Surgery to remove uterine fibroids
A uterine fibroid is a benign tumor that develops from the muscle tissue of the female reproductive organ. In some cases, it requires surgical intervention, since conservative methods do not have the desired effect.
Content:
- Do you need surgery? Indications for surgery
- Operation types
- Sizes of uterine fibroids for surgery in millimeters
- Complications and consequences
- Popular questions and answers
- Rehabilitation after surgery to remove uterine fibroids
Do you need surgery? Indications for surgery
There are specific indications for surgical intervention:
- The size of myoma nodes or the size of the tumor itself exceeds the size of the uterus at 12 weeks of pregnancy;
- The tumor threatens to transform into a sarcoma;
- Pressure exerted by the tumor on nearby organs;
- Accelerated growth rates of education (during the year it grows by 4 weeks);
- The fibroid node dies;
- Formation of a submucosal node, or its necrosis;
- Submucosal myoma, or the presence of adenomyosis;
- The occurrence of metrorrhagia, which causes anemia;
- Inability to endure pregnancy or conceive a child;
- The myoma has a leg;
- The tumor disrupts the process of urination.
As for the method by which the formation will be removed, the doctor makes the final decision. It depends on a number of factors: on the location of the tumor and its nodes, on the woman's age, on the state of her health, etc.
Operation types
As for the types of operations carried out for this disease, they are divided into two large groups: operations with the preservation of the genital organ and removal of only the formation (myomectomy), as well as operations with the removal of both fibroids and the uterus at the same time (hysterectomy).
As for hysterectomy, it is considered a radical operation, which is most often performed after a woman reaches 40 years of age and if she no longer plans to conceive a child. In the process of performing a surgical intervention, the uterus can be removed along with the cervix, or with its preservation. At the same time, the cervix is a necessary element in a woman's body, since it makes it possible for the urogenital organs and intestines to function normally. Therefore, whenever possible, doctors try to preserve it. However, you need to make sure that there are no fibroids and malignant cells on it. In addition, appendages may be removed or retained during the operation.
Hysterectomy
Hysterectomy is performed in several ways:
- Laparotomic hysterectomy is practiced, when access to the organ is opened by making an incision in the skin with a scalpel. This method is considered outdated and is resorted to in rare cases when the fibroid has given multiple nodes, and itself has grown significantly, and it is not possible to remove it through a small incision.
- Laparoscopic hysterectomy, when the removal takes place using a special device - a laparoscope. To carry out the operation, several small incisions are made on the abdominal wall, special instruments are inserted through them, and the uterus, along with the myoma, is removed. In this case, the doctor monitors the progress of the operation on the monitor.
Myomectomy
As for myomectomy, this operation allows you to save the organ, and can also be performed in three ways:
-
Abdominal surgery is performed only if it is not possible to remove the tumor by other methods. It is extremely rare for modern doctors to use this type of intervention. Most often, they resort to it when twisting the legs of the fibroid or with necrosis of the neoplasm. A woman will have to spend several days in a hospital, while the stitches themselves will heal for a long time. The rehabilitation period before a woman can return to her previous lifestyle lasts, on average, two months.
- Myomectomy using a laparoscope. Due to the fact that this method is less traumatic, and the stitches are very small, the rehabilitation period after such an intervention lasts only a few days.
- Myomectomy using a hysteroscope. It is inserted into the vagina and the neoplasm is removed. This type of surgery is possible with a single tumor that is located on the wall of the uterus (front or back). The operation is most often carried out in an outpatient clinic and the woman is released after several hours of observation.
Sizes of uterine fibroids for surgery in millimeters
To determine the size of the neoplasm, it is necessary to conduct an ultrasound examination. The sizes are determined, both in weeks of pregnancy and in millimeters.
Fibroids in size are:
- Small - up to 2 cm (20 mm). Corresponds to 4-5 weeks of pregnancy;
-
Average - from 2 cm (20 mm) to 6 cm (60 mm), which is compared to the interval from 4-5 weeks to 10-11 weeks;
- Large - more than 6 cm (60 mm) or 12 or more weeks.
It is necessary to remove with the help of surgical intervention the fibroid that is large and exceeds 12 weeks of pregnancy, or 60 mm.
Complications and consequences
After surgery to remove fibroids, certain complications may develop. Although in most cases they can be avoided, since this type of surgical intervention is not considered difficult or dangerous for the life and health of a woman. However, in some cases, the following complications may occur:
- The tumor may recur;
- The risk of developing breast cancer increases;
- The likelihood of the formation of coronary heart disease increases;
- There is a risk of infection, as with any surgery.
However, the risks of developing these and other pathologies increase significantly if the uterus was removed along with the myoma. In this case, the period after surgery is divided into early and late.
In the early postoperative period, a woman may experience:
- Severe pain in the abdominal cavity, in the area of the seams. Therefore, doctors prescribe at this time the use of potent pain medications.
- In order to prevent thrombophlebitis, a woman is prescribed anticoagulants, to replenish the blood volume - intravenous infusion of solutions, to eliminate the risk of infection - antibacterial drugs.
- The stomach will remain painful for another 2 weeks.
- The scar on the skin may become inflamed or dispersed.
- The process of urination is disrupted if the mucous membrane of the canal has been damaged.
- There is a risk of developing both external and internal bleeding.
- Thromboembolism of the pulmonary artery may occur, which threatens the development of pulmonary hypertension, pneumonia and even death of the patient.
- There is a risk of perionitis formation, which in turn can cause sepsis.
- Hematomas often occur in the area of the seams.
The later consequences after removal of the uterus along with myoma include:
- Inability to conceive a child, as the fertile site is removed;
- The suture from the operation will be visible on the abdominal wall;
- The formation of adhesions in the peritoneum, which can be expressed in pain, increased gas production, difficulty urinating;
- Earlier onset of menopause;
- The risk of developing osteoporosis increases;
- There is a risk of vaginal prolapse.
Therefore, doctors try, if possible, to preserve the uterus. Especially if a young or middle-aged woman is undergoing surgery.
Popular questions and answers
Naturally, a woman who is to undergo surgery is tormented by many questions.
The most popular ones:
- Is it possible to give birth with uterine fibroids? The answer to this question depends on a number of factors. Firstly, the very location of the nodes can already become an obstacle to conception. Secondly, if conception did occur, and the fibroid was detected later, then the woman will need to be under special supervision by the doctor, since it is not known how the tumor will behave when the hormonal background changes. An unambiguous indication for medical abortion is: fibroid necrosis, torsion or infringement of the tumor stem, stealing of the fetus with a tumor and delayed child development, detection of malignant processes, the presence of submucosal nodes, their location in the cervical region, pronounced node growth. In addition, doctors do not recommend a woman to give birth if her age exceeds 40 years, there is a fibroid, and the birth is the first.
- Is it possible to have children after removal of uterine fibroids? After removal of the fibroid, there is a high probability of conception, but only if the uterus has been preserved. In addition, after elimination of the tumor from the body, the woman will need to drink hormonal drugs, which will allow the menstrual cycle to be restored. After a while, it will be possible to plan the pregnancy again.
- When can I get pregnant again after surgery? The timing of when it will be possible to conceive a child again is directly proportional to how the tumor was removed. If a laparoscopic or hysteroscopic myomectomy was performed, then doctors recommend refraining from possible conception for a year. When an abdominal operation was performed, the recovery period can take up to 3 years. However, it all depends on the individual characteristics of the woman and on her ability to recover.
- Bloody discharge after removal of uterine fibroids - what is it? Do not worry about the appearance of bloody discharge from the uterus. They are always observed after such operations. As a daub, this process can take two weeks after the intervention. This is due to natural healing processes. However, if their character changes, the discharge becomes abundant, begins to be accompanied by a putrid odor, or changes color and resembles the color of meat slops, then it is necessary to consult a doctor as soon as possible. This can be a sign of infection or inflammation, which can lead to serious complications.
- How long is sex possible after removal of uterine fibroids? Intimate life is banned for at least a month. Most often, doctors recommend refraining from sexual intercourse for two months, since it is at this time that the scar on the uterus will heal. In addition, there is a risk of infection.
- How long does a sick leave after removal of uterine fibroids last? Most often, after the operation, sick leave is given for 29 calendar days. Although this period can be shortened or increased, depending on how the woman is recovering, what are the conditions of her work, what type of operation was chosen to eliminate fibroids.
- Can uterine fibroids be cured without surgery? In most cases, the formation is treatable without the use of surgical intervention.
On the subject: Treatment of uterine fibroids without surgery - 3 modern methods
Rehabilitation after surgery to remove uterine fibroids
Rehabilitation is an obligatory process after a surgical intervention.
Doctors give the following recommendations, observing which, a woman can recover quickly and without problems:
- As little as possible to be in direct sunlight.
- Refuse to go to the bathhouse, sauna and solarium.
- Abstain from sexual activity for 2 months.
- If there is such a recommendation as wearing a bandage, do not ignore it.
- Do not lift heavy objects, the weight limit is 3 kg.
- Performing exercises using a special simulator.
- Refuse to use tampons, only sanitary napkins should be used.
- Stick to a specific diet.
- Exercise in the long-term rehabilitation period.
The implementation of these recommendations will allow a woman to recover faster after the operation and return to work. In addition, most women claim that their quality of life has improved significantly after surgery. Therefore, in the presence of any symptoms indicating the presence of a pathological process, it is necessary to undergo a full medical examination. When prescribing a surgical intervention, one should not abandon it.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
