In gynecology, various conservative methods are used to treat bleeding from the uterus. But all these methods do not always give the desired result, so they recommend a planned or emergency operation to remove the uterus.
The frequency of this surgical intervention in gynecology is observed in 25-40% of cases with an average age of women who are recommended for removal, 40 years. Increasingly, instead of using conservative therapy for uterine fibroids in women in their forties, doctors are increasingly recommending the removal of the genital organ, motivating this decision by the fact that the function of childbearing has already been implemented and the uterus is no longer needed. But when is hysterectomy justified? What methods are used, what are the consequences and rehabilitation?
Indications for surgery to remove the reproductive organ
Removal of the uterus (hysterectomy) is indicated in the following cases:
- Multiple fibroids or a solitary nodule that enlarges rapidly and bleeds profusely.
- Fibroids in women over 50. Although there is no tendency to malignancy, they easily turn into a malignant form, so the removal of the uterus in this case is necessary to preventcancer. But often such an intervention is associated with subsequent pronounced vegetative-vascular and psycho-emotional disorders, for example, the manifestation of post-hysterectomy syndrome.
- Necrosis of the fibroid node.
- Subserous nodes that threaten the patient with torsion.
- Submucosal nodules affecting the myometrium.
- Polyposis and regular heavy menstrual bleeding, which are complicated by anemia.
- 3-4th stage of endometriosis or adenomyosis.
- Malignant neoplasm of the reproductive organ and appendages, radiation therapy played a role. Most often, for older women, the removal of the uterus and appendages is recommended precisely because of cancer.
- Organ prolapse.
- Chronic pelvic pain that does not respond to other treatments.
- Rupture of an organ during childbirth or during childbearing.
- Uncompensated hypotension of the organ with severe bleeding.
- Gender change.
Despite the fact that hysterectomy is considered the perfect method, it remains technically difficult and is accompanied by frequent complications during and after the intervention.
Complications during surgery may be associated with damage to the rectum, bladder, ureters, hematomas are formed in the parametric region, there is heavy bleeding.
Types and methods of surgery
Despite the fact that the outcome is always the same, the operation to remove the uterus can be performedin several ways at different levels, with different consequences.
Types of operation depends on the scope of intervention:
- Radical (extirpation of the uterus) technique involves the complete removal of the reproductive organ with the cervix and ovaries. The upper part of the vagina and the lymph nodes located in the pelvis are also removed.
- Total, when the uterus and cervix are removed.
- Supravaginal involves removal of the uterus, but the cervix remains.
If it is possible to save the reproductive organ and ovary, especially for women under 40, then the doctor will definitely do it.
Also, all operations are divided into types according to their technique.
Laparoscopic method
Laparoscopic hysterectomy involves the use of a special camera that is inserted into the patient's abdominal cavity through an incision. Organs are isolated using instruments that are inserted into the peritoneum through other openings. The image from the camera goes to the monitor, and the surgeon can see everything he is doing. The woman lies with her legs elevated during this operation.
This method cannot be used if the patient's organ has fallen out, with large formations, since it will not be possible to remove them through a small hole in the peritoneum.
Laparotomic method
This technique is used for extensive adhesions in the abdominal cavity, with an enlarged uterus, if neighboring organs are also involved, or if the intervention is performed urgently.
ThisThe technique involves an incision from the navel to the pubis. The entire area of the peritoneum and the pelvis are clearly visible, the removal of the genital organ is carried out. At the time of the operation, the woman lies on her back and is under anesthesia.
Vaginal surgery
This technique is recommended for small benign neoplasms in the uterus or adnexa.
An incision is made in the upper part of the vagina, through which the surgeon conducts all further actions. This technique can be combined with the introduction of the camera, and then laparoscopy is performed. Removal of the organ is carried out with a special tool.
But you can not use the operation through the vagina in such cases:
- if the uterus is too large;
- patient diagnosed with cancer and no accurate information on its prevalence;
- if there are many adhesions in the pelvic region;
- previous caesarean section;
- when there is inflammation or fungal discharge.
Laser removal
Laser removal of the uterus is the latest technique, which is especially popular with doctors, because it has a number of undeniable advantages over other surgical methods:
- reduces the risk of bleeding, the operation is performed almost without blood;
- recovery time is greatly reduced;
- no major muscle damage;
- reduces pain and discomfort during the rehabilitation period;
- minimum risk of urinary incontinence;
- reduces the risk of infection;
- less risk of scarring;
- reduced libido after surgery is minimal;
- laser removal goes well with laparoscopy and endoscopy.
With the help of a laser scalpel, many surgeries are performed to remove the uterus. The procedure is performed under intubation anesthesia. Instruments are inserted through incisions in the umbilical and iliac regions. The separated organ is removed through the vagina.
How to prepare for surgery?
Preparation for a planned operation is to conduct examinations:
- blood tests biochemical and clinical;
- urinalysis;
- blood typing;
- Detection of sexually transmitted infections.
- doctor recommends an ultrasound;
- chest x-ray and ECG;
- bacteriological and cytological analysis of a smear taken from the genital tract;
- colposcopy.
Women in hospital can undergo hysteroscopy, MRI, sigmoidoscopy.
A week before the operation, in order to prevent complications such as thrombosis or thromboembolism, the doctor prescribes specialist consultations and medications.
For preventive purposes and to reduce the severity of the symptoms of posthysterectomy syndrome, which often develops in women after removal of the uterus, the operation is performed in the first phase of menstruation, if they are still there.
A couple of weeks before surgerycarry out psychotherapeutic procedures, 5-6 visits to a psychologist and psychotherapist, which are aimed at reducing the feeling of uncertainty, fear and uncertainty before and after the operation. Herbal medicine, hormonal and sedative drugs are also prescribed, it is recommended to stop smoking and drinking alcohol. All these measures will help facilitate the recovery period after the operation to remove the organ. In this case, the removal of the uterus will be easier for the woman emotionally and physically.
How long does the operation take?
It is impossible to determine the exact time of the operation. First of all, you need to know which method will be used in each case. It also depends on the size of the uterus, the presence of adhesions and other factors. The average operation time is 1-3 hours.
Rehabilitation and Recovery
After surgical removal of the uterus, much attention is paid to inflammatory processes, normalization of water and electrolyte balance, blood composition, and harmonization of the patient's mental state. Recovery after abdominal surgery is a month and a half, after laparoscopy - 2-4 weeks. Vaginal intervention provides for full recovery after a month.
The suture after removal of the uterus by abdominal surgery resolves after a month and a half. To prevent adhesive disease, the patient may be prescribed magnetotherapy. If necessary, the doctor may recommend suppositories, injections or tablets to eliminate serious consequences.surgical intervention. If the uterus was removed, the postoperative period lasts a month and a half, for this time a sick leave is issued.
Diet after removal of the reproductive organ
It is important to follow a diet after the operation to remove the reproductive organ. Be sure to exclude products that irritate the mucous membrane. Cereals, dairy products, broths, nuts - all this should be present on a woman's menu every day. It is also important to eat fruits and vegetables to prevent constipation. It is better to exclude coffee, sweets, tea, chocolate and white flour bread during the rehabilitation period.
Complications after surgery
If the uterus is removed along with the ovaries, then the woman can feel all the symptoms of menopause:
- insomnia;
- hot flashes;
- mood swings;
- sweating.
This condition is called medical menopause. In the event that the ovaries are not removed during the operation, then only one of the symptoms of menopause is observed - the absence of menstruation.
Doctors say that menopause in women who had only the genital organ removed is observed only 5 years after the operation. These patients often develop:
- atherosclerosis;
- osteoporosis;
- reduced sex drive;
- burning sensation;
- Vaginal dryness.
The consequences of the removal of the uterus and ovaries in the first few days, weeks, months can be the following:
- inflammation of the skin around the seam;
- bleeding profusely;
- cystitis;
- occurrence of thromboembolism;
- vaginal prolapse;
- urinary incontinence;
- pain caused by adhesions or bleeding.
Do I need a bandage after removal?
A bandage after removal of the uterus is a must. At a young age, it must be worn for three weeks, for women after 45 years - at least 2 months. The bandage helps the rapid healing of wounds, reduces pain, improves bowel function, and reduces the likelihood of a hernia. It is necessary to use the bandage in the first days only during the daytime, and after that only during a long walk or during physical exertion.
After the operation, the location of the pelvic organs changes, the tone and elasticity of the muscles are lost. All this leads to constipation, urinary incontinence, deterioration of sexual life, vaginal prolapse and the development of adhesions. In this case, only prevention can help, or rather Kegel exercises that will help strengthen and increase muscle tone.
Sex life after surgery
After removing the reproductive organ for two months, it is better not to have sex to prevent infection. The operation can lead to a decrease in sexual desire, and all due to the fact that the risk of hormonal disorders, the development of neurological, autonomic and vascular problems increases.
All of them, in interaction with each other, aggravate the general condition and reduce sexual desire. Basically, sex life is notis prohibited, with the help of a specialist you can choose a set of exercises that will help increase sensitivity. A consultation with a doctor will help you improve your sex life.
Are there periods after hysterectomy?
Do menstruation persist after the operation to remove the reproductive organ? This question interests many women. Preservation of menstruation is possible, and this is due to several reasons. For example, an organ can be removed and the cervix left, and then, under the influence of the activity of the appendages, the endometrium continues to form in a small area, as a result, a woman can continue her periods. But this is no longer abundant discharge, but scanty bleeding during menstruation.
After the removal of the organ and neck, menstruation should not go. If they are observed, then this may be a consequence of the development of pathologies of the genital area, in such a situation it is better not to delay a visit to the doctor.
Sometimes women mistake bleeding for their period, which can be dangerous. That is why, with any spotting, it is better to consult a doctor to exclude the development of complications.
