In the field of fibroid management, one of the common concerns among patients is whether fibroids will return after surgery. While recurrence is a real concern, it’s important to differentiate between true recurrence and situations where fibroids were not entirely removed during the initial surgery. As an OBGYN with a focus on fibroid treatment, I want to shed light on this distinction and explain my meticulous approach to ensuring comprehensive fibroid removal.
The Difference Between Recurrence and Incomplete Removal
1. Incomplete Removal vs. Recurrence
Incomplete Removal:
In some cases, fibroids that appear to return after surgery may not actually be new growths. Instead, they may be residual fibroids that were not fully removed during the initial procedure. This can happen for several reasons:
Fibroid Size and Visibility: Some fibroids are small or located in areas that are difficult to access, making them challenging to identify and remove with conventional imaging techniques. Consequently, these smaller fibroids may remain in the uterus post-surgery.
Surgical Technique: The effectiveness of fibroid removal depends on the surgeon’s technique and the ability to identify all fibroid tissue. If fibroids are not thoroughly assessed or if certain fibroids are missed, they may persist or become symptomatic later.
Technical Limitations: Despite advances in imaging technology, machines may not always detect all fibroids, particularly those that are smaller or located in complex anatomical areas.
2. True Recurrence:
True fibroid recurrence occurs when new fibroids develop after the initial surgery. This is influenced by factors such as hormonal changes, genetic predisposition, and the presence of remaining fibroid tissue. Recurrence is different from incomplete removal, as it involves the formation of new fibroid growths rather than residual fibroid tissue from the previous surgery.
My Approach: Comprehensive Fibroid Removal Through Hands-On Examination
In my practice, I prioritize a thorough and meticulous approach to fibroid removal to minimize the risk of both incomplete removal and recurrence. Here’s how I ensure that all fibroids, including those not visible through standard imaging, are effectively addressed:
1. Hands-On Examination:
Detailed Manual Exploration:
One of the key components of my approach is to conduct a thorough hands-on examination during surgery. This involves feeling around the uterus by hand, regardless of how long it takes, to detect fibroids that may not be visible through imaging or conventional surgical techniques. By palpating the uterine surface and exploring the entire uterine cavity, I can identify and remove not only the large, obvious fibroids but also smaller ones that might be missed otherwise.
Enhanced Detection:
Smaller fibroids, particularly those that are not easily seen on ultrasound or MRI, require tactile exploration for detection. By manually feeling for fibroids, I can locate these subtle growths and ensure they are removed. This hands-on approach allows for a more comprehensive treatment and reduces the likelihood of leaving residual fibroids behind.
2. Comprehensive Removal:
Addressing All Fibroids:
My goal during surgery is to remove all fibroids present in the uterus, not just the large ones. This includes those that are smaller and less visible, which can only be identified through careful manual exploration. This thorough approach helps prevent future complications and reduces the risk of symptoms returning.
Minimizing Recurrence Risk:
By ensuring that all fibroids are removed during the initial surgery, I can mitigate the risk of future fibroid-related issues. While new fibroids can still develop over time, comprehensive removal of existing fibroids helps address current symptoms and enhances overall treatment outcomes.
Real-Life Implications
Case Example 1:
Consider the case of Laura, a 37-year-old who underwent a myomectomy. Despite initial success, Laura experienced recurring symptoms. Upon re-evaluation, it was discovered that several smaller fibroids, not detected during the first surgery, had persisted. In a follow-up procedure, a thorough hands-on examination identified and removed these residual fibroids, alleviating Laura’s symptoms and improving her quality of life.
Case Example 2:
Jessica, a 32-year-old, had a laparoscopic myomectomy where some smaller fibroids were not detected by imaging. During her follow-up visits, symptoms persisted, prompting a second surgery where a hands-on approach allowed for the identification and removal of these overlooked fibroids. This approach provided Jessica with significant relief and addressed the issues not resolved by the initial surgery.
Conclusion
Understanding the distinction between true fibroid recurrence and incomplete removal is crucial for effective fibroid management. While recurrence involves new fibroid growth, incomplete removal can occur when fibroids are not fully addressed during the initial surgery. My approach emphasizes the importance of thorough hands-on examination to ensure that all fibroids, including those smaller and less visible, are effectively removed. This meticulous technique helps reduce the risk of residual symptoms and improves long-term outcomes for patients.
By prioritizing comprehensive fibroid removal and engaging in detailed manual exploration during surgery, we can better manage fibroid-related issues and enhance patient care. For those undergoing fibroid treatment, understanding this approach can provide valuable insights into the management of fibroid symptoms and the prevention of future complications.
References:
Stewart, E. A., et al. (2017). Epidemiology of uterine fibroids: a systematic review.
American Journal of Obstetrics and Gynecology. (2018). Long-term outcomes of uterine myomectomy.
Fertility and Sterility. (2020). Fibroid recurrence rates following different types of myomectomy.
Baird, D. D., et al. (2003). High cumulative incidence of uterine leiomyoma in Black and White women: ultrasound evidence.
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