Hospital

CONSENT FOR ABDOMINAL MYOMECTOMY

(Please read the information below carefully. Do ask questions/ queries/

doubts before you sign the document. Please ensure that your relative signs
as a witness. Federation of Obstetrical & Gynaecological Society of India
wishes you speedy recovery)
Part I: Information about the surgery
1. Name of the procedure:open/ abdominal Myomectomy
2. Meaning: Fibroids or myomas are common tumors that develop in the uterus.Surgical
removal of the myoma/ myomas is called myomectomy. When the surgery is performed by
making an incision on the abdomen, it is called as open or abdominal myomectomy.Most
often fibroids do not cause any symptoms and are harmless. Hence very small fibroids need
not be removed..Most of the fibroids are not cancerous too. Some times fibroids can cause
heavy, excessive, irregular bleeding and severe pain during menstruation. They can cause
difficulty in getting pregnant. Rarely fibroids can get cancerous. Large fibroids can cause
pressure symptoms on surrounding organs.
3. Purpose/ indications: (The list given below only indicates common reasons and
does not include all indications):
Following fibroids need to be operated upon:
˜ Fibroids which cause symptoms
˜ Fibroids which are large
˜ When there is a suspicion of cancer
4. Description of the procedure: This surgery may be done under regional anaesthesia
(where in the lower half of the body is made numb or anaesthetised) or under general
anaesthesia (where the patient is put to sleep by giving injection). The doctor makes an
incision on the abdomen. The fibroid/ fibroids are identified. The uterus is cut open to reach
the fibroid. It is separated from the tissue of the uterus. The blood vessels feeding the fibroid
are ligated. The fibroid is separated and removed. The cut on the uterus is stitched back.
Same procedure is done for other fibroids. After all fibroids are removed, the incision on the
abdomen is closed by taking stitches.
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5. Benefits& effects of the procedure :
The fibroids are responsible directly for the medical condition and the suffering. Thus,
removal of the fibroids means removal of the root cause in itself. After removal of fibroids, the
uterus is expected to continue its biological function of menstruation and child baring.
woman can resume all other activities including sexual intercourse after recovering from the
surgery.
It must be noted that nearly thirty percent women may find another fibroid ( newly formed)
in later life.. Special precautions are needed to be taken during pregnancy and child birth
after removal of fibroid surgery. There is a risk that that area of uterus from where fibroid was
removed may remain weak and rupture during the process of labour. Hence, doctor may
prefer to do caesarean section to avoid this risk.
6.. Alternatives:
˜ Medical therapy:
If woman is suffering from excessive and / or irregular bleeding, hormonal or nonhormonal
medicines can be given to her. There can be oral medicines or injections.
Hormones can be delivered by a device fitted in the uterus. These medical
treatments have their own side effects and failure rates.
˜ Other surgical procedures:
Instead of removal of fibroids, entire uterus can be removed. It is obvious that
woman will not menstruate or get pregnant after the uterus is removed. Usually, this
method is preferred by those who are elderly and not interested in having children
any more.
˜ Other modes of myomectomy:
Once it is decided to remove the fibroids, it is important to understand the ways to
do the surgery. The surgery can be done by making a surgical cut on the abdomen
or through the birth passage or vagina( hysteroscopy may or may not be used)or by
using laparoscopy.
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In laparoscopic surgery there are multiple small incisions made on the
abdomen. But all cases may not be suitable for laparoscopy. Especially if fibroids
are very large or peculiarly placed or if there have been previous surgeries on the
abdomen, laparoscopic surgery may be difficult.
Abdominal surgery is conventional surgery, doesn't need high tech equipment
and is relatively less complex in nature. The surgeon gets relatively easy access to
the tissues. The cut edges can be approximated better. These are the advantages
of open surgery over other modes of surgery.
Vaginal surgery for fibroids is only reserved for specific conditions. If the fibroids
are inside the cavity of the uterus or coming out through the uterus, only then
this surgery is possible.
7. Consequences of refusal of the procedure:
If surgery is not done, woman may need to choose other alternative modalities as
discussed above. If no treatment is done, woman may not get any relief from the
suffering.
8. Outline of substantial risks:
With the advances in medical science, surgeries have become safer than in the past.
However any surgery has its own set of risks and complications.
a. Excessive bleeding/ blood accumulation: Sometimes excessive bleeding may
occur during or after the surgery. Transfusion of blood and blood products may
be needed. In case the blood accumulates inside the body cavity, additional
procedure or surgery to remove the accumulated blood and stop the bleeding
may be required.
b. Infection: If the Pathological microorganisms are not resisted by the body's
resistance mechanism, the infection can set in. Infection commonly causes fever,
pus formation in the area of the surgery. Additional does of antibiotics and
sometimes additional procedure may be required to remove the infection from
the body. If the wound does not heal well, it may need repeated dressings or
repair again. Severe infection or sepsis is uncommon.
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c. Injury to surrounding structures: While fibroids are being separated from the uterus
other surrounding structures such as urinary bladder, ureter,bowel, blood vessels
may get injured. The injury may or may not get detected immediately. Whenever
detected it may need to be repaired by necessary additional surgery.
d. Anesthesia has become much safer in today's world. It is common to have
drowsiness, vomiting, weakness, throat pain for a day or two after anesthesia.
Headache after spinal and other regional anesthesiais not uncommon. Rarely
temporary weakness, numbness in lower part of the body may be caused after
regional anesthesia.
e. Every Individual has a different way to cope up. Sometimes the scar becomes thick
and some- times it stays as a thin line. Some- times hernia formation may occur later.
In some cases surgery leads to adhesions of bowel.As described earlier in the
document, the scar on the uterus may give away during labour( very rarely during
pregnancy). This may pose a serious danger to the woman and the child.
f. Some times the investigations done before surgery indicate that woman is suffering
from fibroid. But the doctor may find that the tumour is not a fibroid. Two common
tumours that may mimic fibroid are adenomyoma and fibrosarcoma. Fibrosarcoma
is a cancerous tumour. This diagnosis is made only when the tissue is checked under
microscope. In that case, additional surgery/ treatment may be needed.
Adenomyoma is a condition of the uterus in which complete removal of the tumour is
not possible. The doctor may resect as much part of tumour as possible or take biopsy.
Rarely, while doing the surgery the doctor finds that the tumour is not arising from
the uterus but arising from ovary or other pelvic organs.
g. Very rare conditions : Allergic reaction to any drug including anaesthesia medicines,
blood transfusion, need for assistance for respiration (oxygen/ ventilation), shock,
stroke or heart attack due to strain on the heart, fluid collection in the lungs,
formation of blood clots in veins leading to embolus further leading to damage to
vital organs, loss of function of any limb or organ or paresis are extremely rare but not
unknown complications of any surgery. Rarely if the uterus is dens
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.THIS INFORMATION LEAFLET WAS RECEIVED ON
…………………...........................................................……………
( date / time)
Signature of the patient: …………………...............................……………..
instruction To Patient: Please Bring This Paper When You Come To The Hospital For
Getting The Surgery/ Procedure Done)
Consent For Abdominal Myomectomy 5