Uterine fibroids is a gynecological disease, which is a dependent hormonal tumor characterized by a benign course. For the treatment of fibroids, conservative methods are used, and, in addition, surgical methods associated with the removal of a pathological formation. The basis of therapy is hormone replacement drug treatment, but it is far from always possible to cure fibroids without surgical intervention. It is in this regard, in the presence of uterine fibroids, the most suitable, and at the same time effective way, is to perform an operation. The cost of an operation to remove fibroids depends on several factors.
Indications
Uterine fibroids, like any neoplasm, can vary in size, ranging from a small pea to a large node, which can weigh about one kilogram. This disease can be manifested only by one focus or immediately multiple or distributed over the surface of the uterus, or they can be grouped together.
Often, fibroids are characterized by nodular growth and can be located in any layers of the organ, for example, in the muscle wall, and, in addition, under the mucosa and above it. To the question of whether it is necessary to remove the fibroids, only the doctor will answer. The method of treatment of fibroids is prescribed by the gynecologist after conducting basic laboratory and instrumental studies. The following factors are indications for surgery to remove fibroids:
- The presence of intensive progressive growth of myomatous nodes.
- The development of menometorrhagia, leading to the appearance of anemia, which requires urgent treatment and correction.
- Activation of tumor enlargement during menopause.
- The process of degeneration of a benign tumor into cancer.
- The presence of intense pain.
- The presence of concomitant endometriosis and ovarian tumor.
- The development of necrotic lesions of the nodes.
- Inability to bear the fetus (frequent miscarriages) or infertility.
- The submucosal nature of the location of the pathological focus.
- The position of the fibroids is not far from the cervix, and, moreover, directly on it.
- Failure of functioning near located organs due to compression by their pathogenic node.
Despite the great effectiveness of conservative methods, surgery in the presence of fibroids is the main method of treatment.
Types of operations
In modern surgery, there are two types of fibroids removal operations:
- Organ-preserving, we are talking about myomectomy, that is, the removal of part of the organ. This technique is applied to women who have not yet given birth and are in reproductive age.
- The radical type of operation involves the removal of an organ without appendages or with them. This method is used for nodes that reach large sizes. Also, similar operations are carried out in relation to already giving birth to patients. Reviews of the operation to remove uterine fibroids are presented below.
Types of Surgical Therapy
When treating this disease, organ-preserving surgeries are always always preferred, but, unfortunately, they are not always effective. In what particular cases does a complete organ removal be necessary? This can only be determined by the attending physician. Such interventions are prescribed mainly to patients who are of reproductive age.
In addition to age, an important role is played by the location of the pathological focus along with its size and degree of neglect. Modern surgical gynecology offers various methods for removing uterine fibroids.
Among the most commonly used methods, abdominal surgery, laparoscopy, hysteroscopy and general abdominal hysterectomy are distinguished.
Abdominal fibroid surgery
Cavity removal is indicated in case of torsion of the leg, on which the tumor usually rests. In addition, such an operation can be prescribed for necrotic lesions or in the presence of large fibroids. Another indication for abdominal surgery to remove uterine fibroids is a significant degree of organ deformation.
The essence of surgical intervention is to remove the lesions through an incision made on the abdomen. Specialists resort to the abdominal surgery to remove fibroids only last because of the severity of the postoperative period and the high likelihood of complications.
True, laparotomy of uterine fibroids also has undeniable advantages. This technique allows surgeons to control bleeding at the stages of husking myomatous nodes. In addition, there is the opportunity to quickly impose several seams to the patient at once, which is important for large tumors. In abdominal fibroid surgery, only general anesthesia is used.
Laparoscopy
Such an intervention is carried out in order to remove a small tumor. Laparoscopic surgery to remove fibroids is done through several small punctures on the abdomen, into which a laparoscope with a special nozzle is inserted. The advantage of this treatment technique is minimal trauma to the tissue and organs along with a low risk of developing postoperative adhesions. The rehabilitation period, as a rule, proceeds quite safely and quickly. Myomas in the presence of pregnancy are predominantly removed by a laparoscopic method.
You can do an operation to remove fibroids in any large clinic.
Hysteroscopy
Such an operation is a gentle surgical removal of fibroids, which is done using a hysteroscope. This operation is carried out in order to remove small single fibroids, while the nodes that are located on the front or rear walls of the organ are operated on. Indications for such an operation are strictly individual.
Performing General Abdominal Hysterectomy
Such a procedure is a complex operation, with it sometimes a radical section of the organ is performed. This is the most traumatic operation, which is used in very rare cases. Usually it is done when the fibroid is located in the thickness of the uterine muscles and is difficult to access. In addition, this technique is used in the presence of progressive growth of an already large node, and, in addition, during the climacteric age of the patient and against the background of "malignancy" of the tumor. Such an operation is performed under anesthesia.
Ways to remove fibroids
In modern gynecological practice, a minimally invasive method for treating fibroids is widely used, which does not require removal of the uterus. Thus, it is customary to distinguish:
- Laser therapy, which is done if a small fibroid has been diagnosed. In this case, the removal of the neoplasm is carried out using a directed laser exposure to the focus. The advantage of this method is the preservation of the integrity of nearby healthy tissue along with the absence of postoperative bleeding. Another plus is the minimum rehabilitation period in combination with the absence of cicatricial changes. Reviews of patients who underwent such an operation are mostly positive.
- Embolization of the uterine arteries is to remove the formation. This procedure is carried out by introducing a specialized substance into the femoral artery, which clogs the vascular bundle that feeds the node. Following this, its gradual withering away occurs. Apply this technique when localizing fibroids under the external serous membranes. In this way, surgeons remove only myomas, while preserving the reproductive organ. Significant disadvantages of this rather expensive method of treatment are high risks of developing amenorrhea along with complications leading to organ amputation.
- FUS-ablation is associated with the removal of fibroids. This procedure is performed under the mandatory control of magnetic resonance imaging. Surgical treatment of fibroids consists in the evaporation of the contents of the myomatous nodes through ultrasonic waves. Specialists, as a rule, resort to this technique very rarely. The procedure is ineffective with subserous formations. But in the event that the task arises of eliminating a small pathology, then this method is quite acceptable.
Preoperative preparation
Immediately before each treatment and when removing fibroids, including, patients should undergo a series of instrumental and laboratory examinations to assess the risks and possibilities of carrying out one or another type of operation. Preparation for a surgical operation to remove fibroids, as a rule, includes the following measures:
- Blood and urine donation along with biochemical analysis and coagulation.
- Conducting an analysis to determine the blood group.
- Performing an electrocardiogram.
- Passing an examination by a gynecologist and consulting a specialist with the mandatory taking of a smear from the vagina, and, in addition, from the cervical canal.
- Performing a cytological examination of biological material that is taken from the neck of the cervical canal.
- Carrying out a polymerase chain reaction.
- Performing a histological examination (endometrium).
- Colposcopic examination.
- Performing an ultrasound examination of the pelvic organs. In this case, doctors conduct a transvaginal or transabdominal examination.
- Inspection and consultation with a dentist and therapist.
- Radiography of the chest.
When large myomatous nodes are present , during preoperative preparation, it is considered mandatory to undergo a three-month course of hormonal treatment aimed at inhibiting the growth of formations. Consultations of a psychologist are also included in the preliminary preparation before a surgical operation aimed at removing fibroids. It is also important not to forget that ten days before the planned date of surgical intervention, patients taking antiplatelet drugs on an ongoing basis need to stop taking the medicine.
Immediately three days before the operation, only digestible and liquid foods should be consumed. And in the morning before surgery, you need to cleanse the intestines with a cleansing enema. In order to make it easier to tolerate anesthesia eight hours before the operation, it is forbidden to eat or drink anything.
How long does myoma removal operation take? The answer to this question can be found below.
Operation
The course of the operation associated with the removal of fibroids, exactly like the method of anesthesia, is determined by the surgeon and the anesthetist, who will directly engage in treatment. The best option for pain relief is general anesthesia.
Now we will describe in detail how the operation to remove large and small fibroids takes place. During the intervention through the vagina, the legs of the patient are bent at the knees, bred to the sides, anesthesia is administered. With laparotomy or laparoscopy, this is not necessary. Special straps fix the legs and arms. Then the patient is given anesthesia, and the doctor begins processing the surgical field with antiseptic agents.
With a laparotomy, the surgeon cuts the abdominal tissue in layers with a scalpel, after which a thorough audit is performed and the state of the myomatous nodes and uterus is evaluated. Next, the doctor decides to remove some or all of the organ. The organ can be removed with or without appendages. After removal of the uterus or its parts, hemostatic measures are performed. Further, after the doctor makes sure that there are no bleeding areas left in the wound cavity, the incision is sutured in layers.
Do the operation to remove the fibroids in different ways. Uterine amputation is a very complex operation, therefore, various surgical procedures can be used in the process. In the event that the surgeon considers it necessary, then he will put a drainage tube, which will ensure the outflow of fluid that accumulates in the small pelvis.
When performing laparoscopy, a surgical instrument with a laparoscope camera is inserted into the puncture in the abdomen. Before starting the operation, the patient’s stomach is pumped with air for better viewing, then the operation is performed in the same way as with an open stomach. The removed organ is removed from the patient through the vagina. Sometimes an organ is removed after its previous separation into small parts, through a tube (this is such a special laparoscopic tube).
Fibroid surgery time
How long a surgical operation will last depends on the type of access (cavity or laparoscopic), as well as the size of the uterus, the number of nodes, the presence of adhesions and cicatricial changes. On average, the duration of an uncomplicated operation is about an hour. In more severe cases, it can last up to three hours.
What happens after abdominal surgery to remove uterine fibroids?
Postoperative period
Any operation is extremely dangerous because of the risks of developing all kinds of complications. After surgery to remove uterine fibroids, much attention is paid to the prevention of the following complications:
- Inflammatory and adhesive processes.
- Restoring blood composition, and, in addition, stabilizing the hemostatic system.
- It is necessary to follow the process of normalization of water and electrolyte equilibrium.
For the full rehabilitation of women after abdominal surgery to remove fibroids, it takes no more than a month and a half. The rehabilitation period after laparoscopy, as a rule, takes about one month. As for the period of postoperative recovery, such after a vaginal hysterectomy very rarely can last longer than four weeks.
After surgery to remove fibroids, women are given a disability certificate for a period of 25 to 45 calendar days. The cost of the operation to remove the uterus largely depends on the methods used in surgical intervention. Prices for surgical services can vary sharply depending on the medical institution and the level of its qualifications, but on average the price will be from 35 to 75 thousand rubles.
Disadvantages of surgical intervention for myoma
The main disadvantages of surgical removal of fibroids are the following negative factors:
- Fairly high risk of relapse. In 7-14% of operated women, after one year, fibroids can be detected again.
- After surgery, it is extremely difficult to plan a pregnancy, even in the long term. For this, most likely, re-treatment is required.
- To reduce the risk of relapse, women are forced to take hormonal drugs, which is not always beneficial for the activity of some organs and systems of the body as a whole.
- Any surgical intervention is always associated with various risks and entails negative consequences for the health of patients.
- Sometimes situations arise in which, against the background of uncontrolled bleeding during operations, the patients have to remove the uterus.
- After the operation, the scar always remains on the uterus . Such a scar always creates an additional risk during pregnancy and can cause the need for a cesarean section, which is also an undesirable measure for women in labor.
- Another possible complication are adhesions that occur in the pelvis, and as a result, this factor provokes tubal peritoneal infertility in women.
Next, we provide feedback on the operation to remove uterine fibroids of women who have had a chance to undergo a similar surgical operation in life, and find out how dangerous it is and what the consequences may be.
Reviews
In patients, operations to remove fibroids are different, since a lot depends on the type of surgical intervention. It is reported that when diagnosing fibroids (two middle nodes), patients undergo laparoscopy. According to women, in this case the operation is successful, and, as for the postoperative period, it also proceeds without any complications.
Women write that with myoma, treatment with drugs is practically impossible and sooner or later every patient with this diagnosis will still have to decide on an operation.
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