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Patients having unnecessary hysterectomy for fibroids

The Coordinator of the Dutch multicentre EMMY Trial which looked at a large number of patients having had fibroid embolisation 10 years previously, and followed up for over 10 years, have shown that over 75% of patients can benefit from this procedure in the very long term i.e. over 10 years rendering hysterectomies for those patients unnecessary.


However, that trial was carried out in the early days of fibroid embolisation by inexperienced radiologists treating very difficult or hard cases with very high technical failure rates which we would consider totally unacceptable in today’s practice. They were also treating extremely difficult cases: very large fibroids, often in patients rejected for hysterectomy or with co-pathologies.


Despite this, there was complete success when followed up for over 10 years in over 75% of cases. When you look at the serious complication rate for hysterectomy (which sadly is often not fully explained to patients) you will see a list of 20 bad complications. These include perforation of bladder, bowel and ureter, abscess formation in the pelvis, complications requiring further major surgery, a death rate of 1 in 900 (mainly from pulmonary embolus), wound dehiscence (that is the abdominal wound breaking open), unsightly keloid scarring, wound herniation, a significant incidence of chronic vaginal prolapse, delayed problems with the bowel and bladder in some cases, and (often what is not mentioned) delayed bowel obstruction from adhesion formation in the abdomen requiring further major surgery.


That has to be compared with a procedure with a very small complication rate ie a tiny incidence of ovarian failure under 45, which should be even further minimised by having an experienced operator, and an extremely low infection rate leading to hysterectomy. In our institution, we have not had a case like that in over 1,700 procedures.


Today we would expect long-term success rates in well over 90% of patients, probably around 95%.

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