The term endometriosis is used in medicine to refer to a common gynecological disease caused by the proliferation of endometriotic tissue in the thickness of the uterine muscle layer or in other organs outside the uterus. When this occurs pathological fociwhich becomes over time more and more. In addition, endometriosis develops adhesion process in the area of the sacrum and the abdominal cavity, which interferes with the normal functioning of nearby organs.
So the pathology itself is characterized by very unpleasant symptoms, in particular severe pelvic pain, menstrual disorders, etc., and also is the cause of serious complications, one of which often becomes infertility, the question of the treatment of endometriosis is acute.
After conducting a series of diagnostic studies, the doctor determines the most effective therapy, based primarily on the localization of the pathology, as well as the physiological characteristics of the patient. In some cases, it is possible to cope with the problem by methods of conservative treatment, including hormone therapy, immuno-strengthening drugs and other means. But there are situations when drug treatment does not give the expected effect or is completely contraindicated, then endometriosis can be cured only with the help of surgical intervention.
Indications for surgical treatment
The main goal of any treatment for endometriosis should be complete removal of pathological foci. Only surgery can fully cope with this task, and subsequent hormone therapy can be aimed at preventing the recurrence of the disease. However, there are situations when it is impossible to do without surgical intervention. So indications for surgery serve as:
- retrocervical localization of endometriosis,
- the presence of an endometrioid ovarian cyst,
- endometriosis of the uterus (adenomyosis), occurring with myoma, complicated by uterine bleeding,
- the ineffectiveness of drug therapy, even with uncomplicated forms of endometriosis.
Types of operations
Any surgery for endometriosis is carried out with the aim of excision or coagulation of lesions. For this may apply following techniques:
- laparoscopy (minimally invasive surgical technique with minimal incisions),
- laparotomy (global abdominal incision in order to gain access to internal organs),
- with help vaginal access,
- with help laparoscopy and vaginal access.
Most doctors agree that even with complicated endometriosis, it is necessary to carry out as much as possible. organoplastic operations, resorting to radical methods only in the most extreme cases, when all other surgical and drug treatment options did not produce results. This is especially important for patients of childbearing age who want to preserve their reproductive function in order to have children in the future.
Today, an effective method of treating endometriosis, which allows to preserve the generative function of a woman, is laparoscopy, which is used to remove pathological foci from the pelvic peritoneum, ovaries, and retrocervical endometriosis, endometrioid cysts and adhesions.
Thanks to the laparoscopic method, the doctor can radically remove the lesions, while at the same time injuring the patient. In addition, such a minimally invasive operation allows you to avoid many postoperative complications, as well as to eliminate the unpleasant clinical manifestations of endometriosis, consisting in pain syndrome, menstrual disorders, dyspareunia, functional infertility, etc.
Treatment by laparoscopy can be carried out repeatedly, given the chronic and recurrent nature of endometriosis. Sometimes repeated surgeries are performed only to control the effectiveness of the treatment. The nature of the pathology and the degree of its distribution determines the amount of laparoscopy.
Surgery to eliminate foci of endometriosis on the pelvic peritoneum
When the pathological process is localized in the pelvic peritoneum, surgical treatment involves following stages:
- a thorough examination of the peritoneal zone, as well as the rectal-uterine and vesicular-uterine cavities, fallopian tubes and ovaries, the sacro-uterine ligaments, the uterus, as well as certain sections of the rectum,
- determination of the size and prevalence of detected endometriotic foci,
- creating conditions that are optimal for the removal of lesions, which may include dissection of adhesions and other manipulations,
- excision or coagulation of foci of endometriosis using a laser, thermodestruction, electrocoagulation or other methods.
Surgical treatment of retrocervical endometriosis
The amount of surgery required for retrocervical endometriosis is determined primarily by the extent of pathology and the involvement of other organs in the process. Before the operation, an ultrasound scan is performed using an intravaginal and rectal probe, as well as colonoscopy.
It is believed that the surgical removal of retrocervical endometriosis is the most difficult task to accomplish, since here it is necessary not only to remove the pathological foci, but also to restore the normal anatomical structure and functioning of the pelvic organs.
In recent years, in medical practice, if necessary, surgical treatment of this type of endometriosis is most often used. laparovaginal methodin which the lesion is first excised by a vaginal route, but at the same time a laparotomy is performed to clarify the extent of the pathology and control the removal of lesions. After all manipulations have been carried out, the affected area is processed with a laser or electrodes.
It is very important to note that the effectiveness of surgical treatment is to the greatest extent ensured by careful preoperative examination of the patient, which allows detecting the forms of endometriosis, as well as determining the extent of pathology. In addition, even at the diagnostic stage, it is important to analyze the stages of surgical intervention and prevent the possibility of complications.
How to evaluate the effectiveness of treatment
A woman may feel that she has completely recovered from endometriosis, if she has not had a chance for five years. disease recurrenceShe felt well and did not detect any clinical manifestations of pathology.
If endometriosis is diagnosed in a young woman, doctors always try to do everything to preserve her ability to bear children. In this case, the main criterion of the patient's health can be considered the occurrence of her pregnancy and successful delivery. It should be noted that in today's gynecological practice, the use of effective minimally invasive surgical methods allows to achieve this result in more than half of patients aged 20-36 years old.
It is a minimally invasive surgical procedure with minimal damage to access to the uterus. On the front wall of the peritoneum, there are three minimal incisions through which the introduction of surgical instruments.
Full control over the procedure and minor injuries during the operation make it possible to preserve the reproductive function of the patient, to stop the further progression of the disease.
It includes two solutions to the problem:
- separate entry - during the operation, the cervix is initially cleaned, followed by the cavity,
- traditional - involves the removal of all tumors blindly, which often contributes to the damage and the development of complications.
The resulting material is histological examination.
Removal of the uterus and the consequences
Excision of the affected organ in endometriosis is carried out in several ways: radical or laparoscopic. After the intervention, the patient is observed in the hospital. During laparoscopy, the discharge takes 3–5 days, with a classical operation, the woman is delayed for two weeks, until the suture is removed.
After the surgical procedure may develop complications:
- inflammatory and purulent processes in the area of sutures,
- impaired urination,
- pulmonary thromboembolism,
- internal or vaginal bleeding.
To prevent consequences, it is necessary to follow the advice of a doctor, wear a special bandage to support the muscles of the peritoneum. Within two months, a woman should not use tampons, take hot baths, go to steam rooms, baths and saunas.
Life after the procedure
Before discharge from a medical institution, the patient explains in detail the rules:
- the first two months should be excluded any physical activity and sexual intimacy,
- transition to a balanced daily menu, enriched with fiber,
- elimination of the use of alcohol, low alcohol products, narcotic substances,
- sports training as the strength and capabilities of the body,
- daily walks in the fresh air
- intimate hygiene requirements
- refusal to use intrauterine contraceptives - spirals.
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Questions and answers on: removal of the uterus with endometriosis
Zdrastvuyte.Mne 35 years. I had 3 pregnancies, 1 childbirth, 2 abortions. Three years ago, an intramural myoma node was found. At first it was 20 mm, now it is 41 mm (8 weeks). There is also a 17 mm node. Endometriosis. Numerous small cysts.
Now I am concerned about the copious periods with blood clots.
I was offered a surgical treatment to choose from:
2. Remove the 41 mm unit and after that put the Mirena Navy
3. Removal of the node with the uterus. At the same time, there are ovaries and maternal tubes.
What do I do? I worry that after the operation I would not have problems with the growth of new nodes. So you can advise me. Can I avoid an operation in my case? Thanks in advance.
Silina Natalya Konstantinovna answers:
Elena, I am totally against the statement of Mirena to you. It is necessary to begin with hysteroscopy - examination of the uterus. After receiving the results, the best will be the reception of Lindinet 20 according to the 24 + 4 scheme. But it is better to make an appointment to discuss in detail the further tactics of reference.
Hello! I am 33 years old. On ultrasound, signs of endometrial polyp and endometriosis. This month I am going to go to the hospital to remove the polyp. Tell me please, is it possible to carry out curettage of the uterus in case of endometriosis and is there not even more endometriosis?
Natalya Dmitrievna Petrik answers:
Scraping is better under the control of hysteroscopy for a more gentle effect. In the postoperative period, hormone therapy is required to suppress the spread of endometriosis under medical supervision.
Hello! I am 31 years old. I have endometriosis after an operation scar of the anterior abdominal wall. At the age of 21, I had a rupture of a cyst of the right ovary, histology confirmed endometriosis. At the age of 22, cyst of the left ovary is endometriosis with laparoscopy. At 23, peritonitis was removed, the right and left ovary along with the tubes. Pain continued taking hormone drugs. At 29, the uterus was removed from the uterus, with histology endometriosis of the uterus and cervix. passed a course of hormonal therapy. After 3 months went seal on the scar. For 2 years I have done 18 operations to remove an endometriosis scar. Blood hormones show elevated estradiol and lutropin. Passed the full course and currently taking danazol 400mg and supporting complex vitamins. All the specialists had them, but they only spread their hands, they say that it is necessary to do another operation in the abdominal cavity to check whether a piece of the ovary is left there, and the ultrasound shows nothing. What can I do if you can answer. with my hemoglobin 138, I now had 75-95 blood transfusions, but it will not rise. Permanent rise in blood temperature to 37.7, but if the seal begins to 40. Blood, urine is sterile. AIDS, Australian, PB, Buck. crops are negative. Help.
Kaliman Victor Pavlovich answers:
Good day, Natalia! I do not think that subsequent operations will bring you improvement. Therefore it is better, in my opinion, to refrain from surgery for endometriosis. Try triptorelin at a dose of 3.75 mg. If this does not improve - contact a highly professional doctor for examination and prescription of the greatest possible etiopathogenetic treatment.
Hello, please tell me, what better use of drugs for the treatment of endometriosis, found after abdominal surgery when removing myomas, the uterus with appendages left.
Petropavlovskaya Victoria O. answers:
Oksana, good afternoon. Endometriosis is a hormone-dependent disease in which benign tissue proliferation occurs outside the uterine cavity, structurally and functionally like endometrium (the location of the intrauterine layer in an unnecessary place). Today there are no methods that would allow to claim its complete cure. Modern methods have in themselves such approaches: observation, conservative treatment - hormone therapy, mainly surgical - removal of foci of endometriosis with organ preservation. Many people prefer to treat women with this problem by combining endosurgical intervention with pre- and postoperative hormone therapy (necessarily) -basic drugs are gonadotropin-releasing hormone agonists.
January 22, 2013 laparotomy surgery was performed to remove bilateral ovarian cysts (endometrioid) and multiple leukomyoma. The uterus was applied napkin Interside. Were identified foci of endometriosis in the peritoneum and intestines. Expanded adhesions. (There was an operation laparoscopy in 2007. removal of bilateral kypyaichnika (endometrioid)). The pipes are good. Tell me, is it possible to pregnancy in this situation? And what can be done against the adhesive processes of the pelvic organs?
Shapoval Olga Sergeevna answers:
Hello Svetlana. Whether the pregnancy will come in this case, no one will 100%, unfortunately, answer you. Try it, especially since the condition of the pipes allows. Are gonadotropin releasing hormone agonists recommended for treating endometriosis? Against adhesions, you can put candles distreptaza, drink enzymes (cerata, biosyme, wobenzyme). Anti-adhesive therapy to spend at least 1.5 - 2 months.
After removal of an endometrioid ovarian cyst, she took femoston for 5 years, as she had menopause. At the same time, internal endometriosis was observed. And in the last 8 months, an ultrasound scan revealed 8 and 9 mm polyps in the uterus. (The truth is in doubt!) The doctor canceled femoston and prescribed a second ultrasound scan in 3-4 months.
The question is whether I am doing the right thing, waiting for so much time, and whether these tumors can pass when Femoston is canceled. Thank you!
Gritsko responds to Martha Igorevna:
I advise you to go through the control ultrasound now to confirm the presence of polyps. If they really will, and they will grow in a few months, then a cleanup will be necessary.
Hello, I am 47 years old, 14 years ago, ovaries-cyst were cut out. Endometriosis. I have chronic pyelonephritis, pancreatitis and cholecystitis, lack of calcium, uterine ultrasound, involution of the uterus. and phytolysin paste and sent for a consultation to the gynecologist, who decided that it lacked hormones (vaginal dryness and pain during sexual activity, pain when urinating) and prescribed HRT and femoston 1/5. After 4 tablets, the lower abdomen got sick, but not as menstrual pain and loins, menstruation is not. Do I need HRT, what to do, nothing had hurt before. Are there any cases of appointment of HRT now if the operation to remove the ovaries was 14 years ago.
Dikaya Nadezhda Ivanovna answers:
Refer again to the examination to the doctor, do a gynecological ultrasound. In parallel - repeat an.moch. Possible exacerbation of cystitis, pyelonephritis. HRT do not rush to cancel, only after examination by a doctor, if indicated.
Hello! On July 13th, I underwent laparoscopic surgery to remove endometrioid cysts from both ovaries, dimensions before surgery: pr. Ovary - 5.7 * 4.1 * 3.3, left - 5.3 * 4.5 * 4.8. Janine was prescribed 3 months after surgery plus postoperative ultrasound and blood and urine tests. I passed the tests 14 days after the operation, my urine was normal, soy was high in the blood (21), a week later the second blood test was normal. Immediately after the operation, bleeding started on day 2, I was warned that it could be so, they lasted 6-7 days, not very abundant as discharge, and not menstruation. My gynecologist said that this ovulatory discharge, and menstruation, I have to wait on schedule. Monthly should have started around July 26-30, since my cycle can be 28-32 days. I waited for menstruation, but only on August 5 there appeared at least some sign of bleeding, that is, the cycle lasted 38 days. Why such a delay, postoperative stress for the body? Before the operation, too, the menstruation was very scanty, on August 5, it was a little dull and calm, that is, it did not bleed like during normal menstruation, just smeared a little and that was all, but I had to start taking Janin from the first day, I hesitated, menstruated or not, and nevertheless, she began to take it on Aug. 5, in the following days she also just smeared, but not blood. What is the reason, because the ovaries were now without cysts? About 2 weeks after the operation, I began to notice the temperature only in the evenings to 37.3, in the morning the usual 37.4-37.8, now (by 20 August) the temperature rises and in the morning to 37.1. What is the reason for such a temperature for 3 weeks already, she told her gynecologist, she said that it could be a postoperative. reaction. Passed ultrasound Aug. 17, a month after surgery, ovaries norms. sizes: right - 1.8 * 2.7, left - 2.4 * 2.8, the conclusion is a diffuse increase in the uterus, the state after the operation, the body of the uterus is rejected posteriorly, dimensions 6.2 * 5.0 * 6.2, internal the structure is heterogeneous due to uneven distribution of signals, the uterus is not expanded. Why is the uterus so enlarged, maybe this is the post of my post. temperature? Magnetic resonance. tomography before the operation showed that the uterus is of normal size, the usual location (anteversio), 9.1 * 4.5 * 5.6 together with the cervix, the zonal structure of the uterine walls is preserved, the endometrium is well differentiated, corresponds to the phase of menstruation. cycle (it was the 34th day of the cycle), the transition layer of the myometrium is unevenly thickened, max. cross-section of 0.3 cm, its contours on the border with myometrium are indistinct, ext. contour (on the border with endometrium) clear, smooth. Postoperative discharge also says that the uterus is normal. sizes and shapes, normal color, agile, no endometriosis in the uterus, the tubes are in order, as the endoscopist said to me, who operated on me. Please tell me what can be associated with a diffuse increase in the uterus (maybe with the reception of zhanin, I have no specific contraindications) and what to do about it? Sex life, I do not live now, after the operation, too, especially not strained after the operation, did not lift anything heavy. Thank you very much, Elena
Klochko Elvira Dmitrievna answers:
Good day. This condition is possible after surgery. Recovery takes about 3 months. Janine drink according to the scheme. It suits you - only possible daub on 1 package - continue to drink and do not throw. the uterus on zhanine will decrease in a couple of months.
Hello, Doctor! Help me please! I am 47 years old, uterine myoma is treated with 30 years and endometriosis. In May 2007, she set the spiral to Miren, until January 2011 everything was fine, and from January the monthly periods became abundant and 10 days, on June 27th I started to have monthly periods, were abundant, and then a small daub, went to the doctor, decided to remove Miren, See how and put a new one. On July 20, Miren was removed, and on July 22, I started, as the doctor said, menstruation, but it just poured from me. On July 29, diagnostic curettage was performed on the background of bleeding, gentamicin and metragil were dripped and began to drink a norkolut with 5 tablets and stopped at 2 pills. Somewhere on August 9, I began to bleed little by little, on August 12, Diferelin was given a shot of 3.75, and the burst was canceled. The first day after the injection, the bloodstream, as during menstruation, was taken by Vikasol, the second day was a little, and today, on the third day, blood was more abundant. The last ultrasound 12.08.11. Length 82, width 65, thickness 93. On the front wall interstitial nodes 32 * 26mm, 13 * 8mm, on the back wall closer to the bottom at the border with the cavity, deforming the last, interstitial node 21 * 19mm, in the lower segment along the back wall of a similar height knot 11mm. On both walls, areas of increased echogenicity without clear contours. Endometrial layer thickness 3mm. The structure of the endometrium is not changed, the uterus is not expanded, the contours of the endometrium at the border with the inner muscular layer are clear. The cervix is visualized. The structure of the cervix - along the cervical canal and several more cysts up to 11 mm thick. The cervical canal is not expanded. The right ovary is visualized not enlarged, localization is typical, length 26, width 15, thickness 16. The structure is unchanged. The left ovary is the same. Pathological formations in the field of malotaza are not revealed. Free fluid in the rest space is undefined. Conclusion - uterine fibroids with submouth growth. Echo indications of internal endometriosis. Pathological examination after diagnostic curettage. - A large fragment (solid knot?) Of fibroleiomyoma of typical structure, with phenomena of small-nesting hyalinosis, is determined in the sent material. The boundaries of the fragment are clear, in some places outside there is a narrow strip of normal myometrium. Separately, very small single fragments of the superficial endometrium. Scraps of cervical epithelium. Before removal, Mirena saw only one node along the front wall and did not see any changes in the neck. I do not know what to do next. continue curing Diferelin, 3 months, then Mirena, or to have an operation? If operation, what? The doctor suggests removing the uterus along with the cervix. What could be the consequences after such an operation? How will affect your personal life? I will get rid of the bleeding, but how will my ovaries work without the body of the uterus and can I leave the cervix? What should I do? Help, please, with advice, thankful in advance.
Kondratyuk Vadim Anatolevich answers:
Hello. Removal of the uterus is a crippling operation, performed in case of a reasonable suspicion of a malignant tumor or confirmation thereof. An effective method of stopping uterine bleeding associated with myoma is embolization of the uterine arteries, however, to confirm the indications for this technique, additional examination at our clinical base is necessary.
Due to the fact that various gynecological diseases concern the overwhelming majority of women, the question of how to cure endometriosis concerns many people. Completely get rid of this disease through treatment is almost impossible. Any type of treatment can only give remission of varying degrees of resistance, but a complete cure will occur only after the onset of menopause.
How to treat endometriosis?
Treatment of endometriosis of the uterus is determined by the doctor, depending on the age of the patient, the stage of the disease and other conditions. To eliminate pain and bleeding most often use hormonal contraceptives and drugs that suppress the production of estrogen. If a woman does not plan a pregnancy anymore, but wants to cure endometriosis, then the bleeding can be eliminated by surgery to remove the endometrium. If it is necessary to preserve reproductive function, doctors do everything to eliminate the symptoms of endometriosis of the uterus and prevent the onset of infertility.
If the foci of endometriosis are extensive enough, then even young women can recommend surgery. During the operation, the adhesions are severed, retaining, if possible, the appendages, uterus and ovaries. After surgery, hormone therapy is prescribed, which is aimed at suppressing the remaining foci of endometriosis. Such an integrated approach can cure the disease, minimize foci and stop their blood supply, which has a beneficial effect on the patient's condition.
Features of the treatment of endometriosis in women
For older women who do not seek to preserve reproductive function, doctors use surgery to remove the uterus and ovaries. Young women may be recommended such an operation in case of a complication of endometriosis by malignant tumors or the ineffectiveness of hormonal treatment. Emergency surgery requires and obstruction of the ureter or intestines. In this case, the operation is necessary in order to free the organs from being overwhelmed by the tumor and remove the affected area. Recently, laser and thermal removal of the affected areas and the combined use of these methods for endometriosis have been very popular. This kind of “cauterization” of the foci of endometriosis allows, without significant intervention, to reduce the localization of the disease and slow down its development.
How to treat uterine endometriosis in adults?
Treatment of endometriosis of the uterus only surgical. The best is the excision of areas of endometriosis, followed by cryodestruction.
For excision of foci of endometriosis, the cervix is exposed in mirrors, fixed with bullet forceps and tightened to the entrance to the vagina. Endometriosis sites are excised with a scalpel and sent for histological examination. In recent years, such treatment has been widely used - evaporation of pathological implants on the cervix with a laser beam (CO2 laser).
With an isolated lesion of the cervical canal within the lower 2/3, laser destruction or cryodestruction of the canal or cone-shaped amputation of the cervix can be performed.
The results of our own research show the feasibility of all surgical operations on the vaginal part of the cervix immediately after the end of menstruation. This is associated with the least bleeding of the wound surface, good tissue regeneration and prevention of cervical endometriosis. However, some clinicians believe that such operations are best performed before menstruation.
Despite the many options for answering the question of how to cure endometriosis, only your doctor can give you the only true one. Therefore, do not neglect regular visits to the gynecologist and ultrasound examinations.
In the treatment of symptoms of endometriosis, doctors use several methods: surgical, endoscopic, medical, and combined, using several types of treatment at once. Good effect gives hormonal treatment of endometriosis.
Whatever treatment method is chosen, the patient must be ready for long-term complex treatment under the constant supervision of a physician. Only in this case, you can achieve a persistent recession of the disease.
Hormonal treatment of endometriosis
When conducting hormone therapy, it should be borne in mind that endometriosis is a chronic disease with a relapsing course and signs of autonomous growth of the implant, with a characteristic complex complex of molecular genetic disorders.
None of the drug does not eliminate the morphological substrate of endometriosis, having only an indirect effect on its biological activity. This explains the short clinical effect of hormone therapy.
The basis of hormonal treatment is the reduction of estrogen levels and the maintenance of a hypoestrogenic effect throughout the course of treatment. The nature and duration of exposure to endometriosis depend on the type, dose and duration of the use of a hormonal drug.
Over the past 30 years, hormonal preparations have been widely used in the treatment of endometriosis, causing the state of "pseudo-pregnancy" (estrogen-gestagens, gestagens), "pseudomenopause" (antigonadotropins), "medical hypophysectomy" (agonists of gonadotropin-releasing hormone)
Table 1. Hormone therapy options
General approaches to the removal of foci of endometriosis
Uterine endometriosis is a hormone-dependent disease that does not have a clear origin. Endometrial cells begin to grow beyond the uterus. The causes of such pathological changes have not yet been fully investigated by scientists. The most likely factor in the development of endometriosis is the presence of a hormonal disorder of immune homeostasis.
Laparoscopy is the leading method of surgical intervention in gynecology. Operations performed by laparoscopy are characterized by a minimal risk of complications both during and after the intervention. In addition, the rehabilitation period after laparoscopy has a lighter course, which is especially important for patients.
Quite often, laparoscopy as a treatment method is used for endometriosis. Endometriosis develops when endometrial cells that are in the mucous membrane of the uterine lining are thrown and grow into tissues unusual for them. This pathological condition is characteristic of women in the fertility phase.
For the relief of signs of the disease is carried out conservative and surgical treatment. The choice of treatment depends on the specific clinical case.
There are lesions of endometrioid growths of the inner surface of the uterus and cervix - adenomyosis and endometriosis, when foci are observed in the tubes, ovaries, in the pelvic cavity. Endometriosis of the pelvic peritoneum, endometrioid ovarian cysts, lesion of the fallopian tubes and adhesions due to endometriosis are considered to be the reason for intervention through the abdominal cavity by means of a laparoscope or a traditional incision.
Adenomyosis or internal endometriosis can be removed by curettage. If during the hystercopy, foci are detected, they are removed, small areas are cauterized.
As a rule, the operation is recommended with the ineffectiveness of drug tactics.
Conservative tactics involve the use of drugs in the following groups:
Surgery for endometriosis usually involves laparoscopy and subsequent cauterization of the lesions. Drug therapy must be prescribed before surgical treatment, as well as after it.
Indications for surgery
Indications for surgery for endometriosis - this is a common localization of endometrioid heterotopias. Generalized external endometriosis becomes a cause of excruciating pain and is not amenable to the conservative method of treatment. It is advisable to carry out the operation with limited lesions of the pelvic organs with endometriosis.
Before deciding to perform the operation for endometriosis, the gynecologist takes into account its feasibility, the extent of the lesions, the age of the patient, and the risk of damage to neighboring reproductive organs. Sometimes during surgery, the rectum and sigmoid colon, ureter and bladder can be injured.
The following indications for surgical intervention can be distinguished:
- persistent or periodic intense pain in the lower abdomen,
- painful defecation
- uterine bleeding.
Before deciding whether to have an operation for endometriosis, doctors consider the following important factors:
- the age of the patient
- the total volume of sites that are affected by endometriotic foci,
- probability of damage to the rectum and sigmoid colon, ureter and bladder.
Terms of operation
Surgery for endometriosis is carried out three days before the onset of menstruation.
A common form of endometriosis, in which the ovaries are affected, the pelvic peritoneum, conglomerate tumors and chocolate cysts are diagnosed, requires immediate removal. In this case, doctors can completely remove the uterus and ovaries. Консервативная операция, во время которой сохраняется непораженный яичник, показан для девушек, которые хотят родить ребенка.It shows the complete removal of all endometrioid tumors.
During a comprehensive diagnosis and examination, the doctor checks the uterus and peritoneum for the presence of lesions. If patients have found an extensive distribution of pathological formations, the operation for endometriosis has its own difficulties. In such a course of the disease, tissue that is very close to the bladder, ureter and rectum is affected. Due to the high probability of injury, physicians confine themselves to removing not all endometrioid heterotopies that are inside the abdominal cavity. Even with such an operation, the development of pathological processes in the future stops. Surgical treatment of women of climacteric age is carried out with a radical removal of the uterus and appendages.
Removal of foci of adenomyosis in women in menopause is performed with ablation - excision of the basal layer to prevent further germination of the endometrium. Young women undergo less invasive surgery. Curettage, cauterization of foci and hormonal treatment, the introduction of drug menopause for 6-9 months.
In the rehabilitation period after laparoscopy, the woman is shown to receive antibacterial, immunostimulating, anti-inflammatory drugs. It is obligatory to prescribe hormone therapy for a long time, thus avoiding the recurrence of endometriosis. Among the most popular hormonal drugs distinguish Janine, Bezanne, Buserelin. Vizanna for endometriosis, as well as other hormones used from 6 to 9 months.
During the first two months after surgery, you must abandon physical activity and sexual intercourse. It is important to observe the following recommendations of the expert:
- balanced diet,
- in the daily diet should be present fiber,
- refusal of bad habits, alcoholic beverages and drugs,
- playing sports
- walks in the open air,
- intimate hygiene,
- stop using intrauterine devices.
If after the operation the women had no relapses during the first five years and there was no pain, then the remission is considered to be stable.
Diagnostics and treatment methods
Endometriosis of the uterus is detected by:
- Ultrasound examination.
- Palpation method. An experienced gynecologist on a routine examination will be able to notice the pathological lesions. And if complaints of a woman are added to this, then with the help of additional tests it is possible to identify the disease in time.
- Hysteroscopy. Using this method, diagnosis and treatment are carried out (if necessary).
- Spiral computed tomography.
The main ways to combat endometriosis of the uterus include:
- Therapy with the help of hormonal drugs such as antiprogestins, oral contraceptives, gonadotropin agonists, the use of Duphaston.
- Removal of pathologies of the inner mucous membrane of the uterus through surgical intervention.
Depending on the presence of lesions and their location, surgical treatment is carried out by:
- Laparoscopy. With this type of operation, minimal cuts are made.
- Laparotomy. Access to the internal organs is obtained by cutting the abdominal wall. This method is used if endometriosis extends beyond the uterus.
- Hysteroscopy. The safest method of removing pathological foci. It is used for minor lesions of endometriosis of the uterus or cervical canal.
- Scraping The method is carried out with the help of an acute curette, with which the doctor cuts off the overgrown layer of the endometrium from the inner surface of the female sexual organ. It is used with a large area of lesions.
- Coagulation. Endometrial pathological tissues are melted and excised with an electric knife, laser, liquid nitrogen or radio waves. The doctor chooses the method of cauterization of endometriosis according to the testimony of the patient and depending on what equipment the clinic has.
- Hysterectomy. Surgery to remove the uterus. It is carried out only in the case when it is not possible to save the affected organ in other ways, there is a threat to the life of the woman.
There are several options for removing endometriosis with surgery. These include:
- Laparoscopy. Through minor incisions, a camera is introduced into the abdominal cavity, which shows on the screen the state of the female organs. Through the same incisions, the pathological formations are removed. This method is characterized by the minimum number of complications in the postoperative period. One of the indications for this procedure is the presence of endometrioid ovarian cysts. They form when the disease reaches this part of the genitals. The event lasts from half an hour to an hour, depending on the extent of pathology.
- Laparotomy. This is a common operation for endometriosis of the organs of the peritoneum and the small pelvis. When using this method to access the affected organs, a large incision is made in the abdomen, so that the doctor will notice any small things during the procedure. However, a laparotomy is characterized by a greater number of complications in the postoperative period.
- Operations with vaginal access to areas affected by endometriosis. This intervention is carried out under local anesthesia. So you can remove the foci of endometriosis, cervix and uterus entirely. This type of manipulation includes hysteroscopy, treatment with a laser, cauterization with current, liquid nitrogen.
- Hysterectomy. It is carried out in the most advanced cases when other types of treatment do not help, the disease greatly complicates the condition or there is a real threat to life and health.
Depending on the complexity of endometriosis, the doctor recommends the type of surgery needed to solve the problem and explains which organs will have to be removed. And the final decision remains for the woman.
After surgery for removal of the uterus prescribed course:
- anti-inflammatory drugs.
This measure is necessary so that during the recovery period after the surgical treatment of endometriosis there is no infection or inflammation. Surgery is a serious stress for the body. The woman's immunity decreases, she becomes vulnerable to viruses and infections. Therefore, up to six months it is necessary to avoid stress and physical exertion. Within 2 months should refrain from sex.
To avoid the causes of relapse due to hormonal fluctuations, hormone-based oral contraceptives are required.
Girls with mild forms of pathology, who have only been burned by foci of endometriosis in the uterine cavity with a laser, liquid nitrogen or other modern means of combating the disease, should also take all these drugs, but the recovery period will be easier. And the likelihood of complications in this case is much lower.
After any type of surgery, women also need to:
- take a multivitamin complex
- drink sedatives
- stop smoking and abuse of hard liquor,
- more often in the open air,
- monitor the purity of the external genital organs.
Treatment: conservative or surgical?
First, the patient is diagnosed. After a series of studies, the specialist decides which treatment will be effective given the localization of the pathological foci and the peculiarities of the woman’s health. Sometimes prescribed hormone therapy, immunotherapy drugs and other drugs. However, this approach does not always give the result. In this case, the operation is shown.
Indications for surgery
Endometriosis surgery is indicated for:
- retrocervical location of endometriotic foci,
- ovarian endometrioid cyst,
- adenomyosis (when the uterus itself is affected by endometriosis), and there are complications - bleeding,
- the lack of effectiveness of medication therapy, even if endometriosis is uncomplicated.
Removal by laparoscopy
Laparoscopy is a treatment that is chosen if the pelvic peritoneum, the ovary (or both ovaries) are affected, with retrocervical endometriosis, adhesions and cysts.
Laparoscopic removal, provided that it is performed by a good specialist, helps to avoid postoperative complications and overcome the symptoms that accompany endometriosis and so torment a woman:
Laparoscopic surgery to remove endometriosis of the uterus does not guarantee 100% cure. It may be necessary to re-intervention, since endometriosis is a chronic, recurrent pathology.
Removal of abnormal foci on the peritoneum
If endometriosis is localized in the area of the peritoneum, then the operation goes like this.
- The specialist carefully examines the area of the peritoneum, dimples (rectouterine uterine, vesicle-uterine), fallopian tubes, each ovary, sacro-uterine ligaments. Also pay close attention to the uterus and some parts of the rectum.
- According to the results of the examination, the doctor determines the size, as well as the degree of spread of the detected lesions.
- After the surgeon dissects the commissures and carries out other manipulations that are necessary to eliminate endometriotic foci.
- At this stage, coagulation or excision of pathological foci. Laser, electrocoagulation, thermal destruction, or other methods are used.
Surgery for endometriosis of the ovaries
If the ovary is covered with endometrioid cysts for a long time, adhesions occur. When this occurs, adhesions: the uterus with the sacro-uterine ligaments and nearby organs.
For the effectiveness of treatment in this case, it is not enough to simply clear the arising cyst. It should remove its capsule.
How is the operation for ovarian endometriosis?
- The ovary with the pathological process is isolated from adhesions of adhesions, cut off adhesions.
- Perform resection of the body, leaving the tissue is not affected by the pathological process.
- If the cyst in size is no more than three cm, then it is easier to eliminate. She husked, the capsule is removed or excised with fragments if it is too large.
- The bed of the cyst is treated with a laser or electrode. This ensures hemostasis.
- The removed cyst capsule is transferred to histology at the laboratory.
Who can be sent to remove the ovaries, or adnquecectomy? Adult women at the age of the upper limit of reproductive age or in the postmenopausal period, those with chronic endometriosis, ovaries infect large cysts, in which the disease often recurs.
Retrocervical endometriosis: volume of intervention
The amount of surgery required depends on the degree of pathology and whether other organs are involved in the process. Therefore, first perform ultrasound, colonoscopy.
Recently often used lapar-vaginal method. To begin with, the doctor excises the endometriotic focus through vaginal access. And at the same time, he conducts laparotomy in order to clarify the degree of pathology, to control how the process of elimination of the affected lesions occurs. Then the exposure area is treated with electrodes or a laser.
What is endometriosis of the uterus?
By endometriosis of the uterus is meant a hormone-dependent disease, the etiology of which is not fully established. It manifests itself in the growth of the endometrium of the uterus outside its normal location, that is, beyond the borders of the endometrium. Hence the name of the pathological condition of the body.
Usually, women who have passed menopause encounter such ailments; however, often, those who have never been a parturient woman seek help from specialists. In addition, it is believed that genetic predisposition to the development of the disease in this case plays a big role.
The disease is characterized by certain symptoms, it develops for certain reasons, and therefore it is extremely important to consult a doctor immediately after their first manifestations.
Depending on the stage of development of the disease, treatment is prescribed. In women of reproductive age, usually the detection of endometriosis occurs in the early stages, which allows not to carry out surgical intervention.
However, it is often the case that girls do not pay attention to the strengthening of symptoms, due to which they reach a state when it is necessary to remove endometriosis.
Given the fact that it is impossible to establish the exact location of the expanding endometrial tissue in the pelvic organs, specialists cannot always determine the causes of the pathology. The mechanisms that promote the development of the disease usually work. In their role are:
- implantation theory - assumes that the cellular elements of the endometrium fall outside the uterus on neighboring organs and tissues during the menstruation period,
- hormonal disorder - there is an androgenic dysfunction of the adrenal cortex, as well as the body has increased levels of certain hormones produced by the thyroid gland,
- predisposition at the level of genetics - it is scientifically proven that there exists in nature a marker responsible for the possibility of the development of an ailment among several representatives of the fair sex belonging to one family,
- immune system dysfunction - if the body's defenses are activated, the “abandoned” endometrial cells outside the uterus will be destroyed, however, if they are dysfunctional, they take root and begin to function,
- transformation (metaplasia) of the endometrium - under the influence of certain factors, the cells of other tissues can be transformed into endometrioid.
As provocateurs of the development of the disease may be:
- damage to the mucous membranes of the internal organs (this leads to numerous abortions and curettage)
- gynecological manipulations on the genitals (for example, cauterization of cervical erosion, cesarean section),
- inflammatory processes involving infectious diseases, genital organs,
- hormone therapy, improperly prescribed by a specialist,
- installation of intrauterine contraceptives,
- liver disease.
In addition, it is imperative that a woman is less exposed to stress, the effects of harmful external environmental factors, as they can also become "indirect" causes of the development of pathology.
Surgical treatment of endometriosis is not simply prescribed. First, the patient observes certain symptoms, then goes through taking medications, after which, in the absence of a result, he is prescribed surgery. The main symptoms of endometriosis include:
- pre- and post-menstrual discharge from the genital tract,
- aggravated abdominal pain during menstruation,
- lumbar pains
- cycle irregularity
- an increased amount of bleeding during menstruation,
- the inability to quickly conceive a child,
- dysmenorrhea (cyclic gynecological lesions, accompanied by lower abdominal pain),
- unreasonable weight gain.
It happens that the disease may not be accompanied by symptomatic manifestations, and therefore its diagnosis in such cases occurs in the final stages of development. Then, based on the patient’s condition, the specialist prescribes surgery, and endometriosis is removed.
But initially it is necessary to carry out certain diagnostic procedures, which include general urine and blood tests, colposcopy, and ultrasound diagnostics.
It is extremely important not to start the state of the body with endometriosis, as this can lead to consequences that will be too difficult to eliminate.
A woman can lose her own fertility, which will cause certain difficulties in sexual life, and can also face a real threat to her own life. It is important to consult a specialist with regular manifestations of even several symptoms.
In endometriosis, massive growth of tissues outside the uterus can occur, leading to disruption of the functioning of the entire reproductive organ. In this case, the uterus is removed, which prevents a woman from becoming pregnant and carrying out the child.
In the case when endometrial tissue takes up too much space on neighboring organs, it is possible that they are partially removed to save the patient’s life.
It is important to consult a doctor for the reason that the foci of endometriosis can sooner or later be the causes of the cancer, which in turn can also lead to the removal of the genital organ.
The worst case scenario in such situations is the helplessness of doctors, which in the last stages of the development of the disease can cause a fatal outcome for the patient.
It is recommended to closely monitor the status of internal genital organs after surgery for endometriosis during the first five years. In the event that the disease does not manifest itself again, it is considered to be completely cured.
Statistics say that about 60% of patients with a similar diagnosis are completely cured and no longer suffer from the disease.
Indications for surgery
Surgical intervention for endometriosis is prescribed only in certain cases, which include:
- заболевания хронического характера, касающиеся органов ЖКТ, крови, сердечно-сосудистой системы,
- intolerance to the components of drugs prescribed by a specialist,
- semi-annual treatment of the disease, not giving positive dynamics,
- diameter of foci of endometriosis more than 20 mm,
- the presence of cysts of the endometrioid type in the ovaries,
- the presence of deformities of the pelvic organs, as a result of which diseases of the gastrointestinal tract, ureters, kidneys, adrenal glands develop,
- the presence of adhesion process.
After all aspects of the disease have been studied, it is determined by what method the surgical intervention will be performed.
Methods of surgical treatment of the disease
Surgical treatment is usually represented by 2 methods:
With conservative surgery, internal organs are not removed. There is the elimination of foci of endometriosis, appointed in such cases as:
- pregnancy planning,
- moderate and severe forms of the disease,
- external endometriosis,
- the value of endometrioma on the ovaries is more than 20 mm.
Conservative surgery involves the use of laparoscopy or abdominal surgery. Most often, the laparoscopic pathway for the elimination of pathological formations is chosen, since the recovery period after the operation in women is much less.
Radical surgery occurs with the removal of internal genital organs. Indications for such treatment are situations when:
- treatment has no effect for women older than 40 years with severe forms of the disease,
- endometriosis turns into retrocervical form,
- develops adenomyosis.
The main ways of radical intervention are considered laparoscopic or laparotomic. They are practically no different from each other.
The recovery period after the transfer of operations of this nature can last up to six months and necessarily includes taking hormonal drugs to prevent the recurrence of the disease.
Features of the operation
Surgery for endometriosis, as with any other disease, has certain features. Showed her holding a few days before the onset of menstruation. The patency of the ureters is surely checked and ureteral catheters are inserted before the operation for the smooth work of the surgeons.
The decision to use a radical or conservative method of surgical intervention is based on the diagnostic examination carried out, as well as on the age of the patient.
The first method is usually recommended for women who are not planning to have more children. The preservation of the reproductive organs is expected in the fair sex who are in reproductive age.
The effectiveness of surgery in the treatment of disease
With endometriosis, recovery is guaranteed only if all the centers of the onset of the disease have been carefully removed. However, no one can give full guarantees, since pathology is prone to recidivistic manifestations.
It often happens that after a few years, repeated conservative intervention is applied. In the case of radical intervention, there is no recurrence.
For specialists treating women of reproductive age, it is important to preserve their reproductive function and get rid of infertility developed on the background of pathology.
In the event that the patient managed to become pregnant after the operation, they speak of a positive result of a conservative intervention. The absence of subsequent relapses, pain during menstruation is the result of a quality treatment.
Indications for removal of the uterus
Excision of an important female body does not always mean its total elimination (extirpation). Sometimes doctors leave the cervix, ovaries and fallopian tubes during surgery. Removal of an organ is required during oncological processes in it or appendages, massive bleeding that are not amenable to conservative treatment, to stop the development of the septic process on the pelvic organs (purulent metroendometritis). More often, the removal of the uterus occurs due to pathological processes that do not threaten a woman’s life.
Leiomyoma, fibroids or fibroids (fibrosis) of the uterus is a benign growth that occurs in the myometrium (muscle layer) of the organ. This is the most common disease of women after 45 years, however, the doctor will never prescribe a surgery without a serious reason. A small tumor is treated with conservative methods, but sometimes it is impossible to do without surgery. If uterine fibroids are determined at a young age, then gynecologists especially try to keep the woman's reproductive function.
In modern medicine, the operation to remove the uterus in the presence of myoma formations is prescribed for the following pathologies:
- the tumor is localized on the neck of the organ,
- fibromatous nodes exert pressure on adjacent tissues and organs, which causes constant pain in the patient,
- there is a risk of reincarnation of a benign tumor in cancer,
- signs that the fibroids on the leg with time will occur torsion, and this will lead to necrosis,
- the development of fibroids occurs with the prolapse of the uterus or the prolapse of the genital organ,
- the tumor has vivid clinical manifestations, and the woman is in menopause,
- fibromyoma has reached sizes greater than 12 weeks of gestation.
Chronic growth of the endometrium (glandular tissue) outside the uterus is called endometriosis. Pathology also refers to the common, and may be inside the reproductive system or outside it. The vast majority of diseases accounted for by the internal course of the disease. Laparoscopic removal of overgrown epithelium is mainly used, which preserves the uterus and other organs. If there is an aggressive course of the disease, a persistent lack of results of drug treatment or the risk of malignant degeneration, then doctors may insist on a hysterectomy.
Cervical or Ovarian Cancer
Removal of the uterus in cancer saves the patient's life. As a rule, in oncology, in addition to surgery, radiotherapy or chemotherapy is also prescribed. In cancer, radical hysterectomy is recommended, that is, not only the uterus is removed, but also the cervix, ovaries, upper vagina, fallopian tubes, and tissues with lymph nodes in this area are removed. The early stage of oncology allows you to perform a more benign operation with preserving the woman's reproductive function: removal of 2/3 of the cervix with preservation of the internal pharynx and other organs so that you can become pregnant and give birth.
Necrosis of fibromatous nodes
The most serious complication of uterine fibroids is necrosis of the fibromatous node. The disease is a violation of the nutrition of its tissues, in which there is edema and sharp pain. On palpation of the node pain increases, vomiting, irritation of the peritoneum, the temperature rises. In the case of the addition of infection, the general phenomena are aggravated. The indication for surgery is to establish the diagnosis. The volume of the operation is decided individually, depending on the age and general condition of the patient.
Omission or prolapse of the uterus
The prolapse or prolapse of the genitals in a woman occurs when the pelvic or peritoneal muscles are weakened. Pathology develops due to hard work, multiple births, endocrine disorders, or chronic inflammation. At the initial stage of the disease, therapy is aimed at strengthening weak muscle groups. Hysterectomy is considered though the most radical, but the most effective way to solve the problem. There are two options: excision of the uterus and the upper part of the vagina or carrying out a partial removal of the vagina, which preserves the possibility of sexual activity.
Preparation for surgery to remove the uterus
How to prepare for the operation? Since the hysterectomy is performed under general anesthesia, taking a long time, the removal of the uterus requires special preparation. The gynecologist before the operation should examine the patient's medical history, be aware of infectious, chronic diseases, allergies and the possibility of anesthesia. The whole complex of preparation for the operation includes a medical one, during which the examination, cleaning of the intestines, treatment of inflammations, medication and psychological correction take place.
Before carrying out hysterectomy, gynecological and general examination of the patient is carried out. Laboratory diagnostics includes conducting biochemical and clinical blood tests for:
- HIV antibodies
- sexually transmitted diseases (chlamydia, syphilis),
- infectious hepatitis,
- hormone levels, minerals, sugar,
- blood clotting
- rhesus factor and group.
Also conducted ECG, spirography, tonometry, radiography of the lungs. In identifying pathologies of the nervous system, kidney, respiratory system or heart, the patient is sent for further examination to other specialists. Gynecological diagnosis includes examination of the vagina and uterus, pelvic ultrasound. If you suspect cancer, the woman is sent for MRI, biopsy and histology. It is important before timely removal of the uterus to identify infections in the urinary and genital tracts.
Before performing any surgery, the intestines should be cleaned. To do this, three days before the operation, doctors prescribe a special diet that does not contain coarse fiber and slag. Rye bread, legumes, fruits and vegetables should be excluded from the diet. On the evening before the hysterectomy, it is advisable not to eat, as a last resort, it is allowed to have dinner with low-fat cottage cheese, yogurt or kefir 8 hours before admission.
You should not clean the intestines on your own before removing the uterus, since active peristalsis can interfere with the normal operation. On the day of surgery, nothing can be eaten and drunk to avoid vomiting during anesthesia.
If a woman does not have infections and pathologies of other organs, then she does not need medical preparation before removing the uterus. Infections are treated and antibacterial drugs are prescribed when the following diseases are detected:
- cold and viral infections
- endocrine pathologies (diabetes),
- neurological diseases
- disorders of the kidneys, respiratory system, cardiovascular system.
An extremely important manipulation before the operation is the preparation of the veins. Even if there is no varicose veins or chronic thrombophlebitis, after surgery there may be stagnation in the blood due to increased venous pressure. Such a process can end with severe complications up to the separation of the thrombus and its entry into the brain or lung vessels. Before the operation to remove the uterus, the patient should always consult a phlebologist or a vascular surgeon. During hysterectomy, compression is created for the veins using elastic bandages.
Recovery after surgery is a long process, and removing any uterus for any woman is stressful. The younger the patient, the greater her psychological trauma. The role of the doctor in this case is to explain the need for such an intervention, why it cannot be avoided, to talk about the course of the operation and the chosen excision.
Many women fear that after removal of the uterus, they will have problems with a partner or their sexual function will be completely lost. Practice shows that after rehabilitation, a woman loses only the function of childbearing, and she continues to experience sexual desire. For reasons of medical ethics, the doctor will advise not to inform the man about the extent of the removal of the uterus.
Course of operation
How is the surgery to remove the uterus? Hysterectomy begins with the choice of volume and access by the surgeon. As already mentioned, they remove either the entire uterus with appendages, or only a part of it. Depending on the operative access, the following types of hysterectomy are distinguished:
- Removal of the uterus through the vagina.
- Supravaginal (subtotal).
- Laparascopic with tools.
- Laparoscopic robot da Vinci.
- Open removal (abdominal surgery).
Surgical intervention to remove the uterus with the introduction of anesthesia begins. Anesthesia is applied, depending on the woman’s body weight, age, general health and the duration of the operation. All patients are introduced into general anesthesia, regardless of the chosen intervention technique for complete relaxation of the abdominal wall muscles.
During abdominal intervention, a surgical incision is made in the lower abdomen to access the uterus. The incisions are vertical and horizontal from 10 cm to 15. The technique is good because the surgeon can see the organs well and determine the condition of the tissues. Abdominal hysterectomy is resorted to with the appearance of large adhesions or polyps, an enlarged uterus, endometriosis, or cancer. The disadvantages of the technique are a long-term recovery, a serious condition after the intervention, a scar from an incision.
The main feature of the vaginal hysterectomy is that it is carried out in a way that is convenient for the woman - after the operation, there are no scars or stitches left on the body. After vaginal removal of the uterus, the patient quickly recovers, and a quick emotional rehabilitation takes place. Unfortunately, only a third of patients operate in this way, since there are many contraindications:
- large size of the uterus,
- cesarean section,
- malignant tumors,
- combined pathologies,
- acute inflammation of other organs and systems.
How long does the operation to remove the uterus? The duration of laparoscopic hysterectomy is on average 1.5 - 3.5 hours. Abdominal removal of the uterus lasts from 40 minutes to 2 hours, depending on the complexity of the surgical procedure. The duration of vaginal hysterectomy is no more than two hours, if the procedure passes without complications.
Any surgical intervention is a different degree of injury caused by damage to the tissues and blood vessels. After removal of the uterus, it takes time to fully restore the body. The scheme and duration of rehabilitation measures always depends on the severity of the disease, the characteristics of the female body, the type of operation, and postoperative complications. For the correction of health in the postoperative period, a whole complex of rehabilitation measures has been developed. Its main components are physiotherapy exercises, proper nutrition, hormonal support.
Recovery and Rehabilitation
The postoperative recovery period after removal of the uterus includes the time from surgical intervention to full performance and the onset of sexual activity. Rehabilitation is divided into two stages: early and late. With a successful abdominal hysterectomy, the early period is from 9 to 12 days, after which the patient is removed the sutures, then discharged from the hospital.
After laparoscopic exposure, early rehabilitation is 3.5–5 days. Bleeding and other symptoms, including possible infection, are eliminated during this period. After vaginal hysterectomy, if there were no complications during the operation, the patient is discharged from the hospital after a week. The late stage of recovery takes place at home with regular consultations of the doctor. On average, the stage lasts about a month. At this stage, there is a strengthening of immunity, recovery of the health and psychological state of a woman.
Nutrition after surgery
After the surgery to remove the uterus should follow the recommendations aimed at improving the gastrointestinal tract:
- Eat at least 6-7 receptions in small portions.
- Drink two liters of plain water every day.
- Food consumed in liquid or semi-liquid state.
It is necessary to introduce porridge in a crumbly form into the diet, and sea fish and lean meat - only in boiled one. Meat broths, low-fat fermented milk products, vegetables (beans, potatoes and cabbage - carefully), vegetable salads with vegetable oil, vegetable purees are allowed to be consumed. Fresh greens, dried fruits, walnuts are recommended. You can drink pomegranate juice, green tea.
- liquid porridge,
- muffin, white bread,
- fried, fatty, spicy dishes,
- semi-finished products
- smoked meat
- black tea, coffee,
- carbonated drinks,
- limit salt intake to prevent fluid retention.
After removal of the uterus gravity can not be raised 1.5 - 2 months. Sex is not recommended for 6 weeks after hysterectomy. Doctors advise to go in for sports, visit the pool and sauna no earlier than six months after abdominal surgery, when the scar is finally formed. Exercise to restore physical activity should be performed daily, without straining. In order to avoid problems with urination, Kegel exercises are shown to restore the normal function of the genitourinary system.
Recommendations of doctors in the postoperative period
Conducting a hysterectomy changes the lifestyle of a woman. Чтобы успешно восстановиться после удаления матки врачи рекомендуют обратить внимание на следующие моменты:
- Бандаж. Особенно рекомендован пациенткам в менопаузе, имеющим множество родов.
- Секс. For 4-6 weeks, sexual life is prohibited, because during this period the discharge continues.
- Special exercises. There is a perine-meter - a special simulator for strengthening the muscles of the pelvic floor and vagina. It ensures the effectiveness of intimate gymnastics.
- Tampons As long as there are excretions, use gaskets. Tampons are allowed only 2-2.5 months after removal of the uterus.
- Nutrition. Healthy food is important. Most of the dishes should be consumed before 16 o'clock in the afternoon.
- Hospital. Disability periods are 30-45 days for hysterectomy. With complications, the sick leave is extended.
Possible postoperative complications and consequences
Rarely there are complications after surgery to remove the uterus, but in order to seek help in time, you need to know about them. In the first days after hysterectomy, the following deterioration is possible:
- seam divergence or scar inflammation with purulent discharge,
- difficulty urinating (cramps, pain) or urinary incontinence,
- different intensity of bleeding (internal or external),
- pulmonary arterial thrombosis or thromboembolism leading to blockage of the branches, which is fraught with death,
- inflammation of the peritoneum (peritonitis), which can provoke sepsis,
- hematomas in the suture area,
- discharge with an unpleasant odor and clots.
If a seam infection occurs, then the patient's temperature rises to 38 degrees. To relieve this complication, the appointment of antibiotics is enough. Peritonitis develops more often if an emergency hysterectomy is performed on the woman. In this case, the pain syndrome is pronounced; therefore, antibiotic therapy and infusion of colloidal solutions are carried out. Repeated surgery may be required to remove the uterine stump and flush the abdominal cavity with antiseptics.
In the following months, there is a menopause, which in this situation is difficult. Most women feel burning and dryness in the vagina, hot flashes, discomfort in the genital area, and anxiety. This is due to hormonal adjustment, when the female body stops producing estrogens, as a result of which the vaginal mucosa becomes thinner and loses lubricant. Sexual intercourse in this condition can be painful, so the woman's desire for sex decreases.
Cost of operation
How much does a uterus surgery cost? The price of hysterectomy depends on several factors: the level of the hospital, the professionalism of the surgeon, the scale of the operation, the region and the length of stay in the hospital. Also, the cost of surgery is affected by the method of surgery. In private clinics in Moscow, laparoscopy will cost from 16 to 90 thousand rubles. Conducting abdominal or vaginal hysterectomy will cost from 20 to 80 thousand rubles. A similar operation to remove the uterus in Israel will cost from 12 thousand dollars.
Natalia, 35 years old: Separation from organs is sad, but when a hysterectomy is the only chance for survival, then there is no choice. I had a benign fibroid for 12 weeks, but while I was collecting the documents, it grew to 20 weeks! Passed lane operation. I was not afraid of her, but waited as salvation, because I thought that I would not survive - the bleeding during menstruation was so strong. He did the best surgeon in Ryazan, so there was only a thin shovchik.
Victoria, 46 years old: There are many women on the forum who have their uterus removed, and many are talking about surgery, not as a big problem, but as a release from it. The only drawback, according to women, is the impossibility of having a baby, but at my age it is no longer relevant, so I easily agreed to have laparoscopy. The operation is simple - after 5 days was already at home. It has been 30 days, and I almost forgot that I had suffered a uterus removal. Only early menopause with gentle but frequent tides reminds of itself.
Larisa, 52 years old: After removal of the uterus, osteoporosis of the hip joints developed. The decrease in bone density over time leads to their fragility, so I constantly sit on supportive medications containing calcium and vitamin D. Doctors say that there have been changes in posture, although so far I have not seen it visually. To prevent the occurrence of complications, hormone therapy was also prescribed.
Indications for hysterectomy
The sooner the disease is detected, the more effective the conservative treatment will be. You can suspect a deviation if a woman is worried about pain, discharge, failures in the menstrual cycle. In this case, you must visit the gynecologist, who will collect the history, conduct an inspection and appoint a number of examinations and tests, including colposcopy, ultrasound, hysteroscopy.
Endometriosis is a chronic disease of the female reproductive system. Properly selected drug therapy can eliminate the symptoms and achieve a state of remission. However, there are indications in which surgery to remove the uterus and ovaries can not be avoided.
Surgery will be the only option available if:
- the disease progresses,
- medicines don't help
- there were complications
- There is a risk of malignant neoplasm.
An important step is to prepare for surgery to remove the uterus. The patient is carefully examined, often require the help of a psychologist.
To understand how recovery takes place after uterus removal in endometriosis, and how to prepare yourself for the upcoming changes, you need to study the feedback from women who have already encountered the problem and managed to survive it.
Tatiana, 38 years old
For almost half a year we tried to be treated with drugs, but everything was useless, the discharge and pain continued. Then two operations were performed. The first is to remove a portion of the uterus. But it was ineffective, pockets continued to appear. As a result, the doctor suggested that I remove the uterus with the ovaries. I thought for a long time and worried about this, but my husband and children supported me. The operation was successful, the rehabilitation lasted almost two months. Now I feel great, even younger. Sexual life remains the same, bright and full.
Anna, 43 years old
I was given endometriosis at 42 years old. I went to the doctor because the discharge, having an unpleasant color and smell, tormented me. After a series of examinations and tests, the doctor said that a hysterectomy was required. I have two children, so I immediately agreed. Everything went well, there were no complications. In the first few weeks there was a slight discharge. In the end, I feel great, enjoy a full life. If you doubt whether or not to perform the operation, my advice is to do it.
Elena, 40 years old
I had my uterus removed early, at 35 years old. The procedure itself was no problem, there were some difficulties during the rehabilitation period. I was faced with psychological problems. It seemed that I was ready for the operation, but after I became irritable, aggressive, I was tormented by terrible insomnia, I could not live as I had before. In what clinics I was not only, but in the end, my husband helped me to cope with the psycho-emotional crisis. He managed to prove to me that I remained the same, beautiful and sexy. And everything worked out, but it took at least half a year.
Irina, 45 years old
When I was diagnosed with endometriosis, an emergency operation was necessary. Laparoscopic hysterectomy was prescribed, but in the process of manipulation complications developed and the uterus had to be removed. Because of this unexpected outcome of the procedure, I was very depressed. But soon I realized that life does not end there, there are many ways to feel complete. The most important thing in life is health. Rehabilitation was quick, the discharge did not bother anymore. I want to appeal to all women: lovely, you should not worry and be afraid! It is important to save your life, no matter what price you pay.
Is it always necessary to remove the attention of ovarian endometriosis
Endometriosis of the ovaries occurs, as a rule, in young girls. Often the treatment of pathology is carried out in the complex preparation for pregnancy or as an IVF stage. Removal of the uterus in ovarian endometriosis is rarely performed, for example, in the following cases:
- If during a surgery to remove cysts, their malignancy cannot be ruled out. Endometriosis ̶ benign pathology. But sometimes (according to some data, in 5-7% of cases) malignant cells may appear in the foci, most often with lesions of the ovaries.
- In women in menopause or after 45 years of age, when combined with uterine myoma, endometrial pathology.
Removal of the ovaries and uterus leads to castration; a condition that is identical to menopause abruptly occurs. The level of estrogen decreases, which leads to regression and other foci of endometriosis. This is the most radical way to get rid of the disease, but at the same time other problems arise: hot flashes, sweating, a tendency to gain weight, mood changes, bone destruction and other manifestations that occur in menopausal women.
If only one ovary is removed (with or without the body of the uterus), this condition develops gradually. Sometimes the remaining appendage assumes the function of two, which leads to its hypertrophy (increase) and often cystic changes.
Pros and cons
Resort to the removal of the uterus should be, carefully weighing all the pros and cons. Without the main reproductive organ in a woman's body, a number of changes occur, which she should be aware of.
For operative intervention, the following factors speak:
- pronounced endometriosis, not amenable to conservative treatment. Removal of the uterus will lead to improved well-being,
- if for some reasons taking pills or injections is impossible to suppress endometriosis, for example, in case of multiple drug allergies or mental diseases,
- combination with other diseases of the genital organs: large fibroids or multiple endometrial pathology, ovarian cysts,
- profuse menstruation with a constant decrease in the level of hemoglobin and the lack of effect from another treatment.
In such situations, the removal of the uterus significantly improves the quality of life of the woman. Blood indices normalize, many manifestations of endometriosis disappear. However, it is not necessary to remove the uterus in the following cases:
- if a woman is planning a pregnancy or is less than 35 years old,
- in the case where no conservative treatment has been applied,
- with unexpressed endometriosis and the absence of other indications for surgery.
Possible consequences after removal of the uterus with endometriosis
The uterus is one of the target organs affected by the pituitary and ovarian hormones. The lack of feedback after removal leads to various changes in the body of a woman.
Among the main consequences of the removal of the uterus with endometriosis are the following:
- a woman can never bear a child by herself,
- after removal of the uterus, even when the ovaries are preserved, menopause occurs faster than in women with a preserved organ,
- after the intervention, adhesive disease may develop, especially against the background of previously established endometriosis, and this may be the cause of pain and discomfort in the lower abdomen,
- endometriosis operations with removal of the uterus often require high qualifications and experience of the surgeon and are accompanied by a high risk of postoperative complications,
- after removal of the uterus, a woman may notice changes in sensations in the intimate sphere, problems with defecation, urination, which depends on the severity of endometriosis and the complexity of the operation.
See this video for the effects of uterine removal:
Depending on the indications for removal of the uterus and the severity of endometriosis, the volume of surgical intervention may be different. The following options are possible:
- amputation: removal of the cervical body only,
- extirpation: if, in addition to the body, the cervix is removed, the vagina subsequently ends blindly.
The question of appendages in each case is solved individually. Both with amputation and extirpation, resection of part of one or both of them, complete removal of the right or left, or two can be performed.
The operation can be performed by laparoscopic method or laparotomic (classic version). At the same time, other endometrioid ectopia are removed on the peritoneum, in the intestine, bladder and in other places. Laparoscopic surgery should be preferred, since the degree of injury is less and recovery is much faster.
It should also be borne in mind that the wounds on the skin of the anterior abdominal wall after laparoscopy are practically not noticeable over time.
See in this video about the surgical treatment of endometriosis:
Recovery and life after
Removal of the uterus ̶ serious intervention. Recovery from such an operation takes at least 2 months, and in some cases even longer. In the case of pronounced endometriosis, exactly when this pathology became the main indication for intervention, taking hormonal drugs with a substitution goal to prevent the symptoms of menopause and improve the general well-being of the woman is not recommended.
The doses of estrogen contained therein can provoke progression of the disease. If endometriosis was a concomitant indication, there were no multiple foci of other localization, then such drugs can be used. Depending on the age of the woman, these may be ordinary oral contraceptives (preference should be given to "Klaire", "Zanin", "Bonade") or adapted ("Femoston" and the like).
After the rehabilitation period, a woman can lead a normal lifestyle, including in terms of intimate relationships.
Even after the uterus has been removed, a doctor should be visited regularly, especially if an amputation has been performed to monitor the condition of the cervix.
When you remove the ovaries together with the uterus and the impossibility of hormonal treatment, you must be ready for the manifestations of menopause. The first symptoms may appear within a few days or a week after surgery. Changes in mood, slowing metabolism and other problems faced by women in menopause, come much earlier.
And here more about the options for removing endometriosis after cesarean section.
Removal of the uterus in endometriosis is a treatment option that allows you to get rid of only one source of pathology in the body. Most operations are performed according to multiple indications: in the presence of fibroids, persistent bleeding, ovarian cysts. There may be several options for surgical treatment, it all depends on the concomitant indications and the age of the woman.