In the article, we will find out what it is - supravaginal amputation of the uterus with and without appendages.
In certain circumstances, a woman may hear a doctor’s decision that she needs to undergo surgery and remove the uterus. Uterine amputation or total hysterectomy is performed in extremely advanced cases, when all other treatment methods 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
Subvaginal amputation of the uterus with and without appendages is performed with the preservation of the uterine neck. 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, as a rule, is carried out at the insistence of a woman who wants to save the uterine neck. In this case, excision occurs only if there is no damage.
Indications
Subvaginal 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 neck is preserved only when it is not damaged. Sometimes surgical intervention is forced, 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?
Organ removal is prescribed in the following situations:
- Uterine fibroids, accompanied by symptoms such as compression of adjacent organs, heavy bleeding, pelvic pain.
- When a tumor in the uterus reaches a size greater than twelve weeks.
- The node shows rapid growth of more than four weeks a year.
- Access to the uterine cervix is difficult due to the formation of adhesions, as well as a high probability of damage to the intestine or ureter during surgery.
- Extragenital disease in severe form, when it is important to reduce the time of the operation.
- In case of emergency surgery also to reduce time, for example, with severe bleeding.
However, in most cases, the uterine neck is preserved at the request of the woman. This allows you to save the menstrual cycle, provided that the ovaries are present.
Benefits
The benefits of subtotal hysterectomy are:
- Prevention of prolapse of the reproductive organs.
- Shortened rehabilitation period.
- Preservation of the structure of the perineum from an anatomical point of view.
The absence of a decrease in libido in women with amputation of the uterus while preserving its cervix is also referred by specialists to one of the advantages of this method. However, there is no scientific justification for such confirmations. A significant disadvantage of hysterectomy is periodic bleeding that occurs outside the cycle. In addition, the remainder of the uterine neck has a tendency to malignancy.
Contraindications
Subvaginal amputation of the uterus with and without appendages is not prescribed for the following contraindications:
- Inflammatory processes occurring in acute form.
- Severe anemia.
- Precancerous and background pathologies of the uterine neck.
Some experts consider a total hysterectomy as a preventive method to combat uterine neck cancer. However, this method of preventing cancer is effective only if the woman is able to regularly monitor the status of the remaining stump.
What are the types of operations for supravaginal amputation of the uterus with appendages?
Types of operations
Surgery can be performed in several ways - with the removal of appendages and their preservation. Subtotal hysterectomy is divided into high, low, and typical, depending on the extent of the crossed tissues.
In the reproductive age, removal of the appendages in a woman may become necessary if serious violations in the structure of the ovaries occur, characterized by endometriosis, polycystic, salpingitis, etc. If we talk about the period of premenopause, then in this case, excision of the formations occurs to exclude the possibility of their malignancy.
Survey
Before an operation is prescribed, the specialist instructs the patient to be examined in order to assess the state of health of the woman and the readiness of her body for the intervention. The survey involves the following points:
- Blood and urine tests for general indicators.
- Blood test for biochemistry.
- Coagulogram.
- Blood test for HIV and AIDS.
- X-ray examination.
- Electrocardiogram.
- Getting advice from related specialists, depending on the medical history.
A prerequisite for the operation is the exclusion of contraindications. At the stage of preparation for uterine amputation, inflammatory processes are treated. An operation is possible only on condition of remission.
Preparatory stage
Before a supravaginal amputation of the uterus with appendages, a woman needs to not only pass all tests and undergo specialists, but also visit a psychologist who will determine her internal readiness for amputation.
Surgery is carried out both under general anesthesia and through regional anesthesia. Most often, the operation is prescribed from 5 to 14 days of the menstrual cycle. To prevent complications after surgery, the following preparatory measures are recommended:
- Compliance with a diet that involves cleansing the intestines before surgery. To do this, three days before the appointed time, you should abandon bakery products, fatty and fried foods, as well as fresh vegetables. Immediately before the operation, specialists prescribe cleansing enemas. If the access during surgery is vaginal, then the enema is performed in the morning and evening.
- Eating a day before surgery should be no later than 8 hours.
If it is an emergency, preliminary preparation for the operation is not carried out.
The course 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.
Restoring the integrity of the reproductive organs is not provided. The operation is performed in several stages:
- The intersection of the apparatus of the ligaments.
- Hemostasis.
- Monitoring the urination process through a catheter.
The main methods of surgical intervention
There are several options for performing a 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 was damaged or there is no possibility to perform the operation by another method. If there is a suspicion of a neoplasm of a malignant nature, 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 uterine amputation. The advantages of this option are the short duration of the operation, the low probability of blood loss and the rarity of the development of complications. Operation by this method involves the mobility of the uterus and a sufficient volume of the vagina. The tumor should not be more than 12 weeks.
- Laparotomy Subvaginal amputation of the uterus with appendages is often performed in this way. With this access path, a section of the anterior abdominal wall is made. The advantage of the operation is that the doctor has a good overview of the uterus and it is convenient for him to perform all the actions. However, in this situation, the patient suffers from an impressive surgical trauma, which often entails severe side effects.
- Laparoscopy. Amputation is performed through three injections into the peritoneum. This method requires highly qualified specialist. Special video equipment allows you to evaluate the uterus, appendages and adjacent tissues to complete the operation. The advantages of the technique are its low degree of invasiveness, a lesser likelihood of developing complications, a low pain syndrome, and a short rehabilitation period. During the operation, a special gas is introduced into the abdominal cavity, which may be contraindicated to the patient.
The choice of the method of uterine amputation depends on the equipment of the clinic with equipment, as well as the qualifications of the doctor.
Rehabilitation
How does rehabilitation work with supravaginal amputation of the uterus with and without appendages?
To prevent postoperative complications, it is recommended to follow these instructions:
- Reception of antibacterial drugs.
- Anesthesia as needed.
- Systematic stimulation of the intestine, as well as dietary nutrition until the first independent implementation of the act of defecation.
- Conducting daily seam processing.
- Bandages and compression garments must be worn for two months.
- Low physical activity with the exception of heavy lifting.
After a subtotal hysterectomy, sexual activity is not recommended for 1.5-2 months. Patients are prescribed to regularly conduct a cytological examination of the remains of the uterine neck.
If it was possible to save the ovaries, then the stump of the uterine neck is attacked by sex hormones, menstruation continues. The discharge is regular and odorless, small in volume.
Complications
The most common complications after uterine resection are:
- Hemorrhagic syndrome.
- Bladder injury
- Ureter dressing.
- The occurrence of a hematoma.
- Thromboembolism and thrombosis.
- Infection.
- Syndrome of premature menopause.
- Decreased sexual desire.
The greatest danger with the supravaginal method of removal of the uterus is hematomas and bleeding.
What are the consequences of supravaginal amputation of the uterus with appendages?
The consequences of the operation
Uterine amputation does not pass without a trace for the female body. The least danger is surgery for those who managed to realize their child-bearing function or entered the stage of menopause. When it comes to a nulliparous woman of mature age, such a solution becomes a problem. Trying to save the uterus can have very serious consequences.
Other consequences of a hysterectomy are also highlighted:
- Psychological. The most common occurrence after removal of the uterus is a state of depression.
- Loss of opportunity to conceive. It should be borne in mind that if ovaries are preserved, surrogacy is possible.
- The onset of premature menopause. This phenomenon is characteristic in the case of removal of appendages. Women after surgery are prescribed hormone replacement therapy.
Uterine amputation is a complex surgical intervention that can affect all areas of a woman's life.
We examined supravaginal amputation of the uterus with appendages. What is it and its consequences are described in detail in the text.