Fibroid surgery is generally safe, with a mortality rate of about 1.3 per 10,000 patients, or 0.013%. That makes it one of the lower-risk elective surgeries. But like any operation, it carries real risks worth understanding before you decide to move forward. The type of surgery, the size and number of your fibroids, and whether the procedure is minimally invasive or open all influence how likely you are to experience complications.
How Common Are Serious Complications?
In a large matched analysis of nearly 7,000 surgeries drawn from a national registry, minimally invasive myomectomy (where fibroids are removed but the uterus is preserved) had lower rates of 30-day complications, hospital readmission, and reoperation compared to minimally invasive hysterectomy (where the entire uterus is removed). The odds of needing a repeat surgery within 30 days were roughly one-third as high with myomectomy.
For either procedure, the overall complication rate in the first month sits in the range of 10 to 12%, and most of these are minor issues like low-grade fever, small wound complications, or temporary pain. Organ injuries during laparoscopic surgery are rare. Accidental bowel injury occurs in about 1 in 769 laparoscopic gynecologic procedures, or 0.13%.
Open Surgery vs. Minimally Invasive Approaches
The biggest factor in your risk profile is whether the surgery is done through a large abdominal incision (open surgery) or through small incisions using a camera and specialized instruments (laparoscopic or robotic surgery). Open abdominal myomectomy involves a median blood loss of about 200 mL, with some patients losing significantly more. About 20% of patients undergoing open myomectomy need a blood transfusion during or after the procedure.
Robotic and laparoscopic myomectomy cut that blood loss roughly in half, with a median around 100 mL for robotic cases. Transfusion rates drop accordingly. Hospital stays are shorter, too. Despite these differences in blood loss, the overall complication rates between open and minimally invasive approaches end up similar, around 10 to 12%, because the types of complications shift rather than disappear entirely.
Not everyone is a candidate for minimally invasive surgery. Very large fibroids, fibroids in difficult locations, or a high number of fibroids may require an open approach. About 1% of laparoscopic myomectomies need to be converted to open surgery mid-procedure, usually because of the number or weight of fibroids encountered.
Adhesions: The Most Common Long-Term Risk
The complication that gets the least attention before surgery but affects the most patients afterward is adhesion formation. Adhesions are bands of scar tissue that form between organs and the abdominal wall. After open abdominal myomectomy, adhesions develop in more than 90% of patients. Even after laparoscopic myomectomy, the rate is at least 70%.
Most adhesions cause no symptoms at all. But in some cases, they can lead to chronic pelvic pain, bowel obstruction, or fertility problems. This is especially important to understand if you’re having a myomectomy specifically because you want to get pregnant later. The surgery preserves your uterus, but the scar tissue it creates can sometimes work against fertility in other ways. Surgeons often use barrier products during the procedure to reduce adhesion formation, though they can’t eliminate it completely.
Does Fibroid Size or Location Matter?
You might assume that bigger fibroids or fibroids in certain spots are more dangerous to remove, but the picture is more nuanced than that. A study of laparoscopic myomectomies for intramural fibroids (the type embedded in the muscular wall of the uterus) found no statistically significant difference in complication rates based on whether the dominant fibroid sat on the front wall, back wall, or top of the uterus. The complication rates ranged from about 3% to 9% across locations.
That said, fibroids on the front wall of the uterus showed a trend toward more bleeding during surgery, even if the overall complication rate was similar. And while location may not dramatically change your risk, the number and total weight of fibroids do. Surgeries involving multiple fibroids or particularly heavy ones are the cases most likely to require conversion from laparoscopic to open surgery.
Pregnancy After Fibroid Surgery
If you’re planning to have children, the most important long-term risk to understand is uterine rupture during a future pregnancy. When the uterus is cut open to remove a fibroid, the resulting scar can weaken under the stress of a growing baby. A meta-analysis found the risk of uterine rupture at about 0.4% after open myomectomy and around 1.2% after laparoscopic myomectomy. The higher rate with laparoscopic surgery likely reflects differences in how the uterine wall is stitched closed through small incisions.
A single-center study following 523 pregnancies after laparoscopic myomectomy found a rupture rate of 0.6%, with 77% of pregnancies reaching full term. About 13% ended in miscarriage and 10% resulted in preterm delivery. These numbers are reassuring overall, but they mean your future pregnancies will be monitored more closely, and you may be advised to deliver by cesarean section depending on how deep the original surgery went into the uterine wall. Most surgeons also recommend waiting several months to a year before conceiving to allow the scar to fully heal.
Warning Signs After Surgery
Most recovery goes smoothly, but certain symptoms in the days and weeks after surgery signal a problem. A fever above 38°C (100.4°F) that persists more than 24 hours after surgery can indicate infection. Heavy vaginal bleeding that soaks through a pad every hour, increasing abdominal pain rather than gradually improving pain, or a visibly swelling or hardening area near your incision could point to internal bleeding or a hematoma forming in the abdominal wall.
Rare but serious complications like bowel perforation or peritonitis (infection of the abdominal lining) can cause sudden, severe abdominal pain, nausea, vomiting, or an inability to pass gas. These require emergency care. In reported cases, hematomas in the abdominal wall have been caught within hours of surgery when patients were still being monitored in the hospital, which is one reason overnight observation is standard for most fibroid surgeries.
Putting the Risks in Perspective
Fibroid surgery carries real but manageable risks. The mortality rate of 0.013% means the overwhelming majority of patients come through without life-threatening complications. Minor complications in the first month affect roughly 1 in 10 patients, and most resolve on their own or with simple treatment. The largest long-term concern, adhesion formation, is extremely common but usually silent.
Your individual risk depends on the type of procedure, the size and number of fibroids, and your overall health. Minimally invasive approaches offer advantages in blood loss and recovery time without meaningfully increasing the complication rate. For people planning future pregnancies, the small but real risk of uterine rupture is worth discussing with your surgeon in detail so you can make an informed choice about timing, surgical technique, and delivery planning down the road.