Total hysterectomy is an operation in which the uterus is completely removed. Such surgical intervention is a radical method of treatment and is used in cases where no other method of treatment brings recovery. The procedure is carried out in a hospital after some preparation. In this article, we will consider what methods the operation can be performed on, and what complications a woman can expect after it.
Indications for surgery
Because total hysterectomy (extirpation) is a very serious procedure that sometimes leads to unpleasant consequences, doctors try to avoid it by using alternative methods of treatment. This is especially true for women of childbearing age. But it happens that situations arise in which the removal of an organ is the only solution. There are quite a few reasons for this. Consider some of them:
- cancer of the uterus or other reproductive organs, especially in an advanced stage;
- the initial stage of cancerdiseases of the female organs in the case when the tumor is not treatable by conservative methods and grows very quickly;
- strong uterine prolapse or prolapse;
- large number of fibroids;
- single fibroids, but larger than 12 weeks of gestation; this can lead to rebleeding or necrosis;
- endometriosis and adenomyosis that cannot be cured by conservative means;
- inflammatory and purulent processes;
- uterine rupture during childbirth;
- a large number of papillomas, cysts;
- placental accreta;
- irreversible hormonal disorders that lead to the constant growth of benign tumors.
- hysterectomy is used in people who decide to change sex.
Most often, such an operation is prescribed for women who have entered the menopause period, since they do not have to maintain reproductive function. And since the ovaries are no longer fully functioning, the negative consequences caused by hormonal failure are not expected.
Hysterectomy types
When choosing the method of the operation, the doctor is based on the primary disease, the condition of the woman herself and her age. The size of the uterus is also determined.
Currently, the procedure is carried out by the following methods:
- total laparoscopic hysterectomy - the operation is performed using a laparoscope;
- abdominal laparotomy - removal occurs through an incision in the abdomen;
- vaginal - access to the affected organ is through the vagina.
Basically, the choice of method occurs at the stage of preparation for the operation and may include a combination of several options.
Contraindications for surgery
Total hysterectomy of the uterus is a very difficult operation, which is accompanied by large blood loss and deep anesthesia. Also, we must not forget that the disease for which this procedure is prescribed could weaken the female body, which increases the risk of complications during or after the operation.
There are a number of relative and absolute contraindications to the procedure. These include:
- blood clotting disorders;
- inflammatory and infectious processes in the reproductive organs of a woman;
- general diseases of the body, including SARS and influenza;
- anesthetic intolerance;
- severe anemia;
- severe diabetes mellitus;
- bleeding of unclear nature.
If an emergency operation is needed, the procedure is performed even if there are contraindications. Such situations include severe bleeding (for example, due to a rupture) or the rapid development of sepsis. In other cases, surgery may be delayed for the time needed to treat comorbidities.
Preparation
After deciding on the procedure for removing the uterus, a woman needs to undergo preoperative preparation, on which the success of the operation largely depends. It is necessary to conduct a comprehensive examination, which specifies the diagnosis, the patient's condition, the presence of contraindications. Preparations may begin months before removal.
Preparatory measures must include the following procedures:
- blood test, both general and biochemical;
- urinalysis;
- tests for AIDS, HIV, hepatitis;
- coagulogram;
- vaginal swabs;
- endometrial biopsy;
- ECG;
- colposcopy;
- ultrasound;
- MRI or CT.
If the results of the tests showed the presence of inflammatory or infectious diseases, therapy is carried out to eliminate them. Also, if necessary, drugs that regulate blood clotting are prescribed to minimize the risk of bleeding or, conversely, thrombosis. When large fibroids are found, therapy is performed to reduce or suppress their growth.
Required consultation with a therapist and gynecologist. They prescribe the necessary measures to stabilize blood pressure, blood glucose levels and other indicators in which deviations were found during the tests.
After all the necessary procedures have been performed and there are no more contraindications for total hysterectomy, the doctor sets the date of the operation and discusses the plan with the patient.
It is worth noting that sometimes doctors neglect preparatory measures. This occurs when emergency surgical intervention is required in case of a threat to life.women.
Infection is being prevented by introducing antibacterial drugs and sanitizing the vagina for 8-10 days. A few days before the operation, gas-producing foods should be excluded from the diet, replacing them with easily digestible foods. 8 hours before the procedure, refuse to eat completely and limit fluid intake as much as possible. It is also necessary to cleanse the intestines, and before removing the uterus, you will need to empty the bladder.
Before a total hysterectomy, a conversation with an anesthesiologist is required, who discusses the type of anesthesia with the patient and informs about side effects.
Sometimes it is advisable to use compression stockings.
Abdominal Hysterectomy
If the doctor decides to perform a total hysterectomy (extirpation) of the uterus by laparotomy, then this involves access to the uterus through a vertical or horizontal incision in the abdominal cavity. This method is the most common in medical practice, but also the most traumatic.
The operation is performed under general anesthesia. After an incision in the abdomen, the uterus is removed. Then the blood vessels and the ligamentous apparatus that held the uterus are crossed. If necessary, a total hysterectomy with appendages is performed.
If a malignant process is suspected, material is taken for urgent histological examination.
At the completion of the main stages of the procedure, the doctor examines and drains the abdominal cavity. Sometimes it may be necessary to install a draintubes.
After all the manipulations, the incision is tightly sutured and a sterile bandage is applied.
Complications of the abdominal method
Performing a total hysterectomy by the laparotomy method is quite traumatic and hard to tolerate by the patient. For quite a long time, severe pain may disturb, which involves taking painkillers. There is also a high risk of infection, the development of an adhesive process in the peritoneum and numbness in the suture area. Sometimes during the operation, neighboring organs are damaged - intestinal loops, ureter and others. The rehabilitation period with this method is increased.
Vaginal removal method
Vaginal total hysterectomy is usually used in women who have given birth and have a small uterus. With this method, the organ is removed through the vagina, so no scarring remains. The main conditions for the operation in this way are the absence of cancer and the flexible walls of the vagina. The procedure is not performed in nulliparous women, as well as if it is necessary to remove the ovaries.
Because visualization of female organs is difficult with this method of operation, a laparoscope is often used.
Manipulations are carried out through an incision in the upper part of the vagina. First, the cervix is removed, and then the body of the uterus itself.
The main indications for the vaginal method are benign small formations, cysts, prolapse or prolapse of the uterus.
Contraindications are the large size of the uterus, the presenceadhesive process or a history of caesarean section.
Laparoscopic method
The procedure for total laparoscopic hysterectomy is performed using a special device - a laparoscope. At the same time, several small-diameter punctures are made in the abdominal cavity, where special tubes of the device and a video camera are inserted, with the help of which the image is displayed on a nearby screen.
The operation takes place in several stages. First, gas is injected into the abdominal cavity in order to lift the abdominal wall. Next, the ligaments and tubes are crossed, and after that the uterus is crossed and the arteries are tied up. The removed organ during laparoscopy of a total hysterectomy is removed through the vagina, in which the incision was made. This stage requires special care to eliminate the risk of damage to neighboring organs. If the uterus is large or myomatous formations are present, it is first dissected into smaller fragments. The puncture sites are then sutured.
Total hysterectomy (extirpation) of the uterus, performed laparoscopically, can be performed in women who have not given birth or have a narrow vagina.
Contraindications to the use of this method include large cystic formations, large organ size (but this condition is relative and depends on the skill of the surgeon), as well as uterine prolapse - in this case, the vaginal removal method is appropriate.
Post-operative period
After the operation, the patient is under control for some timedoctors. The recovery period will depend on the method used to remove the uterus.
With the laparotomy method, the sutures are removed approximately on the 8th day, at the same time the patient is discharged from the hospital. Doctors recommend turning over and small sitting down already on the first day after the operation. This is the prevention of adhesions.
With the vaginal and laparoscopic method, the patient is allowed to gently get up, sit down and drink on the first day after removal of the uterus. The next day you can eat and walk. Discharge occurs 3-6 days after the operation.
For 10-14 days after a hysterectomy, showering is recommended. Of the drugs, painkillers are prescribed for the first time, as well as antibiotics and anti-inflammatory drugs. During the rehabilitation period, you should try to exclude overheating and heavy physical exertion.
Discharge after surgery
The patient may experience spotting for two weeks. But if they continue after the expiration of this period, especially with the addition of painful sensations, this is a reason to consult a doctor. After all, such a condition can be a sign of both bleeding and the development of an inflammatory process.
Complications
After a total hysterectomy, a large number of complications are possible. These include:
- damage to adjacent organs;
- infection;
- peritonitis, which can threaten a woman's life;
- bleeding;
- sepsis;
- intestinal obstruction and urinary retention;
- prolonged pain.
Consequences
After undergoing a hysterectomy, there are two main consequences of this:
- violation of reproductive function and, as a result, the cessation of menstruation;
- if a total hysterectomy with tubes and ovaries was performed - the onset of menopause, which can lead to hormonal imbalance.
Many women experience a decrease in libido. This is facilitated by hormonal and psychological disorders, including sudden mood swings and depression. Sometimes you may need the help of a psychologist. But in most cases, while maintaining the ovaries, sexual life is getting better after a while, although sometimes painful sensations may disturb.
Long-term soreness can also occur, impairing quality of life.
Conclusion
Total hysterectomy is a very serious operation that should only be performed when other treatments fail or life-threatening conditions develop.
