurrent fibroids after myomectomy is a common problem. 12-30% of women who had their fibroids removed face such a complication. Women of reproductive age and menopause are at risk. There are no preventive measures to exclude recurrence after myomectomy. Therefore, doctors recommend that you undergo an examination at least once a quarter.

Uterine fibroid is a benign tumor that grows from the myometrium (muscle layer). It is a collection of randomly intertwined muscle fibers that have acquired a rounded shape. Such nodes can reach large sizes and weights, but they are not prone to malignancy.

According to statistics, the disease is diagnosed in every fourth woman over the age of 40 and in every second one before menopause. Recurrent pathology is characterized by the same symptoms as the primary one:
- Change of menstrual bleeding;
- Feeling of tightness in the lower abdomen;
- Severe cramps;
- Abundant discharge with an admixture of blood after sexual intercourse of physical exertion;
- Profuse gas formation, constipation.

The Causes of Fibroids Recurrence after Myomectomy
Being hormone-dependent diseases, tumors appear as a result of uncontrolled cell division caused by a disorder of the hormonal background. This is proven by the presence of receptors for sex hormones found in them.

More often the recurrence after fibroids treatment in the reproductive age, when the content of estrogen in the blood is high. Also at risk are women who take estrogen-containing drugs during menopause.

Relapse after Embolization (Non-Surgical Myomectomy)
Embolization is the most gentle technique. Today, it is considered the best alternative to surgical excision and is prescribed when, for medical reasons, removal is not otherwise possible. The procedure consists in blocking the blood flow to the neoplasm, after which its tissues die within 2-3 hours. For mechanical blockage, special small balls are used. They are introduced into the vessels through a catheter inserted into the artery. Recurrence after myomectomy occurs in 20% of cases within 1.5-2 years.

Recurrence after Hysteroscopic Myomectomy
Hysteroscopic surgery involves access to pathology through the vagina. In this case, no incisions are made, and all instruments are inserted through a gynecological dilator. Excisions are made with a resectoscope - a special electrosurgical device with interchangeable nozzles: cutting loops, a scalpel, electrodes, and evaporators.

Operational hysteroscopy is prescribed for neoplasms growing in the lumen of the organ and localized in the submucosal layer.

The list of complications resulting from the operation includes:
- Bleeding;
- Mechanical damage;
- Hernia of the abdominal wall;
- Scarring and adhesions;
- Recurrence after myomectomy (up to 30%).

Recurrence after Laparoscopic Myomectomy
Tumors located on the posterior and anterior wall of the uterus, growing deep into its tissues with a diameter of no more than 5 cm, are removed laparoscopically. The manipulation got its name from the word "laparoscope". This is special equipment that is inserted through trocars - hollow tubes. For surgical treatment, three punctures are enough - in the navel and in the lower abdomen. Through the first one, a laparoscope is inserted and air is pumped to provide access to the organs. A surgical instrument is inserted through the lower ones.

The intervention is minimally invasive and an accelerated period of rehabilitation. Recurrence after myomectomy ranges from 10-20%.

Recurrence after Abdominal Myomectomy
Recurrence after myomectomy occurs in 27% of cases. Such surgery is not practiced very often, and the main indications for its implementation are the large size of the tumor, its deep ingrowth, and the presence of multiple nodes.

Manipulation involves dissection of the abdominal wall and uterus with further suturing. Therefore, in addition to recurrence after myomectomy, other complications arise:
- Bleeding;
- Pain;
- Scarring;
- Adhesions;
- Infection;
- Inflammation;
- Reproductive dysfunction.

Regardless of the type of intervention, patients should be observed by a gynecologist, timely take tests for hormones, and undergo diagnostic hysteroscopy.