Conservative myomectomy and hysterectomy if uterine fibroids
Conservative myomectomy is surgery to remove the fibroids with preservation of the uterus. Manipulation shown at a young age and small size of nodes. This operation allows you to get rid of the problem, saving the woman the opportunity to carry and give birth to a child in the future. In difficult cases is removal of the uterus with complete loss of reproductive function (hysterectomy).
When treated with surgery?
Uterine fibroids – a benign tumor of the character, it affects the muscular layer of the body. In most cases this disease appears in women with abnormal hormonal background and when excessive production of estrogen. For the treatment of uterine fibroids using various techniques:
- conservative treatment (hormonal drugs);
- uterine artery embolization;
- conservative myomectomy;
- hysterectomy (removal of the uterus).
Conservative myomectomy is performed when the node size to 5 cm before the operation can be assigned to hormonal medication to reduce the size of tumors and reduce the blood loss. The operation is performed open or laparoscopically (through punctures in the abdominal wall).
Hysterectomy is indicated in the following situations:
- the size of the nodes greater than 5 cm;
- the tumor appeared on the cervix;
- constant pain provoked by pressure of the fibrous nodes in tissues and organs;
- there is a cancer risk;
- the risk of necrosis, if the myoma is on a stalk twisted;
- developing fibroids in parallel with other pathologies of the uterus (prolapse or prolapse of an organ);
- fibroids in menopause;
- fibroids grew to a size 14 – 16-week fetus.
To remove a diseased organ may not completely, but only the diseased part. There are cases that doctors leave the cervix, ovaries and fallopian tubes. Often the removal of the uterus is prescribed for combination of fibroids with other pathological processes in this organ:
The endometriosis. Permanent tissue growth of the endometrium when they are outside of the authority. Common pathologies of the reproductive system. In that period, until the disease is fully manifested, the immune system of women weakens, you may experience other diseases that will aggravate the problem. If the symptoms are strong enough, no medical treatment gives visible results or is a risk of degeneration of benign tumors into malignant, doctors may highly recommend hysterectomy (removal of the uterus).
Hyperplastic process of the endometrium. The emergence of this disease together with uterine (especially in menopause) – reason for removal of the uterus.
Cancer of the female genital organs. In this case, the deletion will save a woman’s life. After deleting this files most often additionally prescribe chemotherapy. If the reason for the surgery was cancer, the doctors have to completely remove the organ and the lymph nodes.
Necrosis of fibromatous nodes. Quite complex pathology of uterine fibroids. The main symptoms, malnutrition of the tissues, swelling and severe pain. If in the body there is infection, the symptoms are worse. With this diagnosis in any case, the prescribed operation. Considering the individual characteristics of the disease and the patient (age), determine its volume.
Prolapse or uterine prolapse. The problem occurs because of loss of tone of the muscles of the pelvis or peritoneum. This problem occurs in women who work with large loads, large mothers, with hormonal disorders or inflammatory processes in the body. In the early stages of the disease the woman is quite simple exercises to train and strengthen the muscles. Despite the fact that hysterectomy is considered a drastic step, it’s a pretty effective way to deal with this character.
Preparing for surgery
Preparing for surgery to remove the uterus requires special measures. It is done under General anesthesia. The doctor examines the history of the disease, he must know all the features of the female organism, infectious and chronic diseases, Allergy to medications, possible reactions to the anesthesia.
Preparing for surgery, conduct a number of activities:
- a full examination;
- clean the intestines;
- treat inflammatory diseases;
- prescribed a special medication;
- provide psychological assistance.
What is the procedure?
How is the operation to remove the uterus? First, the surgeon determines the amount and method of operation. Depending on the method of infiltration, there are several types of hysterectomy:
- Subtotal (remove only the uterine body, cervix left);
- total (removal of the entire body together with the neck).
According to the method of carrying out are distinguished:
- laparoscopic surgery;
- access through the vagina.
Before surgery, the patient is administered anesthesia. Anesthesia is selected, taking into account individual peculiarities of the woman’s body, body weight, age. Has the value and duration of the procedure.
Laparotomy – abdominal (open) surgery. In order to access the uterus, make a vertical or horizontal incision length to 15 cm in the abdomen. The advantages of such a technique is that the doctor clearly see all the organs, evaluates the condition of tissues. Complete removal of do in severe cases of tissue polyps or adhesions, if the uterus is much enlarged, or the patient was diagnosed with cancer. There are drawbacks – a very long and painful rehabilitation, ugly scar.
Laparoscopy. The most gentle of all types. The operation is performed with special tools that make multiple small punctures in the abdomen. Be carried out without a single incision. In one of the holes insert the tube through which is introduced a special gas, the abdomen rises and physicians have access to the necessary bodies. Then lead a special chamber, through which monitor the process and control of it, and special tools that will be manipulated. The main advantage of this method is that postoperative rehabilitation is of short duration, the body almost no trace remains.
Vaginal. The most comfortable operation for women, it leaves no scars and other signs. The physical and emotional rehabilitation is very fast. Despite the fact that this is a quick and simple operation, it can be done not everyone, because there are many contraindications:
- greatly enlarged uterus;
- if a woman had a caesarean section;
- when there is a malignancy;
- severe inflammatory processes in the body.
The average duration of laparoscopic hysterectomy is 1.5 – 3.5 hours. Cavity removal – from 40 minutes to 2 hours, depending on difficulty level. Removal method vaginal hysterectomy takes about two hours.
The postoperative period
After laparoscopy because of anesthesia after surgery, the patient can not stand the first few hours. After the allotted time, the patient may rise from bed, eat, drink, walk. The stitches are not removed, discharged after 2 to 5 days after surgery.
The first weeks it is important to abandon the bathroom and take a shower only, the wounds are treated with a solution of iodine. To normal life the woman is refundable within 2 – 3 weeks.
The postoperative period after removal of fibroids or the entire uterus depends on the woman’s body. The recovery process make it difficult different health problems and the complexity of the operation. Sex life can begin after a month.
Pregnancy after myomectomy
During conservative myomectomy removes only the tumor. The uterus remains, and in the future a woman can give birth to a child. In that case, if the operation was conducted with the aim of infertility treatment, it is recommended to plan pregnancy in the near future. Otherwise, high risk of recurrence of tumor growth, recurrence, and infertility. The exact timing of rehabilitation will set the attending physician.
In this case, after conception it is important to monitor the condition of the uterus. Scar after surgery is quite dangerous for pregnancy, it can cause serious complications including the threat of miscarriage. There is a risk of uterine rupture along the scar during pregnancy and delivery. Natural childbirth after myomectomy is not recommended. Prior surgery and the scar on the uterus – the reason for planned cesarean section.
Naturally, after the operation the man needs a lot of strength for the recovery process. Also during the surgery addressed the abdominal wall, it should not be ignored. After abdominal surgery it is important to eat right, stick to strict diet in order not to provoke the tissue damage.
The first 14 days the patient should eat only well-digested foods, follow the digestion and prevent constipation. At home you also need to stick to a diet. You can eat cereals, meat, fish, brown bread, fresh vegetables and fruits, dairy products.
For rapid recovery, to prevent complications and to secure a full life, you need to adhere to a certain diet, to eliminate unnecessary burdens, to lead an active lifestyle and to avoid stress.