Surgery always causes fear in people, because any intervention has risks. Nevertheless, it is impossible to do without these manipulations. One of the surgical interventions is cystectomy. This is a procedure that is performed in various branches of surgery. It is indicated in cases where conservative therapy has no effect. Like any surgical procedure, a cystectomy is performed solely for strict indications. She is appointed only by a specialist after examination. The operation is performed under stationary conditions. Before carrying out it, preparation of the body is necessary.
Cystectomy - what is it?
As you know, each surgical intervention refers to a particular surgical profile. For example, urology, proctology, oncology, etc. Nevertheless, there are a number of such procedures that are considered universal. One of them is cystectomy. This is an operation, which means the removal of a cyst. Such a benign formation can appear in almost any internal organ. A cyst is a round or oval cavity filled with liquid contents. Most often, it is found in the ovaries, liver, kidneys, and bladder. Also, a cyst can form in the dental canals and gums.
In addition, there is such an operation as a cystectomy of the bladder. This surgical intervention has a completely different meaning, since it is not associated with cysts. This medical term refers to the removal of the organ itself - the bladder. Often, such an operation is performed due to cancer pathologies.
What diseases is cystectomy performed for?
Cystectomy is a radical method of treatment, since it involves the complete removal of a cyst with its shell. This procedure is performed by surgeons of various profiles. Among them are specialists performing operations on the organs of the chest and abdominal cavity, urologists, oncologists, dentists, gynecologists. Despite this, every surgeon should be familiar with the cyst removal technique. And yet, what diseases do cystectomy do? Despite the fact that a cyst can form in almost any organ, such an operation is not always performed. Sometimes a benign formation is treated with medication. In some cases, it is necessary to remove the entire organ (for example, with a large cyst in the kidney). It should be borne in mind that there are contraindications for cystectomy. Sometimes it is impractical to perform such an operation due to the high risk to health. The diseases in which cystectomy is performed include:
- Ovarian cyst. This refers to a large education that is not amenable to other types of treatment.
- Cyst of the liver. Most often, such formations contain not only liquid, but also a parasite (echinococcosis). In this case, surgery is the only treatment.
- Cyst in the oral cavity. It can have different localization. This disease is treated by a dentist surgeon.
- Pancreatic cyst. Despite the fact that this is a benign neoplasm, operations on this organ are dangerous. Therefore, an experienced specialist should perform a cystectomy of the pancreas.
In addition to these diseases, surgery may be required for cysts of the breast and thyroid gland, tailbone, etc. In these cases, treatment tactics are determined depending on the size of the formation.
Indications for radical cystectomy
In addition to removing cysts from organs, radical cystectomy is an operation on the bladder. The main indication for its implementation is a cancerous tumor. A malignant formation can both develop in the bladder itself and grow into the thickness of an organ from nearby tissues. Most often, such tumors include cancer of the cervix and endometrium, ovaries, prostate and rectum. A cystectomy of the urinary organ (bladder) is its complete or partial removal. Given that such a procedure is traumatic and leads to disability, it is performed only in cases where other treatment options do not help. The following pathologies are considered indications for cystectomy:
- Common cancer of the neck and body of the bladder, growing in the thickness of the tissue.
- Multiple papillomas located on the inner surface of the organ.
- Re-formation of the tumor after previous surgical treatment (recurrent cancer).
- Germination of a malignant neoplasm in the bladder from adjacent organs.
With less aggressive forms of cancer, surgeons try to avoid radical cystectomy. In such cases, they are limited to partial removal of the organ in the place where the tumor is located.
Preparation for cystectomy of the bladder
Operation cystectomy is a massive abdominal surgery. Therefore, before proceeding with the procedure, the patient's body should be prepared. Since the operation can lead to the development of an infectious process in the pelvis, it is necessary to start taking antibiotics in advance. Erythromycin and Neomycin are recommended. Also, 14 days before surgery, medications containing bifidobacteria and lactobacilli should be taken. They are necessary not only because of antibiotic therapy, but also to improve bowel function after surgery.
Given that the organs of the digestive system border the bladder, a special diet is required. 3 days before cystectomy, hard-to-digest foods should be excluded. It is allowed to use liquids (boiled water, mineral water without gas, tea, juices), broth and jelly. On the eve of the operation, bowel cleansing is performed. For this purpose, special laxatives or a number of enemas are used.
Bladder cystectomy
A cystectomy is performed in several successive stages. The first step is general anesthesia. For convenient access to the bladder, the patient should be in a special position. The patient is laid on his back, the pelvis is raised by 45 degrees compared with the head and foot end. The cut is performed in the midline. It begins in the area of the pubic symphysis and ends 2-3 cm above the umbilical ring. The first stage of cystectomy is the removal of urine and the creation of conditions for its outflow (derivation). After this, the organ is extirpated. The volume of surgery depends on the prevalence of the tumor. Often, in addition to the bladder, the nearby lymph nodes and other organs are removed. In women, this is the front wall of the vagina, the urethra. With pronounced infiltrative growth of the tumor, the uterus and ovaries are extirpated . In men, in addition to the bladder, it is often necessary to remove the prostate gland and seminal vesicles. Given that massive blood loss occurs during surgery, cystectomy has a number of contraindications.
After urine is diverted to the anterior abdominal wall or intestine, the organ is separated from the peritoneum, ligation of bleeding vessels and its removal. Next, electrocoagulation, spinal anesthesia is performed to reduce pain in the first hours after the manipulation. It should be noted that between 1 and 2 stages of surgery should take from 4 to 6 weeks.
Postoperative Recovery
After cystectomy, rehabilitation can continue for a long time. This is due not only to physiological changes occurring in the body, but also to the psychological state of the patient. Indeed, in addition to the fact that the normal process of urination is disrupted, other functional changes are noted. Recovery of the body does not occur immediately. On the first day after surgery, the patient should be in the intensive care unit. This is necessary in order to monitor vital functions, not to miss the development of bleeding and shock. When the patient is transferred to the general ward, he can already move independently. It is recommended to walk as much as possible so that the adhesive process does not develop in the small pelvis. In some cases, patients have to take food with a probe for a long time. Nevertheless, over time, the work of the intestine is restored, and the patient begins to eat on his own. Urination also gradually returns to normal. However, patients have to walk with a catheter all the time. Therefore, some patients undergo another operation - the creation of an artificial bladder. Such manipulation is performed after several months in the absence of contraindications.
Tooth cystectomy: stages
Removal of a tooth cyst is also called cystectomy. This operation is performed in a dental office. To perform it, general anesthesia is not needed, just local anesthesia is enough. An exception may be children. A cystectomy of a tooth involves the complete removal of contents from the shells of the cyst. The stages of the operation include:
- Preparation of the mucoperiosteal flap using an incision. Then it is peeled off.
- Obtaining a bone plate in order to gain access to the cyst. For this, several holes are drilled over the formation.
- Removing a cyst and part of a tooth root.
- Revision of the cavity.
- Suturing of the mucoperiosteal flap.
Most often, a cyst is a congenital malformation of epithelial tissue. Less commonly, it appears due to long-term inflammatory processes, inadequately performed dental procedures.
Ovarian cystectomy
Ovarian cystectomy is an operation that is necessary for large cysts that are not amenable to conservative therapy. This benign formation is dangerous because it can lead to apoplexy - rupture of the organ. The operation to remove the cyst is performed both in an open way and with the help of laparoscopy. The content of the education is sent for cytological examination. If no malignant cells are detected, coagulation and suturing of the ovary is performed.
Technique for performing cystectomy of cysts of internal organs
Cystectomy of a cyst of other internal organs is carried out in a similar way. Complex operations include the removal of pancreatic, lung, and liver formations. Such interventions are performed by an open surgical method under general anesthesia.
Contraindications to cystectomy
Contraindications to the removal of cystic formations include:
- Acute and chronic insufficiency of the heart, kidneys, respiratory organs, which is in the stage of decompensation.
- Purulent inflammatory processes in the pelvis, abdominal and chest cavity.
- Immersion of the tooth root in the cyst by more than a third.
- Unsatisfactory cytological test result. In these cases, other methods of surgical treatment are required.
Reviews of doctors about cystectomy
Most doctors of various specialties believe that cystectomy of cysts is considered a necessary surgical intervention, since it prevents the development of severe complications (peritonitis, sepsis). Often this procedure does not pose a health hazard and is carried out laparoscopically.
Removal of the bladder, according to doctors, is a serious and traumatic operation, accompanied by a risk of complications. Nevertheless, with malignant tumors, it is considered necessary.