Such an operation, as removal of the uterus, is a radical way of treating certain gynecological diseases. It is conducted in a hospital, and its implementation is preceded by a long preparatory stage. Consider this surgical intervention, types, methods, possible complications and consequences after removal of the uterus.
Removal of the uterus - indications for surgery
Hysterectomy of the uterus - the so-called operation to remove the female genital organ. It is carried out exclusively on the testimony, which there are many. Among the most common it is worth noting:
- malignant processes in the uterus;
- oncology of the cervix;
- uterine fibroids , in sizes larger than 12 weeks of pregnancy;
- rapid growth of the tumor - per year for 4 months of pregnancy and more;
- necrosis of the myomatous node;
- menorrhagia complicated by anemia;
- adenomyosis of 3-4 degrees;
- chronic pain syndromes in the small pelvis;
- prolapse of the uterus ;
- endometriosis without improvement after a conservative (medicamental) therapy, scraping.
Ways to remove the uterus
When performing surgical intervention, various methods of uterine removal are used. The choice of the specific depends on the type of violation, the extent of affection of the genital organ and its appendages. Based on the results of ultrasound, doctors decide to use this or that technique. Often, removal of the uterus is combined with excision of adjacent tissues. Depending on the volume of the operation performed, they distinguish:
- subtotal;
- total;
- pangysterectomy;
- radical.
In addition, depending on the method of access to the childbearing organ during surgery, hysterectomy can be:
- laparotomic - the uterus is removed through the incision on the abdomen;
- removal of the uterus by a laparoscopic method - using a special device, through small holes in the abdominal wall;
- vaginal - access to the affected uterus is through the vagina.
Subtotal hysterectomy of the uterus
Subtotal hysterectomy is carried out when there is a possibility of preserving the cervix, this part of the genital organ is not affected. Manipulation is carried out in order to shorten the time of surgical intervention in severe extragenital pathology. To this method, surgery is also used in pelvic endometriosis, expressed by a commissural process in the small pelvis. With such pathologies, the risk of damage to the ureter increases. Indications for this type of surgical intervention are:
- absence of pathology of appendages;
- presence of sufficient mobility of the uterus;
- omission of the vagina ;
- the size of the neoplasm does not exceed the size of the fetus at 12 weeks of gestation;
- presence of a sufficient surgical field.
Total hysterectomy
This type of surgical treatment is often referred to as extirpation of the uterus. The method is one of the most common types of hysterectomy. Access to the organ is obtained by opening the abdominal cavity. In this operation, the uterus is removed, in the absence of lesion in the neck, this part is left. Simultaneously, the ectomy of the fallopian tubes and ovaries is performed. Restorative treatment after total hysterectomy involves the use of hormones before the onset of menopause .
Removal of the uterus with appendages
Carrying out such a radical surgery is preceded by a special study. It is called as hysterosalpingography - what is it, the patients do not represent, so they ask the doctor. With this survey, the diagnosis of the fallopian tubes is carried out. A special contrast agent is introduced. Then a series of X-ray photographs is taken.
If a cancer process is detected in the tubes and spread to the nearest organs and tissues, the uterus is removed. Access to the affected organ is through the vagina or anterior abdominal wall. Due to the fact that elderly patients do not tolerate extensive operations, surgeons often choose a vaginal type. In this case, completely removed the uterus and appendages - the sex glands, tubes.
Radical hysterectomy
Surgery for the removal of the uterus of this type is carried out with extensive damage to the reproductive system. They resort to it for malignant tumors of the small pelvis, with numerous metastases. The operation involves the removal of the uterus and appendages, the upper third of the vagina, pelvic fat, regional lymph nodes. Often, this type of treatment is used after numerous conservative methods. After such surgical treatment, a woman completely loses the reproductive system, which necessitates hormone replacement therapy.
Uterus removal - postoperative period
After the operation to remove the uterus, a woman must be kept at least 24 hours bedtime, regardless of the type of access (abdominal or vaginal). At the end of this time, doctors are allowed to slowly get up and move. This helps to increase intestinal peristalsis, excluding complications such as paresis. With severe soreness, analgesic medications are prescribed. To prevent infection, a course of antibiotic therapy is conducted.
In parallel, anticoagulants may be prescribed. These drugs prevent the development of such complications as internal bleeding. If regeneration passes quickly and does not become complicated in any way, after 8-10 days, the removal of external seams is carried out. When the operation is performed by laparoscopic method, the patient is allowed to get up after 5-6 hours, and the discharge is carried out for 3-5 days. Obligatory in the early postoperative period is the observance of a diet - mashed and liquid food to establish a stool.
Complications after hysterectomy
Complications after removal of the uterus may be due to non-compliance with the technique of surgery, failure to comply with medical recommendations. If in the early postoperative period this is often the result of a medical error, then in a late (in a few months) - failure to comply with the prescriptions and orders of doctors by patients. Among the frequent complications, such operations as removal of the affected uterus, are:
- internal bleeding ;
- formation of hematomas;
- bleeding from the postoperative suture;
- injury to nearby organs during surgery - intestines, bladder, ureters;
- thrombophlebitis of the legs;
- abaissement of the vagina;
- suppuration of a postoperative wound;
- infection of the bladder (the result of prolonged catheterization);
- peritonitis (inflammation of the peritoneum);
- thromboembolism.
Pain after removal of the uterus
Pain after hysterectomy is localized primarily inside the abdomen, the area of the sutures. To stop a pain attack, doctors often prescribe patients not narcotic analgesics. The duration of the pain syndrome is low. More often patients complain of the presence of pain in the first 3-4 days. After this time, residual tenderness may persist in the area of the external sutures, when access to the uterus was performed abdominally.
Discharge after removal of the uterus
Bloody, brown discharge after hysterectomy is normal. They can be observed for 14 days from the moment of surgical intervention. The presence of soreness and discharge from the reproductive system after this period should be the reason for contacting the gynecologist. This symptomatology may indicate complications of the postoperative period, among which:
- bleeding;
- infectious process in the small pelvis.
Bandage after removal of the uterus
The abdomen after removal of the uterus requires special attention to it. Because of the weakening of the muscular structures, the abdominal press, which is unavoidable in the abdominal type of surgery, women have to wear a bandage. Often, this device recommends patients with menopausal age who have had several pregnancies. The choice of the model should be carried out by a specialist. They wear a bandage daily, taking off only during a shower and before a night's sleep.
Physicians are advised to give preference to a bandage made of natural material. When using it, discomfort should be absent. Pay attention to the width of the product. Doctors speak about the need to exceed the width of the scar with a bandage above and below the minimum of 1 cm (with lower-median laparotomy). Dressing it produces lying on the back.
Drugs after removal of the uterus
What medications to take after the removal of the uterus and whether it is necessary to use them is decided by the attending physician. Often, because of the removal of the glands with the uterus, it becomes necessary to use hormonal means to normalize the body. It is especially necessary hormone replacement therapy for women over 50 years who underwent surgery. In this case, progestogen and estrogen preparations are used.
When the cause of removal of the uterus with the appendages is the presence of large myomatous nodes, the patient is given continuous estrogen monotherapy after surgery. The treatment is complex, involves the use of various forms of medicines:
- tablets for oral administration - Ovestin, Livial, Proginova;
- ointments and gels for external use - Estrogel, Divigel.
If the removal of the uterus was carried out because of endometriosis, complex therapy with hormones, estrogens and gestagens is carried out. In this case, drugs such as:
- Klyane;
- Proginova.
Substitution therapy with hormonal drugs doctors are advised to begin 1-2 months after the removal of the uterus. Such treatment reduces the likelihood of developing cardiovascular diseases, osteoporosis. However, the decision on the need for its use is taken solely by the doctor. Full compliance with his appointments and recommendations guarantees a quick recovery process.
Life after removal of the uterus
Laparoscopic hysterectomy does not affect longevity in any way, but it significantly improves its quality. Women getting rid of the symptoms caused by the disease, completely forget about the need for contraception. Many patients report increased libido. But often the operation forces women to use hormones for a long time. In addition, there is a need for periodic examinations and gynecological examinations. The aim is to monitor the treatment, no relapse, when the cause of removal was a tumor.
Removal of the uterus - consequences for the body
Hysterectomy is reflected not only in the work of the reproductive system, but also in the body as a whole. After the removal of the uterus, the consequences of the operation may be as follows:
- formation of adhesions in the abdominal cavity;
- formation of a keloid scar;
- numbness of the skin in the seam area;
- menopause;
- metabolic disease.
Sex after removal of the uterus
Many patients who underwent surgery are interested in the question of whether it is possible to have sex after removal of the uterus. Doctors respond positively to this question. Sexual intercourse, as before, will be fun - all sensitive areas are preserved. With the preservation of the ovaries they continue to function, releasing sex hormones. However, pain, discomfort during sex can not be ruled out.
Such phenomena are possible in women who underwent extirpation of the uterus (a scar in the vagina) or radical hysterectomy - the part of the vagina is excised. However, this problem can be eliminated, at the expense of trust and mutual understanding between a woman and her partner. Listening to the wishes of the partner, a man can not only have fun, but also deliver it to his beloved.