Open myomectomy

Summary

An open (abdominal) myomectomy is an operation to remove fibroids — non-cancerous growths of the womb muscle — through a cut in the abdomen, while keeping your womb. It is reserved for the cases where the keyhole route is not the safer option, usually because the fibroids are very numerous or very large.

• The operation is done under general anaesthetic through a single abdominal cut, usually along the bikini line.
• Because the womb is kept and repaired, pregnancy remains possible.
• The usual hospital stay is 1–3 days, with a full recovery of about 4–6 weeks.
• Fibroids are removed whole through the cut — no morcellation (division of tissue inside the abdomen) is needed.
• Where the keyhole route is suitable, we usually recommend it — see our laparoscopic myomectomy guide. This page is for when open surgery is the recommended route.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

A myomectomy removes fibroids and repairs the womb, unlike a hysterectomy, which removes the womb itself. In the open approach the surgeon works through one abdominal cut with direct vision and touch — able to feel fibroids deep in the womb wall that a camera cannot see, remove many fibroids through one womb incision where possible, and repair the womb muscle in layers with strong stitches.

That access is the reason this route is chosen for the most demanding cases. The trade-off is a bigger cut: more pain in the first days, a longer stay, a slower return to normal life, and a higher chance of adhesions (internal scar tissue) forming afterwards than with keyhole surgery.

Related operations your consultant may discuss instead, depending on your scan:

• Laparoscopic myomectomy — the keyhole route, suitable for most fibroids — see our guide.
• Hysteroscopic resection — small fibroids bulging into the womb cavity can be removed through the cervix with no cuts at all.

Why it is performed

The reasons are the same as for any myomectomy — fibroids causing problems in a woman who wants to keep her womb:

• Heavy or painful periods that have not responded to medicines or the hormonal coil
• Pressure symptoms — bloating, urinary frequency or discomfort from larger fibroids
• Fertility problems or recurrent miscarriage where fibroids distort the womb cavity

The open route in particular is chosen when the scan shows very many fibroids (where each needs finding and removing), very large fibroids, or fibroids in positions where the keyhole repair would be less secure — or for personal preference or financial reasons, when laparoscopic or robotic surgery is not affordable. Your ultrasound assessment decides this — see "Preparing for surgery" below.

Benefits

• Symptoms improve with the womb kept — bleeding, pain and pressure usually improve once the fibroids causing them are removed, and pregnancy remains possible.
• Complete clearance in complex cases — the surgeon can feel and remove deep fibroids that keyhole surgery might miss when they are very numerous.
• A strong, layered womb repair under direct vision, and the tissue is removed whole — no morcellation.

Be aware: new fibroids can grow over time, so symptoms can return years later — a myomectomy treats the fibroids you have now, not the tendency to form them.

Alternatives

• No treatment now. Fibroids that cause no or mild symptoms can simply be monitored; they usually shrink after menopause.
• Medicines — hormonal and non-hormonal treatments that reduce bleeding, and drugs that temporarily shrink fibroids (sometimes used before surgery).
• The hormonal coil (LNG-IUS) — often effective for bleeding when the womb cavity is not distorted.
• Laparoscopic myomectomy — the keyhole route where suitable — see our guide.
• Hysteroscopic resection — for small fibroids inside the cavity, removed through the cervix with no cuts.
• Uterine artery embolisation (UAE) — a radiology procedure that shrinks fibroids by blocking their blood supply. It is not widely available in Sri Lanka, and suitability depends on your case and fertility plans.
• Hysterectomy — the definitive treatment when your family is complete — see our laparoscopic and abdominal hysterectomy guides.

Preparing for surgery

Every woman having a myomectomy has ultrasound imaging — both abdominal and transvaginal — as a matter of routine. This maps how many fibroids there are, how big they are and exactly where they sit; that assessment is what determines that the open route is the recommended one for you. You will also have a physical examination, blood tests (anaemia from heavy bleeding is corrected first where possible — iron, and occasionally medicines to shrink the fibroids and build up your blood count before surgery), blood pressure checks, and a review of your medicines and general health. Blood is grouped and saved in case a transfusion is needed. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery or anaesthetic problems.

• Smoking: stopping even a few weeks before surgery reduces chest and wound complications.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first 1–2 weeks and someone to take you home; plan to avoid heavy lifting for several weeks.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including what should happen if unexpected findings are encountered. You can still change your mind at this point. Compression stockings are usually fitted, and a dose of antibiotics is given at the start of surgery.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. The surgeon opens the abdomen, usually through a bikini-line cut, and inspects and feels the womb to locate every fibroid mapped on your scan.

Steps are taken to keep blood loss down — the womb has a rich blood supply, and techniques such as a temporary tourniquet around the womb's vessels or medicines injected into the muscle are commonly used. The womb muscle is opened over the fibroids, each fibroid is shelled out, and the womb is repaired in layers with strong dissolvable stitches. An adhesion barrier may be placed over the repair before the abdomen is closed. The operation commonly takes 1–2 hours, longer with many fibroids.

In theory, uncontrollable bleeding could make removing the womb the only safe option. This is very rare, but it is discussed with you before consent.

After the operation

You will wake in the recovery room with a drip and usually a bladder catheter, removed the next day.

• Pain relief: open surgery is more painful than keyhole surgery in the first days; regular painkillers, and stronger medication where needed, keep it controlled.
• Eating and drinking: fluids the same day, building up as comfortable.
• Moving: you will be helped out of bed by the next morning — early walking speeds recovery and protects against clots. Daily blood-thinning injections are often given during the stay.
• Going home: usually after 1–3 days.
• Bleeding: light vaginal bleeding or spotting for a few days to weeks can be normal.

Recovery at home

• Weeks 1–2: rest with gentle activity — short walks, no lifting heavier than a kettle. Tiredness is normal.
• Weeks 3–4: gradually increasing activity and light household tasks.
• Weeks 4–6: most women are back to normal activity and routine work; heavy physical work may need longer.
• Driving: usually after about 4 weeks — when you can wear a seatbelt comfortably and perform an emergency stop without hesitation. Check your insurer's policy.
• Follow-up: attend your follow-up appointment so your recovery and the womb repair can be checked.
• Trying for a pregnancy: the womb repair needs time to heal — the standard advice is to wait 6 months before trying to conceive. Because the repair usually involves the full thickness of the womb wall, a planned caesarean birth is usually advised for future pregnancies; ask what applies to you.

These are typical figures for open surgery; your own advice may differ and comes first.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on the number, size and position of your fibroids, your health and previous surgery, and will be discussed with you.

Expected, temporary effects

• Wound pain and tiredness for some weeks
• Light vaginal bleeding or spotting
• Constipation and wind in the first days

Complications

• Bleeding — the main risk of myomectomy; a transfusion is needed more often than with keyhole surgery, and blood is kept ready (uncommon).
• Infection — of the wound, urine or chest; most cases settle with antibiotics (common but usually minor).
• Injury to the bladder, bowel or ureters — recognised injuries are repaired (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Adhesions — internal scar tissue is more likely than after keyhole surgery and can affect fertility or cause pain (common, usually without symptoms).
• Wound problems — haematoma, slow healing, or later an incisional hernia (uncommon).
• Hysterectomy during the operation — for uncontrollable bleeding; very rare, but discussed before consent.
• Fibroid recurrence — new fibroids can form over the years; some women need further treatment later.
• Scar on the womb — the repair leaves a scar that matters in future pregnancy and birth planning (see recovery section).
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• A wound that becomes red, swollen, hot, opens or leaks fluid
• Burning on passing urine, or being unable to pass urine
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this operation — and the open route — is recommended for you, what the realistic alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline NG88. Available from: https://www.nice.org.uk/guidance/ng88 [last checked 9 August 2026].
2. National Health Service (UK). Fibroids — treatment. Available from: https://www.nhs.uk/conditions/fibroids/treatment/ [last checked 9 August 2026].
3. Royal College of Obstetricians and Gynaecologists. Patient information — browse all. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 9 August 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Laparoscopic myomectomy — surgery guide. Available from: https://sugabi.lk/surgery-guide/laparoscopic-myomectomy/
2. Sugabi Clinic Ragama. Uterine fibroids: symptoms, diagnosis and treatment options. Available from: https://sugabi.lk/blog/1142/…