Adnexectomy is an effective method of treating a woman's reproductive system. Quite quickly and practically without pain, the formations on the tubes of the uterus and ovaries are removed, which can have a different etiology.
For women, this operation will be the last measure, and it is shown mainly when malignant tumors are detected, or if it is not possible to stop the purulent process, as well as when an ectopic pregnancy is detected. With the onset of menopause, the list of indications for surgical intervention expands significantly.
Indications
First of all, laparoscopy and adnexectomy are indicated for patients with benign tumors on the ovaries. If the woman is postmenopausal, these masses should be removed laparoscopically, given their size. In addition, this method can successfully cure the initial stages of ovarian cancer, endometrial cyst, and ovarian tuberculosis.
Also an indication for laparotomyand adnexectomy will be:
- rapidly developing abscesses;
- inflammation of the uterine tube with pus formation;
- necrosis or tissue torsion;
- chronic recurrent inflammation of the uterine appendages, which is not amenable to standard medical treatment and causes adhesion of the inflamed appendages with intestinal loops and the uterine wall;
- sactosalpings, in which fluid accumulates in the lumen of the fallopian tube;
- ectopic pregnancy developing in the uterine tube;
- pyovar - the formation of pus in the appendages;
- cysts or tumor formations occurring in the appendages;
- damage to the reproductive organs by tuberculosis;
- ovarian cystic endometriosis, in which multiple endometrial cysts form;
- endometriosis, in which there is damage to the appendages.
Contraindications
Usually, the main contraindications are due to extragenital pathologies that are behind the reproductive organs of a woman:
- blood clotting disorders that can cause massive blood loss;
- arterial hypertension, which is difficult to correct;
- failure of the kidneys or liver, which is in the acute and decompensation stage;
- acute vascular disorders: heart attack or stroke;
- acute infections.
Excessive exhaustion, obesity of the patient, as well as eczematous and pustular changes can become a relative contraindication to the operation. If changes in appendagesthreaten the life of the patient, contraindications to surgery are usually considered relative, and sometimes they can even be ignored in order to save the patient's life.
Types of adnexectomy
Surgery can be:
- Laparoscopic - performed through punctures in front of the peritoneum.
- Laparotomy, in which all manipulations are performed through an incision in the skin of the abdomen.
Laparoscopy is performed if the woman does not have severe bleeding and inflammation of the abdominal cavity, and the tumor is not malignant. The main positive quality of the endoscopic technique is low trauma, the absence of significant incisions, long non-healing scars, as well as a relatively fast recovery period.
If the laparoscopy requires access expansion, the surgeon may decide to proceed to laparotomy. In particular, this procedure is indicated in the inflammatory process, bleeding, as well as a malignant tumor. Also, the laparotomy method is more appropriate to use if a woman has excessive obesity, and a strong process of adhesion formation has been diagnosed.
Depending on the indications, surgery can be unilateral or bilateral. Surgeons strive to damage the ovary as little as possible so that the production of sex hormones does not stop. With bilateral removal, the patient will be prescribed special drugs in the future.
Due dates
The following types of operations are distinguished by the timing of adnexectomy:
- Elective surgery is safer than emergency surgery, because it gives much fewer complications, since it is performed at the appointed time, without haste. Often this operation is done laparoscopically, after examination and careful preparation, in the case of a stable condition of the woman.
- Emergency should be performed in case of rupture of the cyst, torsion of the uterine appendages, as well as conditions that may threaten the woman herself. It is carried out during the first 6 hours after the formation of an "acute abdomen" in the patient. In this case, it is more appropriate to use the laparotomy method.
Preparation for adnexectomy
First, you need to conduct a complete gynecological examination of the patient: conduct a general examination, take all the necessary smears, make an ultrasound of the reproductive organs. Also, in order to finally confirm the diagnosis, the patient is prescribed the most complete analysis of urine and blood, be sure to conduct tests to determine the main infections.
To determine the general condition of a woman, she is prescribed a fluorogram of the lungs and an ECG. The patient should be examined by a gastroenterologist, a cardiologist and a nephrologist, and the patient should also consult an anesthesiologist. Be sure to take hygiene measures: remove hair from the genitals and wash well.
Before performing the operation, clean the intestines using a cleansing enema. For 7-8 hours before the start of the operation, it is undesirable to eat any food.
Execution
Unilateral or bilateral adnexectomy is performed under anesthesia. Perform it planned or urgently when evidence appears. The woman is on a ventilator. Carbon dioxide is injected into the abdominal cavity using a very thin Veress needle, and then 1 large hole is made in the peritoneum with three trocars no more than 10 mm thick in the area near the navel, as well as 2 holes in the iliac regions.
After that, the surgeon, using a laparoscope (a tube with a camera), visually examines the peritoneal cavity, as well as the uterus with its appendages. Next, the patient's body position is changed so that the internal organs located in the abdominal cavity are moved upward. This will create optimal conditions for monitoring the progress of surgery.
The tube of the uterus with the ovary to be removed is carefully grasped with a special clamp, slightly pulling it to the upper side. After that, coagulation is performed using bipolar forceps.
When coagulation is completed, part of the uterus is slightly excised, retreating from the end of the ligament by about 1 cm. The same manipulations are performed with the ovarian mesentery and uterine tubes. In order to excise tissues as accurately as possible, in addition to scissors, surgeons can use a laser or a special ultrasonic scalpel.
Operation in other countries
In foreign clinics, to perform adnexectomy on the left or right and eliminate possible bleeding, a special device is used that looks like a conventional stapler. The use of such an effective device canbe limited by its rather high cost.
After removal, tissues must be crushed and removed from the peritoneum with a special morcellator. Once the damaged tissue has been removed, the adnexal tissue should be sent for histology in a specially designed container.
The surgeon additionally coagulates the resulting stump to prevent any infectious pathologies and bleeding. The duration of adnexectomy on the right or left in general is approximately 1 hour. Finally, the doctor examines the patient's peritoneal cavity and thoroughly rinses it with effective antiseptics.
The operation of adnexectomy (this is a method of treating gynecological problems) has become very popular due to minimal trauma to organs and tissues, and also due to the fact that a woman does not have ugly scars. In addition, after such therapy, complications are almost eliminated, and the recovery period in most cases takes a short period of time.
Possible Complications
Undoubtedly, with adnexectomy, there may still be a risk of certain complications, for example, damage to the reproductive organs, bleeding. In the postoperative period, the appearance of purulent, septic processes, as well as bleeding should be excluded as much as possible.
Therefore, it is very important that a woman undergoes a thorough examination in the period before the operation. This will help eliminate factors that can cause certain complications. But the use of modern equipmentcan minimize the risk of negative consequences.
Post-operative period
When the patient wakes up from general anesthesia, she will be slightly weak. She will return to normal after 2-5 hours. She can try to get up and eat a little. For 3 days, the patient still needs to be observed in a hospital, under the supervision of a doctor. If there are no complications, the woman is discharged and can continue to be treated as an outpatient.
Immediately after the operation, the patient is prescribed antibiotics and pain medications to prevent infection. Until the stitches are removed (about 10 days), it is forbidden to take a bath - only a shower is allowed. For about a month, sexual activity is not recommended, as well as complex loads. Physical activity can be gradually increased only after 1.5-2 months.
The rehabilitation period is usually about 2 weeks, but full recovery takes about 2 months. Moreover, the risk of complications will be minimal. The patient with a unilateral adnexectomy (this is an effective method of treating female pathologies) retains the ability for a natural pregnancy and childbirth. When performing bilateral surgery, menopause can develop, which has characteristic symptoms.
Result
Adnexectomy is a very effective procedure that helps to solve many problems with a woman's reproductive system. The main thing– identify the pathology in time and perform the correct surgical intervention.
