Uterine fibroids are benign tumor growths that form in the muscle layer and are caused by hormonal imbalance. However, the exact reasons for its appearance are unknown. The choice of a specific method of therapy depends on the condition of the woman, the location and size of the tumor, as well as the presence of concomitant diseases. At the initial stage, when the myoma is small, hormone therapy is usually prescribed. Its disadvantage is the appearance of relapse. Most doctors recommend a slightly traumatic, organ-sparing surgery to remove uterine fibroids. The final decision on the choice of treatment method is made after receiving the results of the examination and the conclusion of specialist doctors.
Factors affecting the hormonal background
Myoma is mostly asymptomatic. Therefore, it is quite difficult to identify it in the early stages, and without treatment it increases in size.
In recent years, more and more doctors talk about the dangers of sunburn, especially with a detected myoma. Thermal procedures can cause complications in the form of progression of the pathology. In addition, the following factors provoke the disease:
- late birth;
- endocrine disorders;
- surgical interventions;
- poor nutrition;
- heredity;
- early onset of menstruation;
- sedentary lifestyle;
- venous congestion.
Indications for surgery
The main indication for surgery to remove uterine fibroids is its size. Due to the fact that a tumor, forming in the muscle layer of the main female organ, contributes to an increase in its size, it is customary to measure the stages of development of fibroids in weeks, as during pregnancy:
- huge formations - 16 or more;
- large - from 12 to 15;
- medium - about 10–11;
- small - within 5.
Removal of fibroids is indicated if:
- against her background, infertility is diagnosed;
- there are concomitant pathologies in the form of endometriosis, ovarian cancer;
- fast growth;
- there is a risk of degeneration into a malignant formation;
- a malfunction in the intestines;
- there is pain;
- necrotization of tumor tissues is observed as a result of a violation of its nutrition;
- there is heavy bleeding outside the regular period.
Preoperative preparation
After making the final decision on the need for surgical intervention in a planned manner, the first stage of preparation for surgery to remove uterine fibroids is carried out on an outpatient basis. It consists in:
- Hysteroscopy with histological examination of the endometrium.
- Various blood tests, including determination of blood group, Rh factor. Make a Wasserman reaction to AIDS, etc.
- Analysis of urine, feces on the ovum.
- Studies of biomaterial taken from the vagina, urethra, cervical canal for purity and microflora.
- Ultrasound of the pelvic organs.
- ECG.
- X-ray or x-ray.
- Consultations of specialists whom the attending doctor will recommend.
- Depending on the presence of concomitant diseases , special training is carried out. For example, in case of a disease of the cardiovascular system, the fundus is evaluated, an ultrasound of the heart is done, the pressure is monitored, and all indicators are evaluated in dynamics.
The second stage is carried out in a hospital and it lasts from one to three days:
- On the eve of the operation, the patient is visited by an anesthesiologist, anesthesia method is selected.
- In some cases, re-sampling of biomaterial for biochemistry and coagulation is carried out.
- Patients undergo sanitization: hair is removed from the pubis, taking a hygienic shower.
- Before the operation, the patient is given a light supper, bowel cleansing is performed. Complete starvation is not shown, since it can disrupt metabolic processes in the postoperative period.
- For good sleep and rest, the patient is given sleeping pills.
Abdominal surgery
Surgical intervention by:
- Abdominal surgery. It is used in extreme cases. How is the operation to remove uterine fibroids in this way? They do it under general anesthesia. The essence of the method: an incision is made on the peritoneum transverse or longitudinal, then the remaining tissues are dissected. After the nodes are clearly visible, they are excised. After removal of the myomatous nodes, sutures are applied. Inpatient treatment after surgery takes about ten days. The recovery period is long, up to two months.
- Laparotomy is a cavity operation to remove uterine fibroids. This method is recommended in the presence of a large number of deeply located subserous nodes, as well as the presence of scars on the body of the uterus or adhesions. Rehabilitation after this type of intervention is about four weeks. The occurrence of complications occurs with errors during the operation.
Rehabilitation period
After a cavity operation to remove uterine fibroids, the postoperative period takes a considerable period of time. In the first days after the intervention, a woman feels severe pain and weakness. At this time, she is shown analgesic therapy and rest. To get up and walk is allowed on the second day. The body recovers faster thanks to movement. In order to prevent inflammatory processes, a ten-day course of antibiotics is prescribed. In addition, an important point in the quickest recovery is dietary nutrition. In the early days, liquid food is recommended: broths, teas. Gradually meat and fish of low-fat varieties, porridge from buckwheat or oat groats, vegetables, fruits, and dairy products are introduced into the diet. It is very important to restore normal stool as soon as possible. During the rehabilitation period, you should engage in physical education and relax more.
Removal of the uterus with myoma
A cavity operation to remove the uterus in the presence of myomatous nodes is a necessary measure and there are certain indications for choosing exactly this type of treatment:
- myoma has reached tremendous size;
- a large number of nodes;
- severe pain in the pelvic area;
- bleeding that is permanent;
- endometriosis in the last stage;
- against the background of pronounced signs of the disease, health problems are identified;
- the presence of recurrent polyps;
- prolapse of the uterus due to the large volume of the tumor;
- the risk of fibroid necrosis associated with twisting of the leg of the node.
There are supravaginal amputations of the uterus, removal of the last and cervix, as well as removal of the uterus, cervix and ovaries. In the case of preservation of the appendages, the hormonal background does not undergo changes. Regardless of the volume of surgical intervention, a woman is waiting for a long period of rehabilitation, including psycho-emotional recovery.
Oral surgery to remove uterine fibroids: reviews
Despite possible complications, the operation saves life, saving the woman from the painful symptoms of the disease. Feedback from those who have gone through this procedure is as follows:
- quality of life has improved;
- ceased to torment prolonged bleeding, leading to anemia;
- severe pain in the lower abdomen is gone;
- after the surgical method of removing fibroids with preservation of the uterus with the strict implementation of the recommendations of the attending doctor, the recovery period is faster;
- a woman after a short period of time begins to live in the same rhythm and can give birth;
- for the prevention of complications, antibacterial drugs should be taken;
- the ability to conceive a baby is preserved.
A cavity operation to remove uterine fibroids, according to doctors, is not a sentence. A woman can plan a long-awaited pregnancy no earlier than six months after surgery.
Other ways to remove fibroids
Tumor Removal Techniques:
- FUZ ablation. Its essence is as follows. Under the influence of ultrasonic waves, the cellular tissues of nodes are heated and destroyed. Manipulation is carried out under the control of MRI. The necessary conditions for its conduct is the location of the tumor, the diameter of which does not exceed 9 cm, on the bottom or front wall of the uterus. This method is not recommended for women with a diagnosis of infertility, with subserous nodes on the leg.
- Laparoscopic surgery to remove uterine fibroids is a less traumatic surgical intervention that is performed under local anesthesia. The essence of the method is as follows. Punctures are made in the peritoneum. The camera is introduced into the umbilical ring, then the stomach is inflated with carbon dioxide to raise the internal organs. A special laparoscope is introduced into the punctures, with the help of which the myomatous nodes are removed. After completion of the manipulation, punctures are sutured. If there are subserous nodes in diameter no more than a centimeter, a uterus size of 15–16 weeks of pregnancy shows laparoscopy - an operation to remove uterine fibroids. The postoperative period takes about two weeks.
- Hysterectomy. In this case, the uterus is completely removed. Such an operation is done with huge tumors, the risk of developing a malignant neoplasm, the presence of heterogeneous nodes in large numbers.
- Laser therapy is an effective, gentle, safe, painless, bloodless and very expensive method. The laser has a metered effect on the myoma, without affecting adjacent tissues and without leaving scars on the uterus.
- Hysteroscopy is an organ-preserving technique that does not require dissection of the abdominal cavity and removal of the uterus. How is the operation to remove uterine fibroids using this method? The procedure is performed under general anesthesia using a special device, a hysteroscope, which is inserted through the vagina into the main female organ. This manipulation is effective with single nodes on the anterior or posterior wall of the uterus. The length of stay in stationary conditions is not more than a day.
- Uterine artery embolization is a highly effective method that is performed under local anesthesia. Contraindication is the presence of subserous nodes. A side effect of the absence of menstruation occurs in five percent of women. The essence of the method: a microcatheter with a special solution is introduced through the femoral artery. As a result, the vessels that feed the myomatous node become clogged and die, and the tumor eventually dissolves on its own.
Laparoscopy
Laparoscopy for myomas with superficial nodes is the gold standard for the provision of planned surgical care. This method is shown with:
- rapid growth of neoplasms;
- the complex structure of subserous nodes;
- the threat of abortion due to fibroids;
- painful and prolonged bleeding leading to anemia;
- a large number of surface nodes that contribute to the deformation of the uterus;
- the presence of a large node that exerts pressure on neighboring organs.
The duration of an operation to remove uterine fibroids using a laparoscope is on average 40 to 180 minutes. This factor is affected by the complexity of the operation, the qualifications of the doctor, and the necessary equipment. Walking and performing special exercises is recommended a few hours after the removal of nodes. Early motor activity prevents the formation of adhesions and contributes to the rapid release of gas residues. Shown around the clock wearing compression stockings or bandaging the legs for two weeks after the manipulation. The bandage is recommended to be worn for a month. Sutures are removed on the ninth day. After surgery to remove uterine fibroids, sexual rest lasts about four weeks. Pregnancy planning is possible no earlier than six months later, since early pregnancy can lead to uterine rupture.
There are contraindications to this method of removing fibroids. They are divided into absolute and relative. The first include:
- hernias on the anterior wall of the peritoneum;
- little weight;
- concomitant pathologies excluding anesthesia;
- diagnosis of submucous or interstitial fibroids.
Relative contraindications are:
- fluid in the abdominal cavity;
- diagnosed with obesity;
- swelling of the cervix or ovaries;
- myoma for more than 12 weeks;
- adhesive disease.
Advantages of laparoscopic surgery to remove uterine fibroids:
- The woman still has the opportunity to get pregnant, since with this method the uterus is not removed.
- Short recovery period due to rapid healing.
- The absence of pain.
- A short period of stay in the hospital.
- Adhesions after surgery are practically not formed.
Disadvantages: there remains the likelihood of new myomatous nodes.
The consequences of surgery
Consider the consequences of operations to remove uterine fibroids, depending on the method chosen:
- FUZ ablation. In this case, severe complications are minimized. During the procedure, there is no infection and tissue damage, no anesthesia is required. Minor pain and bleeding observed within a few days after the manipulation is a natural reaction of the body as a result of which the uterine cavity is freed from the dead tumor cells.
- Embolization - this method, like the previous one, is less traumatic. Complications after blocking the blood flow of the uterine arteries are found in about 5% of cases in the form of bleeding, thrombosis and infection. The main consequence is the re-growth of the tumor in the next three years, which is recorded in almost 30% of cases.
- Hysteroscopy. Complications after such an operation to remove uterine fibroids are manifested by bleeding in case of vascular damage, infection and inflammation in violation of the rules of asepsis and antiseptics, damage to the cervical uterus (cervical canal) during its expansion, uterine perforation, when the node was not carefully removed, and an air embolism in due to air entering the tube. Thus, the occurrence of the above consequences is associated with the actions of medical personnel. Minor painful sensations and discharge of a different color (yellowish, brownish or pink) are not pathologies and do not require treatment. They pass on their own in three to five days.
- Laparoscopy. The consequences of this method, as in the previous case, depend on the actions of doctors. Bleeding from damaged walls of blood vessels, requiring immediate abdominal surgery, occurs due to the absence or insufficient control of the doctor during the procedure. In addition, after pregnancy, it is necessary to monitor the condition of sutures that were imposed during the laparoscopic operation. The risk of relapse is significantly lower than with the first two methods.
- Laparotomy The consequences of abdominal uterine myoma removal are associated with infection and long healing of incisions, with prolonged anesthesia. Among the negative aspects, the following can be distinguished: a long recovery period (up to two months with a weakened body), endometritis, myometritis, complication after anesthesia, associated with a shock condition or impaired heart function, the formation of adhesions.
Despite all the consequences, surgical removal of myomatous nodes is an incomparably lower risk than untimely started therapy, which leads to more serious surgical intervention - removal of the uterus.