In the article we will find out what it is - supravaginal amputation of the uterus with and without appendages.
Under certain circumstances, a woman may hear a doctor's decision that she needs surgery to remove her uterus. Amputation of the uterus or total hysterectomy is performed in extremely advanced cases, when all other methods of treatment have been tried, or in a situation where they are contraindicated. There are various medical techniques and methods for performing surgery to remove an organ.
Description
Supravaginal amputation of the uterus with and without appendages is performed while preserving the uterine cervix. The issue of removal of appendages is decided taking into account the age of the woman and the nature of the disease. This type of operation is usuallyperformed at the insistence of a woman who wants to preserve the uterine cervix. In this case, excision occurs only if there is no damage.
Indications
Supravaginal amputation of the uterus with and without appendages is prescribed for irreversible disorders in the functioning of the organ, when other therapeutic methods have been ineffective. The uterine cervix is preserved only if it is not damaged. Sometimes surgery is performed involuntarily, since it is not possible to use other methods of treatment.
What are the indications for supravaginal amputation of the uterus with and without appendages?
Removal of an organ is assigned in the following situations:
- Uterine fibroids, accompanied by symptoms such as compression of adjacent organs, heavy bleeding, pain in the pelvis.
- When a neoplasm in the uterus reaches a size greater than twelve weeks.
- The node is showing rapid growth, at more than four weeks per year.
- Access to the cervix is difficult due to the formation of adhesions, as well as a greater likelihood of damage to the intestines or ureter during surgery.
- Extragenital disease in severe form, when it is important to reduce the time of the operation.
- In case of an emergency operation, also to reduce the time, for example, in case of heavy bleeding.
However, in most cases, the cervix is preserved at the request of the woman. This allows you to save also the menstrual cycle, providedpresence of ovaries.
Benefits
The benefits of having a subtotal hysterectomy are:
- Prevention of prolapse of reproductive organs.
- Shortened rehabilitation period.
- Preserving the structure of the perineum from an anatomical point of view.
The absence of a decrease in libido in women during amputation of the uterus with the preservation of its cervix is also one of the advantages of this method by specialists. However, there is no scientific basis for such evidence. A significant disadvantage of hysterectomy is periodic bleeding that occurs outside the cycle. In addition, the remnant of the uterine cervix has a tendency to malignancy.
Contraindications
Supravaginal amputation of the uterus with and without appendages is not prescribed for the following contraindications:
- Inflammatory processes occurring in an acute form.
- Severe anemia.
- Precancerous and background pathologies of the uterine cervix.
Some experts consider total hysterectomy as a preventive method of fighting cervical cancer. However, this method of preventing cancer is only effective if the woman is able to regularly monitor the condition of the remaining stump.
What types of surgery are there for supravaginal amputation of the uterus with appendages?
Types of transactions
Surgical intervention can be carried out in several ways - with the removal of appendages and their preservation. Subtotalhysterectomy is categorized as high, low, and typical, depending on the extent of the transected tissue.
At reproductive age, the removal of appendages in a woman may become necessary if there are serious disorders in the structure of the ovaries, characterized by endometriosis, polycystic disease, salpingitis, etc. If we talk about the premenopausal period, then in this case, excision of the formations occurs to exclude the likelihood of their malignancy.
Examination
Before prescribing an operation, the specialist instructs the patient to be examined to assess the state of the woman's he alth and the readiness of her body for the intervention. The survey includes the following items:
- Examination of blood and urine for general indicators.
- Blood test for biochemistry.
- Coagulogram.
- Blood testing for HIV and AIDS.
- X-ray examination.
- Electrocardiogram.
- Getting advice from related specialists depending on the medical history.
A mandatory condition for the operation is the exclusion of contraindications. At the stage of preparation for amputation of the uterus, inflammatory processes are treated. The operation is possible only under the condition of remission.
Preparatory stage
Before supravaginal amputation of the uterus with appendages, a woman needs not only to pass all the tests and go through specialists, but also to visit a psychologist who will determine her internal readiness for amputation.
SurgeryIt is performed both under general anesthesia and with regional anesthesia. Most often, the operation is prescribed from the 5th to the 14th day of the menstrual cycle. To prevent complications after surgery, the following preparatory measures are recommended:
- Compliance with the diet, which involves bowel cleansing before surgery. To do this, three days before the appointed time, you should refuse bakery products, fatty and fried foods, as well as fresh vegetables. Immediately before the operation, specialists prescribe cleansing enemas. If the access during the operation is vaginal, then the enema is carried out in the morning and in the evening.
- Meals on the day before surgery should be no later than 8 hours.
In case of emergency, there is no preliminary preparation for the operation.
Progress of the operation for supravaginal amputation of the uterus with and without appendages
Removal of the uterus in most cases is carried out as planned. The patient should be aware of all the pros and cons of the planned intervention. Subtotal hysterectomy is one of the most radical options.
Restoration of the integrity of the reproductive organs is not provided. The operation is performed in several stages:
- Crossing the ligament apparatus.
- Hemostasis.
- Control of the process of urination through a catheter.
Basic methods of surgicalinterventions
There are several options for hysterectomy:
- Abdominal. Amputation occurs through an incision in the skin. Access is through the bikini area. This method is preferable in the case of a large tumor, as well as when the ligament apparatus has been damaged or there is no possibility to perform the operation by another method. If a malignant neoplasm is suspected, then an open operation is performed in order to gain access to all affected tissues.
- Supravaginal method. It is considered the most optimal and modern method of amputation of the uterus. The advantages of this option are the short duration of the operation, the low probability of blood loss and the rarity of complications. The operation by this method assumes the mobility of the uterus and sufficient volume of the vagina. The tumor should not be more than 12 weeks old.
- Laparotomy. Supravaginal amputation of the uterus with appendages is often performed in this way. With this access route, a section of the anterior abdominal wall is performed. The advantage of the operation is that the doctor has a good view of the uterus and it is convenient for him to perform all the actions. However, in this situation, the patient is subjected to an impressive surgical trauma, which often leads to severe side effects.
- Laparoscopy. Amputation is performed by means of three injections in the peritoneal region. This method requires a highly qualified specialist. Special video equipment allows you to evaluate the uterus, appendages and adjacent tissues in order to carry out the operation inin full. The advantages of the technique are its low degree of invasiveness, lower likelihood of complications, low pain syndrome, and a short rehabilitation period. A special gas is injected into the abdominal cavity during the operation, which may be contraindicated for the patient.
The choice of method for amputation of the uterus depends on the equipment of the clinic, as well as the qualifications of the doctor.
Rehab
How is rehabilitation for supravaginal amputation of the uterus with and without appendages?
To prevent postoperative complications, it is recommended to follow these guidelines:
- Taking antibiotics.
- Pain relief as needed.
- Planned stimulation of the intestines, as well as dietary nutrition until the first independent implementation of the act of defecation.
- Daily suture treatment.
- Bandages and compression stockings must be worn for two months.
- Low physical activity except for heavy lifting.
After a subtotal hysterectomy, sexual activity is not recommended for 1.5-2 months. Patients are ordered to regularly conduct a cytological examination of the remnants of the uterine cervix.
If it was possible to save the ovaries, then the stump of the uterine neck is attacked by sex hormones, menstruation is preserved. The discharge is regular and odorless, small in volume.
Complications
Mostcommon complications after uterine resection are:
- Hemorrhagic syndrome.
- Injury to the bladder.
- Ureter ligation.
- The occurrence of a hematoma.
- Thromboembolism and thrombosis.
- Infectious disease.
- Premature menopause syndrome.
- Decreased sex drive.
The greatest danger with supravaginal hysterectomy is bruising and bleeding.
What are the consequences of supravaginal amputation of the uterus with appendages?
Consequences of the operation
Amputation of the uterus does not pass without a trace for the female body. The least dangerous operation is for those who managed to realize their childbearing function or entered the stage of menopause. When it comes to a nulliparous woman of mature age, such a decision becomes a problem. Trying to save the uterus can have very serious consequences.
There are also other consequences of a hysterectomy:
- Psychological. The most common post-hysterectomy experience is depression.
- Loss of fertility. It should be taken into account that in case of saving the ovaries, the option of surrogate motherhood is possible.
- Premature menopause. This phenomenon is typical in the case of removal of appendages. Women are prescribed hormone replacement therapy after surgery.
Amputation of the uterus is a difficulta surgical intervention that can affect all areas of a woman's life.
We have considered supravaginal amputation of the uterus with appendages. What it is and its consequences are detailed in the text.
