How are you? Good afternoon. How are you? Today I want to talk to you about three patients who came to us at Creafam. One of the reasons they most often come to us at Creafam is because they want to get pregnant, obviously, but they have fibroids. And these fibroids often also cause anemia. Remember, knowledge is success.

I like to say that this is the most common case we have at Creafam. Women with fibroids who are trying to get pregnant, but also have anemia, and they usually have large fibroids or multiple fibroids.

The first patient is a woman from Reynosa, Tamaulipas, who saw us on YouTube thanks to the videos we’ve uploaded. She, in particular, had already been told by more than four doctors that her uterus was going to be removed. Obviously, it wasn’t a simple surgery; it was a large tumor weighing 1 kilo 400g on the anterior surface of the uterus, most subserosal.

In these types of patients, it’s very careful or very delicate to try to perform a well-planned surgery and avoid bleeding because she already had anemia. We even had to give her two red blood cell packs before surgery and one during the procedure. The bleeding was only 600 ml, but she had severe anemia with a hemoglobin level of 6.6.

Imagine that if you have surgery with that hemoglobin level without giving blood, the likelihood of complications is very high. That’s why it’s important to always consult a specialist.

Look closely, this little patient had a large fibroid. So, what we did was an infra-supraumbilical approach. What’s that? We start the incision in the midline below the navel or above the pubis. We extend it circumferentially toward the navel and above the navel. With this incision, we have a better surgical field and can work with that fibroid. If you notice, we didn’t use the Alexis retractor to work with it. Why? Because this way, we damage the tissue much less, are less invasive, and also allow us to perform surgery with much less bleeding.

It looks grotesque here, but this tumor weighed 1.4 kilograms. Imagine what the repair of that uterus is like, because the stitches have to be hemostatic, meaning they don’t bleed after the stitches are applied. And second, we have to properly address that uterine tissue so that later, in the future, I can try to conceive and avoid complications during pregnancy. The most important thing here is that this patient will be able to get pregnant or try to get pregnant after about 8 months or a year of resting and allowing the uterus to heal properly.

Our second patient is from Puebla, but she works in Durango, so she signed up via Zoom to see if we could see her and take advantage of her vacation time to visit us and see if she could get surgery.

I reviewed all her tests via Zoom, and she arrived a week later. I did an ultrasound and an evaluation, and the truth is, if you look at the MRI, she had an MRI that showed multiple fibroids, both intramural and subserosal, anterior and posterior. What we did here was a Pfannenstiel approach, that is, the incision we call aesthetic, which is horizontal above the pubis on the bikini line, called the Pfannenstiel. With this, we performed aesthetic surgery, but we were able to do it with the Alexis retractor because the incision was much smaller, since she had many fibroids, but they weren’t that large.

The largest one measured 10 cm. But her unique characteristic, like the previous patient, is that she had severe anemia, with a hemoglobin level of 8.7, so we had to give her two blood packs. Fortunately, she only bled 100 ml.

So, remember, in this type of surgery, the important thing is to perform a procedure that doesn’t cause any bleeding, to have a prior assessment, both pre-anesthetically, to check her hemoglobin level and make sure there’s no anemia, and obviously, the coagulation times, and to be able to plan ahead if it’s necessary to have packed red blood cells.

This third surgery is for a patient who lives here in Puebla but is 39 years old. So remember, 34, 41, 39. The average is around 37 years old. That’s the most common reason women over 34, 35 come to us with multiple or large fibroids, a desire to conceive, most importantly, and many of them with anemia.

This patient had a hemoglobin of 10.5, we didn’t give her blood, we crossed packed red blood cells, she bled 400 ml during surgery and only one pack was placed, but she also had multiple fibroids. We removed 12 fibroids, and like the previous patient, we were able to make an aesthetic Pfannenstiel incision to perform a much more beautiful postoperatively, so the incision wouldn’t be noticeable. But the most important thing is to place the Alexis separator when the patient already has a blockage.

Why? Because the patient is now relaxed, we can perform a thorough palpation and determine whether the incision is a Pfannenstiel or a mid-infraumbilical or supraumbilical incision, and whether or not to place a retractor.

The most important thing in these types of patients is always to know approximately how many fibroids we have, whether an MRI or CT scan is necessary, which we request in the vast majority of cases. And third, to be able to give them an indication of how long it will take and whether blood draws are necessary.

Okay… Something very important is that we’re always asked: is whether surgery is very difficult or very risky? It depends on multiple factors. The first and most important factor is whether we have anemia. Remember, that’s crucial. And how long have we had anemia? Because if we have constant bleeding, and the vast majority of patients who seek us out have been bleeding and have anemia for two or three years, that’s more risky because your body is inflamed and obviously less able to withstand a surgical procedure.

Many times when people write to me or we meet via Zoom, they ask, “But how difficult is this surgery? Can I have it here?” The truth is, it’s very difficult for me to advise them on who will perform the surgery or where it will be performed. It’s not the same to do it in a private setting as it is in a public setting. Generally, in public settings, what we do, or what the doctors do, is remove the uterus. Why? First, because sometimes the resources aren’t available. Second, because there are many doctors still in training, and third, because it is indeed complicated to obtain blood and have everything on hand to perform procedures that are sometimes complicated.

So, what I always tell them is, if you can, come with us. The most important thing is that the doctor has extensive experience with fibroids, especially fibroid surgeries. At Creafam, 98% of the fibroid surgeries we perform preserve the uterus, even in surgeries involving large, multiple elements, or patients with severe anemia. So the most important thing is who you go with, where you go, and who will operate on you.