When should a myomectomy be done and when a hysterectomy?


Dr. Verónica Rembis Sáinz. 

When should a myomectomy be done and when a hysterectomy?

Each patient I have operated on is given a different treatment, because their cause and their anatomical problem is different.

For example, patients who want to have children can definitely not have a hysterectomy but rather a myomectomy. This may be performed by open surgery such as a cesarean section or laparoscopic surgery depending on the location and size. If the fibroid is submucosal it can be removed by hysteroscopy.

In contrast, my patients who have bleeding, pelvic pain, anemia and fibroids but no longer want to have children, can have laparoscopic surgery for hysterectomy if the uterus is relatively small, that is, if it is below the navel and it is not very wide. Patients whose uterus is too large and above the navel need open surgery, which can be vertical or horizontal depending on the characteristic.

Finally, patients who have uterine prolapse, that is when the uterus is visible or emerging from the vulva, should have a vaginal hysterectomy, in this way the uterus is extracted through the vagina.

In the three types of hysterectomy I can remove only the uterus, or the uterus and the ovaries, depending on whether the patient has been through menopause or not, and on whether the ovaries have any problems such as cysts, endometriomas or tumors.

In my 20 years of experience I have attended many different congresses and training courses where I have extended my knowledge with new options such as the use of lasers, or new surgical techniques that facilitate the recovery of the patient.