Open Myomectomy Procedure Steps before surgery
Updated: Jul 24
Millions of women deal with symptomatic fibroids each day. Some women are still able to carry out their daily activities and have a good quality of life even with these fibroids. However, so many of us are not that fortunate.
One thing women don't talk about enough is what the steps to prepare for an open myomectomy look like. What can and can't you do a week before, a day before, and even the day of surgery?
Let me walk you through the open myomectomy procedure steps.
So many women suffer from any number of the following fibroid symptoms: very heavy bleeding, severe cramps, back pain, bloating, a protruding and hard belly, anaemia, frequent urination, headaches, painful intercourse and more.
Oftentimes, after years of trying non-invasive procedures and medications, an open myomectomy is necessary to improve the patient's quality of life.
An open myomectomy is the most invasive of all myomectomies. It entails cutting the patient open (either vertically or horizontally) to surgically remove all of the fibroids.
This surgery tends to be reserved for when the fibroids are large (above 11cm), multiple and/or in hard to reach areas.
It has the longest recovery time (6-8 weeks), requires general anaesthesia and a hospital stay of at least 2-3 days.
I happened to need an open myomectomy for all 3 reasons. I had several very large fibroids (13cm) and they were spread out across my abdomen with some in harder to reach cavities.
I had tried different medications such as Fibristal and different birth controls to try and manage them but nothing had worked and my fibroids kept growing. I was placed on medically induced menopause using Lupron to try and shrink them but the largest fibroid happened to triple in volume. I finally decided to get an open myomectomy 8 years after being diagnosed.
If like me you have never had major surgery, you probably have so many questions with regards to preparing for this procedure. Hopefully I can answer most of these questions running through your mind below:
Pre-op appointments: Once my gynaecologist had a surgery date booked, the hospital where my open myomectomy would be performed contacted me firstly over the phone (about 6 weeks before my surgery) where they went over my medical history, inquired about any medication allergies, asked if I would have someone to take care of me once I was discharged etc.
I had a bad/confusing experience with this because the nurse I spoke with insisted that I would be an outpatient and would be discharged the same day. I kept telling her that my doctor had said otherwise but she insisted hospital policy had changed and I would only be an outpatient.
Every single video and article I had watched/read about open myomectomies mentioned that at least 2 overnight stays at the hospital were necessary post-op. I decided to rather listen to what my doctor had mentioned and prepared for a stay at the hospital post surgery.
About 2 weeks later, I was asked to come to the hospital for blood work. I had had an iron transfusion some weeks prior and was happy to note that my haemoglobin levels were still great.
At this time, I was also given a specimen cup and was told I would need to provide a urine sample the morning of my open myomectomy.
About a week before my surgery, the hospital pharmacist called me to go over all prescription and non-prescription medications I was on. She asked me to leave all of these at home as the hospital pharmacy carried all of them.
Two days before my surgery, I was sent to get a PCR Covid test done. I had no idea you are not supposed to eat or drink (except water) 30 minutes prior to the test.
I had ensured to stay away from crowded environments and areas where people had recently tested positive for Covid.
As I knew recovery would be about 2 months, I decided to get my hair braided into no fuss short cornrows. A protective style that would be easy to maintain and sleep with.
Day before surgery:
The nurse who had called me about 6 weeks from my surgery date also advised me to not wear any nail polish, jewellery nor any deodorant nor body sprays the day of my surgery.
I was also asked to bathe with a disinfectant called Dexidin 4 (about $3) on the day before and day of my open myomectomy.
The Dexidin is meant to prevent you from getting an infection in the surgery remove as well as disinfect your skin for the surgeon
Apparently the no nail polish rule is to ensure the finger scanner they place on your index finger to check your vitals can obtain accurate information. Moreover, doctors look at your finger nails to ensure you are getting enough oxygen while sedated.
I was informed of the time my surgery would be occurring at around 4pm the day before. It would be happening at 7:30am the following day but I had to be at the hospital for 6:15 am. I was advised I could not eat anything from 9pm and no water from 2am.
I actually preferred an early surgery because that way it would be out of the way first thing in the morning and it could be behind me. I also could not imagine not being able to drink water all morning if my surgery had been in the afternoon.
Day of surgery: It is important to have someone accompany you to the hospital, even if just for moral support but also because you could become anxious before the procedure and this could impair you mentally.
My mother drove me there but we got separated not soon after, as soon as I checked in at registration. I asked her to return to my apartment and wait there for the hospital to contact her.
I had packed a backpack with a loose nightgown, toiletries, my phone charger, headphones, water, gum, pads, adult diapers, underwear and my foldable cane.
I ended up not needing most of the items as the hospital supplied the gown, pads etc.
After I had changed into a hospital robe, the anaesthesiologist, attending OB/GYN and my gynaecologist all came to see me before my surgery. The anaesthesiologist ran through my allergies and medical history once more and then informed me that general anaesthesia meant you would need to be intubated - here I was thinking I would just be asleep and breathing on my own.
He also recommended I get an epidural to reduce the pain I would be in upon waking up. This would be done after I had already been put to sleep.
Right before my surgery, my gynaecologist came to tell me that unfortunately she did not think I would be able to get the 'bikini' incision we had discussed because after taking a closer look at my MRI, she noticed the largest fibroid was extending up towards my stomach and a C-section incision would not allow her to reach it. I would be getting a vertical incision but she would do her best to make it as small as possible.
I won't lie, I was just a little disappointed to hear this news but at this stage, you're not going to refuse the surgery! Also, I just needed these fibroids out ASAP. I had been bleeding for 4 months consecutively.
A nurse came to ask if I needed to use the bathroom one more time, which I did, and then he wheeled me away to the theatre where there were several nurses, doctors and techs awaiting me. Anaesthesia was administered via my IV and within seconds, I was out like a light.
The last thing I remember is the anaesthesiologist asking me what my favourite cocktail was. I replied, 'sex on the beach' to which he responded that he had just given me 3 shots of those. I started laughing and the next thing, I was out.
A number of people have asked if an open myomectomy can be performed during menstruation and the answer is yes, as I am living proof.
Not everyone needs staples on top of stitches but I did and my staples were taken out a week after surgery.
Home preparation: Some thing no one tells you about the myomectomy recovery is how important it is to have a firm bed/mattress!
When I came home, my mattress was too soft to sleep on and so I have been sleeping on my couch for the last 3 weeks.
I noticed that it's very painful on the abdomen if I lie completely flat and so my mother would put pillows under my feet and under my feet to create a sort of V shape. This would prevent my abdomen from over stretching at night.
You could actually get a mattress topper to make your mattress more firm because it will be very challenging to get in and out of bed.
Another thing that a lot of people do not mention is how you may not be able to wear any sort of underwear for weeks. My incision cut deep towards my vagina and so any underwear irritates the area. However, as I am still bleeding vaginally here and there, I have to wear a pad.
These pads are the most comfortable and thick enough to not get lost up there.
You can consult my full list of must- have myomectomy recovery items here.
Remember that the uterus takes a good 6+ months to heal and so it is very important to rest properly as well as provide your body with all the nutrients it needs during this time.
While feeding the body, don't forget to also nourish your mind. It is important to surround yourself with only positive energy during your recovery. I am mindful of the news stories I read, the shows I watch, the podcasts I listen to etc. during this vulnerable time.
I am protecting my energy even with the guests I allow to visit me and video calls I accept.
This is my time to take care of myself first and foremost. Everything and everyone else can and will wait.
It is so important to have someone assist you the first week of your surgery. No two myomectomies are the same! I know some people who were going for walks before week 2 and here I am, still not able to leave the house on my own at week 3. That's okay.
Are you awaiting a myomectomy?
Did you recently have one?
Let me know if you have any questions.