Laparoscopy in endometriosis and pregnancy

 

Endometriosis is a disease of the uterus, in which there is excessive proliferation of cells of the inner layer of the organ. The endometrium can grow within the genital organs, and can grow into nearby tissues (e.g., intestines). The disease is characterized by bleeding and inflammation. In the initial stages endometriosis be hormonal therapy. The ineffectiveness of treatment, surgical intervention. Laparoscopy in endometriosis is performed using General anesthesia.

The reasons for the development of the disease

What are the causes of this disease? According to most experts, endometriosis develops in the presence of retrograde menstruation. During menstruation pieces of the endometrial of the uterus fall into the fallopian tubes and abdominal cavity. Pieces of tissue are fixed in organs and begin to function independently. Under the action of certain hormones in the menstrual phase of ectopic foci of endometrium begins to bleed, causing inflammation in organs and tissues. In the development of endometriosis is of value immune status of women, hereditary factors, features of the structure of the uterus and appendages.

What kind of complaints can turn a woman with endometriosis?

  1. Usually the first symptom in the development of the disease are painful menstruation. But pain, menses accompanied by profuse bleeding.
  2. Pain during sexual intercourse.
  3. Pain in the pelvic region of the diffuse nature.
  4. Discomfort at the time of defecation or urination.
  5. Dizziness, weakness, drowsiness may be signs of anemia in the background of endometriosis.

Diagnosis of disease

In cases of suspected endometriosis, the doctor will prescribe diagnostic procedures:

  1. Ultrasound examination of the uterus, ovaries and other abdominal organs.
  2. Hysteroscopy of the uterus.
  3. Colposcopy.
  4. Laparoscopy.

In the latter case we are talking about diagnostic laparoscopic examination. Examination of the uterus and other organs will allow to estimate the localization of foci of disease, degree of organ damage, the activity of the pathological process. During a laparoscopy, the issue of further therapeutic actions.

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After conducting a comprehensive survey of women defined treatment strategy. What features of the patient should be considered when prescribing treatment?

The first thing to pay attention to the woman’s age, her gynecological history (number pregnancies, deliveries and abortions), the woman’s desire to have subsequent pregnancies.

Also, the importance of the localization of lesions, their prevalence and the presence of comorbidities.

Therapy endometriosis conservative method

Patients of childbearing age, young girls, women before menopause are shown medication. Drug therapy includes:

  • The purpose of the combined hormonal products containing progestins and estrogens.
  • The purpose gestagennah drugs.
  • Use of drugs from the group antigonadotropnym.
  • Other hormonal agents.

The choice of drug depends on the stage of the process, the woman’s age and presence of comorbidities.

Surgical treatment of the disease

If necessary, surgical intervention specialist selects one of the two possible directions of treatment:

  • Operation with preservation of the reproductive organs.
  • Radical therapy (removal of the uterus and appendages).

Surgical intervention with preservation of the uterus and appendages is performed laparoscopically. The purpose of laparoscopy in this case is the removal of endometriosis, cysts, adhesions of the elements. In some situations, surgical treatment?

  • The presence of endometriotic cysts.

  • The severity of adhesions of the uterus and fallopian tubes, which is manifested by inability of a woman to get pregnant.
  • Pus formation in organs and tissues as a result of endometriosis.
  • Localization of lesions of the uterine layer on the abdominal organs in violation of their functions.
  • Ineffective treatment of hormonal drugs.

Conducting laparoscopy requires special training women:

  1. Examination of smears from the genital tract on the composition of the microflora and cellular composition.
  2. According to the testimony of the investigation of the cervix by colposcopy.
  3. The definition of indicators of blood coagulation.
  4. Ultrasound diagnostics of abdominal cavity and small pelvis.
  5. Preparation of the intestine for a few days before surgery.
  6. Counseling to normalize the emotional state of women (if necessary).
  7. Inspection specialists narrow profile in the presence of concomitant pathology.
  8. Electrocardiogram.
  9. Clinical blood analysis and General examination of urine.

What are the advantages of laparoscopy to abdominal surgery before?

  1. Because laparoscopy is a fairly low-traumatic operation, the risk of development of adhesive processes in the abdominal cavity is minimal.
  2. The recovery period after surgery with this method is of short duration.
  3. The risk of development of infectious complications of endometriosis after laparoscopy is negligible, because the operating wound, usually has a large area. In the process of the surgical intervention is performed laparoscopically, several small incisions in abdominal wall (1-2 cm). This is enough for introduction of a laparoscope into the abdominal cavity.

The postoperative period

The postoperative period in this case is characterized by short duration and lack of severe complications. What may bother in the first days after laparoscopy, and what rules should be observed?

  • On the first day a woman may experience severe pain in the abdomen. In this case, shown by appointment painkillers anti-inflammatory drugs in the form of injection of Ketorolac, Analgin, Ravagin, Spazmalgon. In case of pronounced pain syndrome intramuscular assigned to narcotic analgesics.

  • In addition, in the first few days after surgery, possible bloody spotting from the genital tract. This is a normal reaction of the body to surgical manipulation does not require special treatment. However, if the bleeding was too profuse and is accompanied by increased pain, you should immediately put notify the attending physician.
  • If laparoscopy were involved in a large area of the abdominal cavity, is assigned to antibiotic therapy to prevent the development of complications.
  • In the first week after the laparoscopy shows the diet to prevent increased gas formation.

Recommended in the subsequent prevention of endometriosis, which is regular visits to the gynecologist, the correct choice of contraceptives, hygiene sexual contact (especially during menstruation), proper treatment of chronic diseases of the reproductive system. In addition, preventive measures include normalization of body weight and sufficient physical activity women.

Pregnancy and endometriosis

Many women are interested in the question can you get pregnant after the operation? If so, when you can get pregnant after laparoscopy? Pregnancy can have a positive impact on the course of the disease. The possibility of pregnancy after laparoscopy comes after the end of the period of treatment with hormones. Normally, experts recommend to plan pregnancy not earlier than 3-4 months after surgical therapy of endometriosis. Pregnancy after laparoscopy of endometriosis requires enhanced medical monitoring.

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