Now doctors often prescribe conservative myomectomy for the treatment of fibroids. What it is? This method is one of the most common and effective. Its main advantage is that women retain the uterus and childbearing function. It is desirable for all representatives of the weaker sex to have an idea about myomectomy, since no one is immune from diseases of the genital organs. In our article, we will talk about the indications for such a surgical intervention, as well as the recovery period following it.
Treatment methods
Many women are very worried when they are scheduled for a conservative myomectomy. What it is, they don't know very well. As mentioned above, the uterus is not removed during this operation, only myomatous nodes are husked. Depending on their size, location in the organ, shape and other indications, the doctor decides howthe way they will be removed. Conservative myomectomy is of the following types:
- Abdominal.
- Laparoscopic.
- Blank.
- Endoscopic.
- Hysteroscopic.
Each type of operation has its indications and contraindications. Each is characterized by a different degree of complexity. An alternative to myomectomy is UAE (uterine artery embolization). In this case, the embolizing drug is injected into the vessels of the uterus, after which the blood supply to the myomatous nodes can be interrupted. They are significantly reduced in size, some may disappear altogether. In this case, the symptoms of the disease disappear, the restoration of the organ begins, and the opportunity to become pregnant again appears.
For a woman, this is the easiest and least traumatic type of treatment. UAE is performed without anesthesia on an outpatient basis. Even if therapy is carried out in a hospital, the patient is discharged home the next day. The advantages of UAE also lie in the fact that the impact is carried out only on the problem area, absolutely not affecting he althy tissues.
However, this wonderful method can not be used for all patients. UAE is contraindicated in intramural-serous fibroids (more than 8 cm), giant tumors, single subserous formations on a thin stalk. With such indications, only myomectomy is performed. We will consider all methods in more detail below.
Causes of a tumor
For many years it was believed that uterine fibroids -it is a benign tumor that eventually turns into a malignant neoplasm. That is why gynecologists recommended completely removing the organ in order to save the patient's life. A woman after such an operation actually became disabled. Her quality of life was significantly reduced, she lost the opportunity to give birth to a child. At the same time, in the process of recovery, mental he alth disorders often began, hormonal levels were disturbed.
Modern studies have proven that the myomatous node is not a tumor, although it has some signs of a benign formation. The risk of its transformation into cancer is extremely low and is comparable to the likelihood of developing this dangerous disease from he althy uterine tissue. That is why, when fibroids occur today, the uterus is no longer removed.
The causes of fibroids are not fully understood. There are several factors contributing to its growth. This is a change in the hormonal background, in which the amount of estrogens increases, stress, abortion, diagnostic curettage, uterine trauma during obstetric manipulations, late onset of menstruation, heavy periods, inflammatory diseases of the female genital organs.
In most cases, fibroids develop in patients with thyroid diseases, diabetes mellitus, arterial hypertension, and also in those who are overweight. According to official data, among all diseases of the genitourinary system in women, fibroids account for 25%. However, doctors believe that the figure is underestimated by about half.
Symptoms
To start timely treatment of the disease, you should understand its symptoms. However, in the early stages, this disease may not manifest itself at all. Signs appear only with the progression of formations. These include heavy and prolonged periods, menstrual irregularities, spotting between periods, infertility, pain in the lumbar region or lower abdomen.
Fibroids that appear on the cervix put pressure on the rectum and bladder. As a result, a woman develops constipation or problems with urination. If they are too large, this can lead to an increase in the size of the abdomen. If the blood circulation of the myomatous node is disturbed, fatal necrotic changes begin to occur in the neoplasm. When a symptom of the so-called acute abdomen appears, surgeons perform an emergency operation.
The result of heavy and constant bleeding is chronic anemia. At the same time, patients complain of dizziness, general weakness, fatigue for no apparent reason. The next manifestations of uterine fibroids are rapid heart rate, low blood pressure, a violation of the rhythm of cardiac activity. With chronic anemia, nails become brittle and hair begins to fall out.
Fibroids cause problems with conception and pregnancy. The uterine cavity may be deformed. In this case, the embryo does not implant into the wall of the organ. The uterus with such disorders is often in good shape, which leads to the threat of premature birth orspontaneous abortion. Also, with myoma, the development of the fetus itself is disrupted. The main consequences of this disease are miscarriages, impaired fertility, difficult childbirth.
Conservative operation, pros and cons
Conservative myomectomy helps to cope with the disease. What is it, we will consider further. Gynecologists recommend this operation to women who plan to have a child in the future. Benefits of this treatment method:
- The uterus is not removed. The patient's quality of life is not impaired.
- It is possible to remove the formation completely in one operation.
- Low invasiveness, especially during closed myomectomy.
The method also has disadvantages:
- Recurrences are common (fibroids grow back in about 70% of patients).
- Open surgery leaves a scar on the abdomen and on the wall of the uterus.
- Sometimes there are complications after surgery.
Contraindications
Dealing with what it is - a conservative myomectomy, one cannot but mention the contraindications to its implementation. The operation is not performed in such cases:
- Recurrence of a neoplasm after a similar operation performed earlier.
- Severe anemia.
- Chronic inflammatory process that develops in the pelvic organs.
- Submucosal (submucosal) nodule measuring 10 cm or more on a stalk, fully protruding into the body of the uterus.
- Submucosal tumor,protruding into the uterus in whole or in part.
- Uterus size up to 14 weeks.
- Subserous nodes.
- Interstitial fibroids (develops from the myometrium).
This operation is also not prescribed for women who do not want to give birth anymore, who are in the menopause period, as well as for those patients who have suspicions of uterine sarcoma. Doctors do not perform myomectomy even in cases where the myomatous node is located in a hard-to-reach place, so its removal is associated with great risks for the patient.
Complications
Patients should be prepared for the fact that after conservative myomectomy surgery, there is a high probability of recurrence. Myoma may grow back. If a woman does not plan to have a child, she may even be advised to remove the uterus in our time to solve the problem with fibroids once and for all.
However, many doctors believe that such a procedure is unacceptable. An alternative option is uterine artery embolization, after which the quality of life of the patient improves, her reproductive function is restored. If the patient is of reproductive age, this may be an important indication for conservative myomectomy.
A serious complication arising during the operation is bleeding. However, this can mainly happen with abdominal or abdominal myomectomy. To reduce the risks, the patient is treated with hormonal agents before the operation. Another way is to perform UAE, and after it, the removal of tumor nodes. In addition, temporary occlusion of the iliac arteries is done during the operation.
After surgery, the following undesirable processes are possible:
- Seam separation.
- Infection.
- The formation of adhesions on the walls of the uterus, which can become an obstacle to pregnancy.
If there are too many formations, the course of the operation with conservative myomectomy can be carried out with an open method. Usually, before surgery, for one to three cycles, the patient is recommended to take contraceptives, which in this case can facilitate the operation and reduce bleeding.
Laparoscopic
Let's now consider what it is - laparoscopic conservative myomectomy, because this is one of the most common methods for this operation.
This is a minimally invasive intervention in which all actions are performed with the help of several punctures in the abdominal wall and uterus. The finest instruments are introduced into them. The surgeon watches all his actions on the monitor screen.
The advantages of laparotomy with conservative myomectomy are minimal damage to surrounding tissues, preservation of the uterus, which allows you to become pregnant in the future and bear a child on your own. Rehabilitation of the patient in this case is very fast. You can get pregnant six months after surgery.
Laparoscopy is a conservative myomectomy, the indication for it is the presence of nodes of not very large size, as well as single and multiple neoplasmswith a specific structure. They can lead to disruption of the reproductive function and activity of neighboring organs, problems with pregnancy.
There are a number of contraindications for which laparoscopic conservative myomectomy is not recommended. These include:
- Complicated hemorrhagic diathesis.
- Disturbances in the activity of the organs of the cardiovascular system and respiratory functions.
- Suspicion of malignant neoplasms.
- Chronic or acute renal failure.
- Identification of a large number of myoma nodes.
- The location of the tumor in places in the uterus where it is difficult or impossible to work with a laparoscope.
- Fibroids over 9 weeks.
The duration of rehabilitation after such an operation is usually two to three months.
Abdominal
During the conservative myomectomy (abdominal) surgery, two incisions are made. One - on the patient's abdomen, through which it is possible to reach the uterine cavity, and the second - on the uterus itself, in order to remove the node. The operation is performed under anesthesia, after which a suture is applied, leaving a very noticeable scar. The woman has to stay in the hospital for several weeks as part of the recovery period.
Relations to this operation are very ambiguous, as it has many shortcomings. These include the need for general anesthesia, a long recovery period, a high likelihood of recurrence, scars and scars.on the body.
The indication for surgery is a fibroid in a hard-to-reach place, its large size, the formation of a tumor in the muscle layer.
Pros are:
- The ability to preserve the childbearing function of the patient.
- Performing surgery in clinics not equipped with laparoscopes.
- The ability to apply a special suture after removal of a large fibroid, which securely fixes the tissues, which allows a woman to become pregnant and give birth in the future.
Hysteroscopic
This operation is the removal of a benign tumor through the vagina using a special device called a hysteroscope. It is recommended if the patient has one of the following indications:
- Fibroids on the leg, which causes severe pain.
- Small myomatous nodes directed to the uterus.
The main advantages of this surgical method are the short duration of the operation itself, the absence of complications in subsequent births, the preservation of reproductive function, the cosmetic effect (there are no scars and sutures), minimal blood loss. It is performed on an outpatient basis without anesthesia.
Blank
The most traumatic type of operation. It is used for very large fibroids, as well as for a large accumulation of tumor nodes. Also, this myomectomy can be performed with torsion of the fibroid stem and with necrosis of the tumor itself and adjacent tissues.
During the operation, a sufficiently large incision is made, allowing you to visually assess the complexity of the case and getaccess to any part of the uterus. The recovery period after such an intervention is more than two months.
Endoscopic
This is one of the least traumatic ways. The operation can be performed using a laparoscope or a hysteroscope. In any case, it is performed under general anesthesia. After the intervention, there is no scarring on the uterus, and only small marks from punctures for the introduction of a laparoscope (if it was used for treatment) can be seen on the abdomen.
Recovery period
The postoperative period with conservative myomectomy lasts several weeks. If the procedure is performed laparoscopically, the patient is allowed to get out of bed already on the second day.
After a conservative myomectomy in the postoperative period, a woman has to wear a special bandage for several months, avoid constipation, and avoid heavy physical exertion. All this can lead to divergence of seams. Intestinal disorders can also cause inflammatory diseases of the appendages and uterus.
After conservative myomectomy, it is recommended to monitor your diet. It should include foods with a lot of fiber, which help cleanse the intestines. If, as a result of the operation, the uterus was saved, you should wait for the restoration of its inner layer.
Many women are wondering if it is possible to plan a pregnancy after a conservative myomectomy? How many months does it take for the uterus to fully recover? ThisThe process can take 6 to 12 months. Each woman's recovery process is individual. Therefore, before conception, you need to undergo a complete examination.
