How Fibroids Leave Their Mark: Fibroid Removal and Scarring Risk

For women who struggle with symptoms of uterine fibroids—pelvic pain, heavy menstrual bleeding, painful periods, and/or frequent urination— a variety of surgical treatments offer potential relief. Of course, virtually any kind of surgery carries some risk for post-operative complications. Scarring is one issue of significant concern to many women who are looking at fibroid removal procedures. And unsightly visible scars aren’t the only scars to warrant concern: internal scars, called adhesions, present their own set of symptoms, which – in extreme cases – can be more problematic than those that motivated the surgery in the first place.

They may not be a painful consequence, but abdominal scars can be unsightly. However, for women facing a fibroid removal surgery who are haunted by visions of a friend’s post-C-section tummy, there’s some good news: long-term, visible scarring is rare with most fibroid removal procedures. Dr. Donald Galen, MD and former Surgical Director at the Reproductive Science Center of the San Francisco Bay Area, explains, “severe scarring from elective surgery is very uncommon.”

In part, the infrequency of major scarring is due to the size of incisions that most methods entail. The external incisions required for laparoscopic surgeries are typically small, ranging from 5-12mm (i.e. less than 1/2 inch) in length. Hysterectomies may require longer abdominal incisions, since they, by definition, involve complete or partial removal of the uterus. Still, the approximate length of incisions varies by method. Some hysterectomies can be performed using minimally-invasive surgical techniques. “The benefits of minimally-invasive surgery for hysterectomy are that only two to three 0.5-1 inch incisions are necessary, [which enables] rapid healing and minimal visible scarring,” says Dr. Galen.

What can patients do to inhibit the formation of abdominal scarring after surgery? Not much, unfortunately. According to Dr. Galen, “Many methods, such as topical steroids, massage, [and] Mederma, have been…used to try and minimize external scarring. These [topical treatments] may help minimize scar formation, however, the more important ingredients seem to be the patient’s own genetic makeup and race, as well as the type and size of sutures used for closure.”

Internal scars, called adhesions, are another potential consequence of fibroid removal surgeries, and ones that can pose a risk to the patient’s health. Abdominal adhesions can result in pelvic pain, cramping, bowel obstructions, and even infertility.1

Adhesions form when the body’s attempt to heal internal incisions goes awry. During the healing process, a layer of new scar tissue forms over damaged tissue. If this new tissue attaches to other organs or locations within the abdomen, it is called an “adhesion”.
Logic dictates that, the greater the number of incisions, the higher the risk for developing adhesions after surgery. For this reason, different fibroid removal procedures present different levels of risk in terms of adhesion formation. A laparoscopic myomectomy, for example, requires a surgeon must make one or more incisions in the uterus; the incisions create the circumstances for adhesions to form.2 Dr. Galen describes the typical case, saying, “when myomectomy is performed… there are usually considerable post-op adhesions that form from the incisional sites on the exterior of the uterus to other abdominal structures such as bowel, anterior abdominal wall, and bladder.”

Less invasive options for fibroid removal, like the Acessa procedure (radiofrequency volumetric thermal ablation or “RFVTA”), present little risk of adhesions: the Acessa procedure utilizes heat from a probe to destroy fibroids, thereby avoiding the need for uterine incisions and the potential for subsequent internal scarring.
Women diagnosed with uterine fibroids should consult with a physician to determine the best course of treatment. While minimal scarring and adhesion risk is obviously preferential, different surgical fibroid treatments are appropriate in different cases. The number, location, and size of fibroids, along with other factors, will ultimately determine which method(s) of treatment is medically advised.

Sources:

  1. “Abdominal Adhesions”, MedicineNet.com, http://www.medicinenet.com/script/main/art.asp?articlekey=143560. Retrieved September 23, 2014.
  2. Macer, James A. For uterine-sparing fibroid treatment, consider laparoscopic ultrasound-guided radiofrequency ablation. OBG Management, Nov. 2013:Vol.25(11).
  3. Endoscopic Surgery for Gynaecologists, page 31, edited by Chris Sutton and Michael Diamond, Published by W.B. Saunders Co. Ltd, Philadelphia, PA, 1993
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