Total hysterectomy is an operation in which the uterus is completely removed. Such surgical intervention is a radical method of treatment and is used in cases where no other method of treatment brings healing. The procedure is carried out in a hospital after some preparation. In this article, we consider what methods an operation can be performed, and what complications a woman can expect after it.
Indications for surgery
Since total hysterectomy (extirpation) is a very serious procedure, which sometimes leads to unpleasant consequences, doctors try to avoid it by using alternative methods of treatment. This is especially true for women of childbearing age. But it happens that situations arise in which organ removal is the only solution. There are many reasons for this. Let's consider some of them:
- cancer of the uterus or other genital organs, especially in advanced stages;
- the initial stage of cancer of the female organs in the case when the tumor cannot be treated with conservative methods and grows very quickly;
- strong prolapse of the uterus or its prolapse;
- a large number of myomatous nodes;
- single myoma, but having a size of more than 12 weeks of pregnancy; this can lead to repeated bleeding or necrosis;
- endometriosis and adenomyosis, which cannot be cured by conservative methods;
- inflammatory and purulent processes;
- uterine rupture during childbirth;
- a large number of papillomas, cysts;
- increment of the placenta;
- irreversible hormonal disorders that lead to the constant growth of benign tumors.
- hysterectomy is used in people who decide to change their gender.
Most often, such an operation is prescribed to women who have entered the period of menopause, since they do not have to maintain reproductive function. And since the ovaries are no longer functioning fully, the negative consequences caused by hormonal failure are not expected.
Types of Hysterectomy
When choosing a method of surgery, the doctor is based on the primary disease, the condition of the woman herself and her age. The size of the uterus is also determined.
Currently, the procedure is carried out by the following methods:
- total laparoscopic hysterectomy - the operation is performed using a laparoscope;
- abdominal laparotomy - removal occurs through an incision on the abdomen;
- vaginal - access to the affected organ is via the vagina.
Basically, the method is selected at the stage of preparation for the operation and may include a combination of several options.
Contraindications for surgery
Total hysterectomy of the uterus is a very difficult operation, which is accompanied by great blood loss and deep anesthesia. Also, one should not forget that the disease, due to which this procedure is prescribed, could weaken the female body, which increases the risk of complications during or after the operation.
There are a number of relative and absolute contraindications to the procedure. These include:
- bleeding disorders;
- inflammatory and infectious processes in the reproductive organs of women;
- general diseases of the body, including acute respiratory viral infections and influenza;
- intolerance to anesthesia;
- severe anemia;
- severe diabetes mellitus;
- bleeding of an obscure nature.
If emergency surgery is necessary, then the procedure is carried out if there are contraindications. Severe bleeding (for example, due to a rupture) or the rapid development of sepsis can be attributed to such situations. In other cases, surgery may be delayed for the time needed to treat concomitant diseases.
Preparation
After deciding on the procedure for removing the uterus, a woman needs to undergo preoperative preparation, on which the success of the operation largely depends. It is necessary to conduct a comprehensive examination, in which the diagnosis is clarified, the patient's condition, the presence of contraindications. Preparation may begin several months before removal.
The following procedures are mandatory for preparatory measures:
- a blood test, both general and biochemical;
- Analysis of urine;
- tests for AIDS, HIV, hepatitis;
- coagulogram;
- swabs from the vagina;
- endometrial biopsy;
- ECG;
- colposcopy;
- ultrasonography;
- MRI or CT.
If the results of the tests showed the presence of inflammatory or infectious diseases, therapy is carried out to eliminate them. Also, if necessary, blood clotting drugs are prescribed to minimize the risk of bleeding or, conversely, thrombosis. If large myomatous nodes are detected, therapy is performed to reduce or suppress their growth.
Mandatory consultation of the therapist and gynecologist. They prescribe the necessary measures that stabilize blood pressure, blood glucose and other indicators in which deviations were found during the analysis.
After all the necessary procedures have been carried out and there are no more contraindications for performing a total hysterectomy, the doctor sets the date of the operation and discusses the plan with the patient.
It is worth noting that sometimes doctors neglect preparatory measures. This occurs when emergency surgical intervention is required in case of a threat to the woman's life.
Infection is prevented by the introduction of antibacterial drugs and vaginal debridement for 8-10 days. A few days before the operation, gas-forming products must be excluded from the diet, replacing them with easily digestible food. 8 hours before the procedure, refuse food completely and limit the intake of fluids as much as possible. It is also necessary to cleanse the intestines, and before removing the uterus, you will need to empty the bladder.
Before a total hysterectomy, a conversation with an anesthesiologist is required, who discusses with the patient the type of anesthesia and notifies about side effects.
Sometimes it is advisable to use compression underwear.
Abdominal hysterectomy
If the doctor decides to conduct a total hysterectomy (extirpation) of the uterus using the laparotomy method, this implies access to the uterus through a vertical or horizontal section of the abdominal cavity. This method is the most common in medical practice, but also with great trauma.
The operation is performed under general anesthesia. After an abdominal incision, the uterus is removed. Then the blood vessels and ligamentous apparatus, which held the uterus, intersect. If necessary, a total hysterectomy with appendages is performed.
If a malignant process is suspected, material is taken for an urgent histological examination.
At the completion of the main stages of the procedure, the doctor examines and drains the abdominal cavity. Sometimes a drain pipe may be required.
After all the manipulations, the incision is tightly sutured and a sterile dressing is applied.
Abdominal complications
Performing a total hysterectomy with the laparotomy method is quite traumatic and difficult to tolerate by the patient. For quite a long time, severe pain can disturb, which involves taking painkillers. Also, there is a high risk of infection, the development of an adhesion process in the peritoneum and numbness in the suture area. Sometimes, during the operation, neighboring organs are damaged - loops of the intestine, ureter, and others. The rehabilitation period with this method has been increased.
Vaginal removal method
Vaginal total hysterectomy is used, as a rule, in women giving birth, having a small size of the uterus. With this method, the organ is removed through the vagina, so no scar remains. The main conditions for the operation in this way are the absence of cancer and flexible walls of the vagina. The procedure is not performed in nulliparous women, as well as if necessary, removal of the ovaries.
Since the visualization of female organs is difficult with this method of surgery, a laparoscope is often used.
Manipulations are carried out through an incision in the upper part of the vagina. First, the cervix is removed, and then the uterine body itself.
The main indications for the vaginal method are benign small formations, cysts, prolapse or prolapse of the uterus.
Contraindications are the large size of the uterus, the presence of adhesions, or a history of cesarean section.
Laparoscopic method
The procedure for total laparoscopic hysterectomy is performed using a special device - a laparoscope. At the same time, several small diameter punctures are made in the abdominal cavity, into which special tubes of the device and a video camera are inserted, with the help of which the image is displayed on a nearby screen.
The operation takes place in several stages. First, gas is injected into the abdominal cavity to raise the abdominal wall. Then the ligaments and tubes intersect, and after that the uterus intersects and the arteries are ligated. The removed organ during laparoscopy of total hysterectomy is excreted through the vagina in which the incision was made. This stage requires special care to eliminate the risk of damage to neighboring organs. If the uterus is large or myomatous lesions are present, it is first dissected into smaller fragments. Then, stitches are placed on the puncture sites.
Total hysterectomy (extirpation) of the uterus, performed by the laparoscopic method, can be performed in nulliparous women or with a narrow vagina.
Contraindications to the use of this method include large cystic formations, a large organ size (but this condition is relative and depends on the skill of the surgeon), as well as uterine prolapse - in this case, the vaginal removal method is advisable.
Postoperative period
After the operation, the patient is under the control of doctors for some time. The rehabilitation period will depend on the method used to remove the uterus.
With the laparotomy method, the sutures are removed approximately on the 8th day, then discharge from the hospital takes place. Doctors recommend already in the first day after the operation of turning over and small sitting down. This is the prevention of adhesions.
With the vaginal and laparoscopic method, the patient is already allowed to get up, sit down and drink accurately on the first day after removal of the uterus. The next day you can eat and walk. Extract occurs 3-6 days after surgery.
Within 10-14 days after a hysterectomy, it is recommended to bathe in the shower. Of the drugs, painkillers, as well as antibiotics and anti-inflammatory drugs, are prescribed for the first time. During the rehabilitation period, you need to try to exclude overheating and great physical exertion.
Discharge after surgery
Within two weeks, the patient may be disturbed by spotting. But if they continue even after the expiration of this period, especially with the addition of painful sensations, this is an occasion to consult a doctor. After all, such a condition can be a sign of both bleeding and the development of the inflammatory process.
Complications
After total hysterectomy, a large number of complications are possible. These include:
- damage to neighboring organs;
- infection;
- peritonitis, which can threaten a woman's life;
- bleeding
- sepsis;
- intestinal obstruction and urinary retention;
- prolonged pain.
Effects
After undergoing the procedure for removing the uterus, two main consequences of this are distinguished:
- violation of reproductive function and, as a result, the cessation of menstruation;
- if a total hysterectomy with tubes and ovaries was performed - the onset of menopause, which can lead to hormonal imbalance.
Many women experience a decrease in libido. This is facilitated by hormonal and psychological disorders, causing, among other things, sharp mood swings and depression. Sometimes you may need the help of a psychologist. But in most cases, with the preservation of the ovaries, sexual life is improved after a while, although painful sensations can sometimes disturb.
Prolonged pain may also occur, worsening the quality of life.
Conclusion
Total hysterectomy is a very serious operation, which should be prescribed only in the absence of a result from treatment using other methods or the development of conditions that threaten a woman's life.