Surgical removal of uterine fibroids. When is it necessary and what kind of abdominal surgery for uterine myoma, the postoperative period

The most common surgical interventions for women are precisely those that are performed on the organs of the reproductive system. This pattern is due to the fact that pathologies have a high incidence rate.

Hysterectomy

Surgery to remove the uterus, hysterectomy, is one of the most extensive gynecological surgeries. It is carried out only in cases where other methods of treatment or surgery will not make it possible to completely eliminate the pathology.

The indications for such surgery include:

• Malignant tumors of the uterus
• Rapidly growing benign tumors (a sign of malignant process)
• Ruptured uterus (most commonly seen during childbirth or extensive trauma)
• Endometriosis (uterine drift)
• Neglected forms of prolapse and prolapse of the uterus

Hysterectomy is a rather extensive operation that requires special training and the creation of a rehabilitation course. The most common complication during a hysterectomy is bleeding. It should be noted that such a complication can develop with any surgical intervention.

Hysterectomy leads to irreversible changes in the woman's body - she will no longer be able to have children. At the same time, due to the preservation of the ovaries, the premature menopause may not occur, which allows maintaining a normal hormonal background for a long time.

The operation to remove the uterus takes a different time. The duration of the operation depends on several factors, such as the qualification level of the doctor, the indication for the operation, as well as the individual characteristics of the organism (the presence of adhesions in the abdominal cavity, etc.).

The shortest duration is the operation to remove the uterus, which is carried out for such indications as endometriosis, early stages of cancerous tumors without invasion of the surrounding tissues, benign tumors, and total polyposis. In such a situation, with the proper skill level of the doctor, the operation can last within 40 minutes, but rarely exceeds 1 hour.

At the same time, the duration of the operation can exceed 3-4 hours, as the doctor will need to completely remove the affected tissues.

Hysterectomy is performed under endotracheal and epidural anesthesia.

Full recovery takes at least six months, since complete healing of the tissues of the anterior abdominal wall is a long process.

Removal of uterine fibroids

A uterine fibroid is a benign tumor that forms from muscle tissue. The incidence of this pathology is quite high. Small tumors do not require urgent surgical intervention. Most gynecologists take a wait-and-see attitude - regular check-ups with a doctor in order to control the growth of fibroids.

Urgent removal of fibroids is necessary in cases where its active growth is observed. The acceleration of this process indicates that malignant cells appear in the tumor, which stimulates its growth.

The operation to remove the fibroids can be performed in two ways: laparoscopic and laparotomic. The laparoscopic view is more modern and less invasive, so it is preferred by most women. Endoscopic surgery has many benefits.

The only drawback of laparoscopic surgery is a narrow view, which can lead to the myomatous node on the uterus being unnoticed. Moreover, after laparoscopic surgery, a woman can go home after a few days. Most often, endoscopic intervention is performed with small myomatous nodes (less than 3 cm in diameter)

In laparotomy surgery, access is through a Pfannenstiel incision (a transverse incision on the anterior abdominal wall just above the pubic joint). In rare cases, a lower midline laparotomy is performed. The laparotomic method is used for large tumors.

The operation itself to remove the fibroid is called myomectomy. If the intervention is performed using a laparoscope, then the operation to remove uterine fibroids lasts no more than 1 hour. With abdominal surgery, the time required to remove the fibroid may be shorter.

These numbers are approximate and may vary.

Intravenous, epidural, endotracheal, or local anesthesia may be given.

See also: Uterine fibroids, treatment with folk remedies

Extirpation

Extirpation is an operation during which the uterus is removed along with the cervix, as well as the accessory apparatus. The epididymis consists of an ovary and a fallopian tube. This is the most radical intervention in gynecology.

In most cases, the indication for this type of surgery is an advanced form of uterine or ovarian cancer. In contrast to hysterectomy, extirpation causes premature menopause, as the ovaries, which are the only source of estrogen and progesterone in the woman's body, are removed.

Such surgical treatment causes severe psychological trauma, especially in young women, since after it serious changes occur, and most importantly, a woman cannot have children.

Extirpation is performed only in cases where there is no other alternative treatment. Whenever possible, doctors always try to preserve the appendages, but this is not always possible. Elimination of the disease may require the most radical measures.

Surgery to remove the uterus and ovaries lasts the same as a hysterectomy. Under favorable conditions and no complications, the doctor can complete it within an hour. Complex cases take longer.

Most often, general anesthesia is performed in the form of endotracheal anesthesia. Loading...

Polypectomy

Another benign neoplastic disease of the uterus is polyposis. Polyps are small formations that grow in the uterine cavity. Most often, these formations are multiple, they can cover the entire surface of the endometrium.

Removal of polyps is carried out transvaginal, and can take place in a gynecological office. This is due to the fact that the removal of a polyp belongs to minor gynecological operations. It does not require special preparation or special management of the postoperative period. In most cases, women are advised to stay in the hospital for a day under supervision, as there is a risk of bleeding.

Topical agents can be used as anesthesia.

The operation itself is performed using a laser, a diathermocoagulator or a cryodestruction apparatus. Such equipment can significantly reduce injuries and reduce the risk of damage to blood vessels to a minimum.

Depending on the severity of the polyposis process, the operation to remove the uterine polyp lasts from 20 to 45 minutes. After manipulation, women are advised to refrain from sexual intercourse, physical activity and going to the bathhouse for 2-3 weeks so that the wound surface has time to recover.

Trachelectomy

Removal of the cervix is \u200b\u200bone of the rarest gynecological operations. Usually, doctors practice extirpation of the uterus together with the cervix and appendages, or supravaginal amputation of the uterus.

A trachelectomy is the removal of all or part of the cervix. A trachelectomy is performed in the presence of such pathologies:

• Cervical cancer. It is worth noting that this malignant disease is most often diagnosed in the early stages. This is due to the fact that all women during routine examinations take a smear for cytological examination. Atypical cells appear even at stage 0-1 cervical cancer, when a sparing operation can be performed and the problem can be completely eliminated.
• Erosion of the cervix. A fairly common pathology of the cervix is \u200b\u200bvarious erosion. They can cover a large enough area of \u200b\u200bthe organ, which creates the risk of bleeding. (Read also: What causes uterine erosion)
• Dysplasia. Dysplasia of the cervix is \u200b\u200ba precancerous condition, so it requires immediate treatment.

Removal of the cervix is \u200b\u200bperformed through the vagina. Local anesthetics such as lidocaine or novocaine are used to relieve pain. The operation to remove the cervix lasts an average of half an hour.

Rehabilitation usually does not last long - several weeks.

Effects

All surgical interventions have their consequences. These include:

• Infertility after hysterectomy and extirpation
• Activation of the adhesion process in the abdominal cavity after open surgery
• Premature menopause with ovarian removal

In order to reduce the risk of complications during the operation, special training is required, which is prescribed individually, taking into account the characteristics of the organism.

It is also worth noting that the postoperative period requires full compliance with all the doctor's recommendations. If they are not adhered to, then the risk of suture failure increases, which entails bleeding and the development of pelvioperitonitis, which will endanger the patient's life.

The main limitations in this period are:

• Complete elimination of physical exertion, as well as light work for six months
• Avoiding sexual intercourse for at least 2 months
• Periodic visits to the gynecologist to check and assess the condition
• Regular ultrasound of the pelvic organs

If the operation was performed for malignant tumors, then it is necessary to periodically donate blood for tumor markers in order to timely identify a relapse.

It is impossible to determine the exact duration of the operation. It can depend on a variety of factors and circumstances. Correct psychological preparation and high qualifications of the operating doctor will help to easily transfer the intervention and are the key to a favorable outcome.

Video: removal of the uterus and possible consequences

Video: removal of uterine fibroids - myths and facts

Video: Trachelectomy - fertility-preserving cervical cancer treatment

Video: Supravaginal amputation of the uterus

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Possible consequences after removal of fibroids together with the uterus

It is difficult to imagine how many women hear the diagnosis “uterine fibroids” at a doctor's appointment.

Pathology is a benign neoplasm of the uterus that develops and grows under the influence of female hormones. The peculiarity of the pathology is that in the early stages, myomatous nodes do not make themselves felt in any way, and when they are found, in most cases only surgical intervention is indicated. In especially advanced cases, the fibroid is removed along with the genital organ. How is the operation to remove uterine fibroids performed? Do you need anesthesia for its implementation? When is the removal of the uterus required for fibroids? How many options are there for the operation? What are the consequences of this surgery? How long does rehabilitation take?

Having heard the diagnosis of uterine myomatosis, the woman believes that her life is over. Undoubtedly, it is psychologically difficult to agree to an operation, but such measures will help get rid of profuse bleeding, severe pain, depression and weakness, improve family relationships, get rid of miscarriages and eliminate the problem of infertility. But in some cases, more drastic measures may be required when the operation to remove the fibroid involves removing the uterus itself. At the same time, it is possible to get rid of all the symptoms of pathology, however, the possibility of getting pregnant is excluded for a woman.

How is uterine fibroids removed?

The decision on the choice of the method of conducting the operation is made by the surgeon, taking into account all the circumstances: the number, size and localization of myomatous nodes, the peculiarity of their structure, how old the woman is, the reaction to anesthesia, the presence of other chronic pathologies in the patient.

Today, as a treatment for pathology, doctors often use such a minimally invasive method as uterine artery embolization. However, this method cannot be applied in every case, therefore, the operation to remove the tumor is still used in medical practice.

Conventionally, surgical intervention aimed at removing the myoma nodes can be divided into myomectomy (an operation during which only the fibroid nodes are removed, while the uterus is preserved) and hysterectomy (a radical operation in which the myoma nodes are removed together with the uterus; anesthesia is required to perform it ). It is possible to remove uterine fibroids with a laser, for which anesthesia is also used.

So, myomectomy is possible if:

• small nodes;
• the number of nodes - one or more and they are located in accessible places;
• the presence of heavy bleeding, not associated with menstruation;
• pressure of fibroid nodes on neighboring organs, disrupting the work of organs;
• it is impossible to save the uterus (hysterectomy is performed);
• the age of the myomatous node is more than 12 weeks;
• severe symptoms of pathology in women over 45 years old;
• prolapse and prolapse of the uterus in the presence of myomatous nodes;
• the rapid growth of no-education;
• the appearance of myomatous nodes in the cervix;
• swelling on a thin long leg;
• frequent relapses of the disease after other types of treatment of pathology;
• the presence of concomitant diseases in a complex form.

Hysterectomy is indicated when all other treatments have failed. It is mainly applicable for women who have reached the age of menopause. However, sometimes such a radical operation is performed on young women. How is uterine fibroids removed?

There are the following options for an operation to remove fibroids together with the uterus.

1. Laparoscopy. Anesthesia is required. Several small incisions are made in the abdomen, through which the surgeon removes the uterus affected by the fibroid in parts.
2. Laparotomy. Anesthesia is required. One incision is made on the abdomen, through which the affected genital organ will be removed. The scar after surgery is small.
3. Hysteroscopy. Anesthesia is required. The surgeon conducts surgery through the neck of the genital organ, as a result of which there are no scars on the woman's body. But this version of the operation is possible only if the size of the myomatous nodes is small and the uterus is not greatly increased in size.

What can you expect after surgery to remove a uterus with fibroids?

As mentioned above, removal of the uterus (hysterectomy) helps to eliminate all pathologies of the genital organ along with it, but the most unpleasant consequence of this is infertility, which can no longer be eliminated. Complications can occur already during the operation, as well as immediately after it. Among them are the following:

• anesthesia can negatively affect the patient;
• nearby organs or vessels can be damaged by surgical instruments;
• bleeding during surgery or during rehabilitation;
• inflammatory processes;
• intestinal obstruction (reoperation may be required);
• peritonitis;
• pulmonary embolism.

The consequences of removing the uterus can be roughly divided into physiological and psychological. Even if a woman has already given birth, the very understanding that she will no longer be able to give birth to offspring - due to the absence of a uterus - can cause severe stress.

After the operation, a syndrome (posthysterectomy) can also develop, which is expressed in disorders of the work of various body systems (endocrine, nervous, cardiovascular and others). After removal of the uterus, the risk of developing serious pathological changes increases, which in especially severe cases can be fatal for the grandfather.

There are frequent cases when, simultaneously with the uterus, the removal of the ovaries is shown (anesthesia is applied), which not only causes hormonal imbalance, but can also cause the development of many diseases. Simultaneously with the uterus during the operation, using anesthesia, the surgeon removes a branch of the uterine artery, which leads to a violation of the blood supply to the ovaries. Even if the ovaries are not removed, they will still not be able to feed sufficiently through other vessels, which will cause degenerative processes and, accordingly, the level of hormone production will decrease.

The following possible negative consequences of hysterectomy can be identified:

• relapse of the disease;
• infertility;
• diseases of the heart and blood vessels (if the ovaries were removed, the likelihood of developing serious pathologies of the cardiovascular system increases);
• the risk of developing oncology of the breast, kidneys, thyroid gland increases;
• malfunctions of the urinary system (urinary incontinence, frequent urination);
• sexual disorders: pain during intercourse, vaginal dryness, decreased libido;
• the risk of prolapse of the vagina;
• frequent and unreasonable depression, irritability, insomnia and memory impairment;
• hair loss;
• pain in the joints;
• the development of osteoporosis, which makes bones less strong (there is a high risk of fractures, injury);
• rapid weight gain due to endocrine disorders.

What should not be done after surgery to remove a uterus with fibroids? How long does recovery take?

After a hysterectomy, a woman will have to change her usual lifestyle:

• it is allowed to eat only pureed food, cereals;
• do not eat products made from white flour;
• do not push - this can lead to rupture of the seams;
• avoid physical exertion, walks should be moderate;
• avoiding stress-related household chores;
• you cannot stay in the sun for a long time, visit the solarium.

Already after quite a certain time (3-4 months) after the operation, the woman will be able to return to her usual way of life.

How long the recovery will take will depend on the surgical method used. Abdominal surgery involves a lengthy rehabilitation process.

Sexual life after surgery

Removal of uterine fibroids or the genital organ itself is not a reason for refusing to have sex. If a woman feels pain during intercourse, and this means that her body has not yet fully recovered (especially if an abdominal operation was performed). In this case, you need to consult with the surgeon who performed the procedure.

If an abdominal operation was performed and it was possible to preserve the reproductive organ, it is necessary to discuss with the doctor the contraceptives that can be used. In the case where the uterus has been removed, the use of contraceptives is not required.

How long does it take before the patient's sex life is restored? How much should you refrain from having sex? In most cases, after surgery to remove the uterus with fibroids, you can have sexual intercourse after about a month and a half.

What should be the nutrition after removal of the uterus with fibroids?

Eating after surgery requires compliance with certain rules:

• the amount of fat in the diet should be minimal;
• exclusion from the menu of fatty cheeses, meat, butter, eggs;
• vegetable oil should replace animal fats;
• mandatory presence of fish in the diet.

How long does this regime need to be observed? Ideally, if a woman completely revises her diet, eliminating harmful foods.

The categorical refusal to remove the uterus with fibroids is explained by the fact that women see from their relatives and friends what consequences this leads to. However, some patients note that their life after the operation has improved, pain and other unpleasant symptoms have disappeared. Therefore, the final decision whether to agree to the operation or not depends only on the woman herself. However, it is important to realize that the disease does not go away by itself.

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Surgery to remove uterine fibroids: hospital, postoperative period, rehabilitation after laparoscopy

One of the effective methods of treating uterine fibroids is surgical intervention, during which myomatous nodes or the entire uterus are removed. Today, there are various options for the operation, each of which has both positive and negative sides. The decision to carry out a certain type of operation is made by a specialist after a thorough examination of the woman.

Surgery is one of the ways to treat uterine fibroids

Modern surgery offers several ways to carry out the surgical treatment of this disease.

One of the common gynecological diseases that can be diagnosed in women of any age is uterine fibroids. This pathology is a benign neoplasm, the origin of which can be any part of the genital organ and its mucous membrane. The development of fibroids is usually considered the result of a change in the hormonal background of the female body and sometimes its size can reach several kilograms.

Modern medicine eliminates this pathology in various ways, among which the most effective is the operation to remove myoma. Among the patients who have undergone such treatment, there are different reviews about the types of surgical intervention. In the event that the tumor is small and does not cause any concern to the woman, that most often experts simply monitor her condition or use hormonal therapy. The decision to carry out surgery is made in the presence of certain indications, which can further worsen the woman's condition.

Indications for surgical intervention

Fibroid surgery is performed in the following cases:

• there is a rapid and rapid growth of the tumor and the result of this is the compression of nearby organs;
• fibroids are the main cause of frequent and prolonged bleeding that causes the development of anemia;
• the size of the benign neoplasm exceeds more than 12 weeks;
• a woman experiences severe pain in the lower abdomen;
• at the site of localization of the myomatous node, the movement of blood is disrupted and the result of this is the development of necrosis;
• the progression of uterine fibroids is combined with gynecological pathologies such as endometriosis and ovarian tumors;
• a woman cannot become pregnant for a long time, and with a positive result, a spontaneous miscarriage occurs;
• there is a danger that a benign neoplasm in the uterine cavity will degenerate into a malignant one.

Reviews of specialists and patients about operations are quite contradictory and the choice of a particular method of surgical intervention depends on many indicators and, first of all, attention is paid to:

• the size of the tumor;
• its location;
• the presence of concomitant pathologies;
• the age of the patient;
• desires and opportunities to preserve fertility.

Varieties of surgery

The decision on whether to operate on the uterus is made by the specialist taking into account the stage of development of the fibroids and the benign neoplasm can be eliminated in the following ways:

• myomectomy;
• embolization
• radical surgical intervention.

Myomectomy

Reviews of many women indicate that today this method of getting rid of uterine fibroids is considered one of the most effective, since it allows you to cure the tumor and at the same time preserve the genital organ. Most often, this type of operation is used when the tumor has not reached a large size. In medical practice, the following types of myomectomy are used:

1. Laparoscopic myomectomy is a type of surgical intervention performed using a special device called a laparoscope. A laparoscopic operation lasts 20-40 minutes and during it a specialist inserts a special device with a video camera and medical instruments into the abdominal cavity. Most often, treatment with this method is used when there is a need to remove subserous neoplasms from the uterine cavity. Positive feedback from patients about this method of treatment is explained by the fact that laparoscopic myomectomy is a less traumatic method, since after its implementation, the recovery is quick and quite successful. In addition, the use of this type of surgical intervention can prevent adhesions in the abdominal cavity. However, removal of fibroids by the laparoscopic method can cause the formation of seals and it is for this reason that it is recommended to be constantly observed by a gynecologist.
2. Laprotomy myomectomy is an operation in which the tumor is removed through an incision in the abdominal wall. Reviews of women who have undergone such an operation indicate that the only disadvantage of this type of surgical intervention is the long-term recovery of the female body. When using laparotomic access to the uterine cavity in the postoperative period, a woman is in the hospital for 5-8 days. In addition, after such an operation, the rehabilitation period is on average one month.
3. Hysteroscopic myomectomy is a type of surgical intervention in which a benign neoplasm is removed using a special instrument inserted into the uterine cavity through the vagina. Most often, treatment with this method is used when a woman needs to remove a submucous node in the uterine cavity. More often you can find positive reviews about this method of treatment, and this is due to the fact that this type of operation is considered the most sparing for the female body and after it is carried out, there is a chance of self-delivery in the future.

Embolization

One of the ways to remove myoma is embolization, in which the blood supply to the myomatous node is eliminated and the result is its drying out.

Most often, positive feedback from patients about such a surgical intervention prevails, because treatment with this method is the least traumatic and complications after it are minimal.

Many women are worried about how long the operation and rehabilitation itself will take.

It turns out that embolization lasts only a few hours and a woman will only have to spend one day in a hospital.

After the operation in the abdominal cavity, the woman is left with two small punctures, which subsequently tighten well and do not leave traces. The postoperative period is largely determined by two factors: when the operation was performed, and how many myomatous nodes were removed.

Radical surgery

Most often, abdominal surgery is performed in cases where:

• in the uterine cavity there is a large number of myomatous catch of impressive size;
• the woman was diagnosed with malignant neoplasms in the uterine cavity.

Abdominal surgery requires careful preparation and it is for this reason that the patient is prescribed a series of tests and a complete examination by her attending physician. Most often, women's reviews about this method of treatment are not entirely joyful, since with this type of surgical intervention, specialists perform an open incision in the abdominal cavity and remove the entire body of the uterus.

However, despite this, in the future, most women experience various hormonal disorders.

Recovery after removal of fibroids

Any type of surgical intervention is a real test for the female body, therefore, after its implementation, it is recommended:

• limit physical activity;
• at least temporarily protect yourself from household chores;
• do not push, as this can provoke a rupture of the seams;
• avoid visiting baths and saunas, as well as limit the time spent in the sun.

Many patients are concerned about how long after the operation it is necessary to limit themselves, and when it will be possible to return to their usual way of life. It turns out that after the operation, you can go about your usual business in 3-4 months. After abdominal surgery, a woman is issued a sick leave for two weeks.

Not every specialist will be able to answer a woman's question about how long her rehabilitation period will last. The rehabilitation of a woman's body is determined by several factors, for example, an open operation requires a longer recovery period, since the healing process is slower. Most often, it is difficult for a woman to overcome the psychological barrier, since many believe that after the removal of the uterus, life ends.

The period of rehabilitation will depend only on the woman herself, because it is the patient's desire to recover that significantly speeds up the recovery process.

Benign tumors on the uterus are not such a rare occurrence, which usually begin to be treated conservatively. And if the neoplasm is large, causes severe symptoms, it will have to be removed with an operation with cutting the abdominal wall, at best, laparoscopy.

Most patients are afraid of the intervention and its consequences. To avoid unnecessary worries, it is worthwhile to find out in advance what the lane operation of uterine myoma, the postoperative period, and how to alleviate them as much as possible.

Read in this article

Early postoperative period

The first day after the intervention, the patient will have to spend in the intensive care unit. This is not due to the danger of the condition, which doctors can hide from her, this is a common practice for monitoring the performance of the body. After the termination of the anesthesia, the woman may feel pain in the area of \u200b\u200bthe incision, as well as in the depths of the abdominal cavity. Some types of anesthesia can cause nausea and even vomiting. But this happens once, does not fall outside the boundaries of the norm. The body gets rid of the drug residues in this way. Strong weakness is also felt.

Further recovery after removal of fibroids for 7-10 days is in the ward. On the second or third day, you can get up, turning on your side and leaning on your elbow.

Hospital stay

The first time a woman spends in a hospital ward, she is provided with the control of doctors. But she herself must monitor her feelings, talk about them to the doctor.

The postoperative period after removal of uterine fibroids with cutting the abdominal wall lasts long enough due to the large area of \u200b\u200btissue damage. Oddly enough, you can shorten it by moving. This will give a chance to avoid adhesions, which cause long-term painful sensations and subsequent infertility, may force an intervention to cut them. But the load needs to be measured, not to torture yourself, not to walk until exhaustion.

Pain after removal of fibroids can be felt throughout the 7-10 days in the hospital and later. The intensity depends on the ability to tolerate them. But the sensations should not be intolerable, this already indicates the beginning of the inflammatory process. The usual pulling or aching pain is caused by irritation of the nerve roots, which were affected by tissue damage during the operation, and is the norm. It is felt mainly in the seam area. To reduce its severity, pain relievers are prescribed. And the prevention of infections is carried out by the appointment of antibacterial agents.

The first couple of days, weakness may persist, the temperature rises in the evening. These are all common postoperative reactions. Every day the strength will return, the body temperature will return to normal.

Nutrition

Since the intervention has affected not only the reproductive system, but also the abdominal wall, it is important that the work of the organs located in the abdominal cavity is clear and does not provoke further tissue trauma. Therefore, a strip operation, in which the uterine fibroids are cut out, requires the entire postoperative period to monitor nutrition, excluding some products.

The first 2 days should be limited to broth, weakly brewed tea, yoghurts, that is, liquid, easily digestible food. Constipation should not be allowed, they force a lot of tension in the abdominal muscles, which is now strictly prohibited.

Therefore, vegetables and fruits should be included in the further diet. If health does not allow them to be eaten fresh due to increased gas formation, it is better to boil or simmer. Flatulence must be fought with drugs and moderate movement.

The diet after fibroid removal and upon returning home should consist of

• Lean meat, fish;
• Oatmeal, buckwheat porridge;
• Soups based on weak meat or vegetable broths;
• Rye bread;
• Vegetables, herbs and fruits in any form;
• Fermented milk products.

It is worth avoiding everything that provokes difficulties with defecation, increased gas formation in the intestines, and interferes with tissue healing:

• Jelly, jelly;
• Rice, semolina;
• Muffins, sweets;
• Alcohol, strong coffee, tea;
• Soda;
• Fatty meat.

What can not be done after cavity intervention

For faster and better rehabilitation after removal of uterine fibroids, abdominal surgery forces one to a certain lifestyle even after discharge from the hospital. A woman should correctly alternate between physical activity and rest, regularly see a doctor, visit him if problems arise. There is a whole list of actions that should be temporarily postponed until full recovery:

• The load of any kind must be feasible. It's not just about fitness for the sake of beauty, but also household chores. This is especially true for the first month after discharge from the hospital. You cannot stay in one position for a long time, it is strictly forbidden to lift weights over 2-3 kg for 3-6 months after the operation. For the next 2 years, you can pick up no more than 10 kg of weight;
• After removal, you cannot have sex for 1 to 3 months. This will have to be clarified with the doctor, guided by your own health;
• You cannot, wishing to protect yourself from complications, spend a lot of time in an upright position. This contributes to the formation of adhesions, muscle weakening, and thrombosis. You need to walk a lot in the fresh air, periodically resting;
• Recovery after removal of uterine fibroids involves avoiding stress. An increased nervous load in this period is contraindicated due to the fact that it prevents not only the healing of tissues, but also the normalization of the balance of hormones. And they are important for many aspects of rehabilitation, primarily in the reproductive sphere.

How to recover faster

The postoperative time does not at all require giving up a normal life, suggesting only some restrictions. Recommendations after removal of uterine fibroids, if carefully followed, will help not only recover faster, without complications, but also avoid recurrence of the disease:

• Limit exposure to the sun, generally try not to overheat. This is important for the healing of internal and external sutures, it goes faster in cool conditions. Until they are finally formed, no creams, physiotherapy procedures can be used for smoothing. Moreover, the solarium, the bathhouse are not shown. Before the seam heals, you need to wash in the shower, treating its surface with antiseptics;
• Show yourself to a specialist 2 times a year, undergo a pelvic ultrasound. It is also worth having a photo of the postoperative suture at different stages of healing so that the doctor can compare it with what will come out in the future;
• For those who have been diagnosed with uterine fibroids, after surgery, recommendations include nutritional wishes. It is worth excluding smoked meats, salinity, limiting sugar from it. All this upsets the balance of sex hormones, on the violation of which the development of a new benign tumor may depend;
• Wear a bandage, you can take it only on the advice of a doctor. Both are not shown in all cases;
• Control your own periods. Malfunctions in the reproductive system respond to the passage of critical days, the amount of discharge, increased pain;
• Take care of contraceptives. in the first year after surgery, it is undesirable, since the uterus may not be ready for gestation. Planning should be preceded by consultation with a specialist, necessary research.

Postoperative medication therapy

Getting rid of a neoplasm is not limited to surgical intervention. Treatment after removal of uterine fibroids is almost always complemented by the intake of hormonal drugs that restore the general balance of substances, exclude the possibility of relapse. It can be:

• Dyufaston, Utrozhestan, stimulating the second phase of the cycle;
• COC Jess, Regulon, Yarina, preventing excessive proliferative processes in the uterus.

Modern methods of performing operations make it possible to preserve the neck of the organ. How uterine fibroids are treated also depends on age.

Uterine fibroids are quite common in middle-aged women, from about 35 to 50. This pathology is a benign tumor that develops in the uterus. It can be localized on the wall of the organ, on the surface of the mucous membrane or under it. The size of the tumor, depending on the degree of its development, can be from a small nodule to the formation of up to a weight of about 1 kilogram; also, myoma can consist of several formations.

Two types of treatment are used to treat this disease: therapeutic and surgical. In most cases, doctors prefer organ-preserving surgery. When conducting conservative therapy, the likelihood of a relapse is very high.

The operation to remove uterine fibroids has several types, selected by the attending physician individually, based on the characteristics of the patient and the clinical picture. In the matter of choosing a method of therapy for this pathology, doctors unanimously say that drug therapy is not able to relieve later of complications and relapses. Therefore, abdominal surgery is the safest and best treatment option.

It is a priority for the doctor to keep the organ functioning, but if removal is most effective, then surgery is necessary. The surgical method of treatment is the most popular for uterine fibroids, for its appointment the following indications are taken into account:

• Pain in the lower abdomen and lower back. By nature, depending on the location and size of the formation, it can be pulling, sharp, cramping.
• Mucous discharge mixed with blood is ichor.
• Spotting or profuse bleeding.
• Disruptions in the menstrual cycle: heavy and prolonged periods, delay or high frequency.
• Manifestation of symptoms of anemia: nausea, weakness, dizziness, pale complexion.
• Stool problems, frequent constipation, frequent painful urination due to squeezing of adjacent organs.
• Fibroids 11 to 12 weeks old, larger than 6 cm.
• The growth of the tumor is more than 3 cm per year.
• Signs of the transformation of a benign formation into a malignant cancer.
• Myomatous nodes on the pedicle, which have a connection with the wall of the uterus through the cervix.
• Development of necrosis associated with circulatory disorders in the area of \u200b\u200bmyomatous nodes.
• Comorbidities such as ovarian tumor and endometriosis of the uterus.
• It is difficult for a woman to become pregnant or maintain a pregnancy.

Myoma formations are divided into several types by size:

• small - up to two cm, which corresponds to a gestation period of 5 weeks;
• medium - reaching a size of 2 to 6 cm, corresponding to 10 weeks of pregnancy;
• large - a tumor exceeding 6 cm, the size of the uterus becomes similar to 12 - 15 weeks;
• giant - the uterus is enlarged to a size equivalent to a period of 16 weeks or more.

Surgical removal of nodes is indicated when the threshold of 12 weeks is exceeded, that is, large and giant. In some cases, the operation is performed with a smaller size of the formations.

Types of operations

There are several types of surgical intervention for a benign tumor. When choosing a specific one, experts pay attention to factors such as:

• the size of the nodes;
• location;
• concomitant diseases and pathologies;
• woman's age;
• desire to preserve the possibility of having a child.

Having considered all these indicators, the specialist prescribes one of the following operations:

Myomectomy

The most effective method of treatment today, judging by the positive feedback from many patients. It makes it possible to get rid of uterine fibroids while maintaining the ability to bear children. Efficiency is manifested mainly in the case of small tumor sizes. There are the following types of myomectomy:

1. Laparoscopy - surgery using a device - a loparoscope. The duration of this operation is from 20 to 40 minutes, when it is carried out, a device with a video camera and the necessary instruments are introduced into the abdominal cavity. In most cases, this method is used to remove subperitoneal fibroids (subserous). Laparoscopic myomectomy is less traumatic, so the rehabilitation period does not last long and without consequences. Another plus is the prevention of adhesions, but seals can be a consequence of this method. In the future, it is necessary to be constantly monitored by a gynecologist.
2. Laparotomy is an operation performed by getting rid of a tumor through an incision made on the surface of the abdominal wall. Patients who have undergone this method of surgery are satisfied with the result, pointing out only one drawback - a long rehabilitation process. The first week after the removal of a benign formation, a woman should be in a hospital, the subsequent recovery of the body lasts about a month.
3. Hysteroscopy - performed by inserting instruments into the uterus through the vagina. Often this method is used for myomatous nodes located in the area of \u200b\u200bthe fallopian tubes. It enables a woman to give birth on her own later.

Embolization

The operation, the essence of which is to deprive the blood supply of the tumor formation, as a result of which it dries out. This method is characterized by low invasiveness of the organism, with minimal consequences and complications. Embolization lasts for several hours, and after it the patient needs to stay in the hospital for a day.

After the treatment of fibroids in this way, small traces of two punctures remain in the abdomen, which subsequently disappear completely. Rehabilitation depends on the size and number of myomatous formations.

Radical surgery

Radical intervention is required when there are several large nodes in the uterus, or there are concomitant cancerous growths.

Before, the attending physician conducts a complete examination of the woman and collection of tests, such as:

• scraping of the uterus;
• fluorography;
• blood tests.

This method of treating fibroids is carried out by an incision in the abdomen and the complete removal of the organ, leaving the ovaries, cervix and its appendages to maintain the body's hormonal levels. Subsequently, a seam remains at the incision site, which causes cosmetic inconvenience. Such an operation is prescribed mainly for women over 40 who are no longer going to give birth.

Such a tumor is characterized by the fact that it grows into the pelvic cavity, leading to irregularities in the woman's menstrual cycle. The operation to remove it has some peculiarities.

Removal of subserous nodes is carried out along the line slightly above the base, in order to reduce the pressure at the site of suturing the tumor bed.

The node is isolated by making an incision through the abdominal cavity, special clamps are installed and benign uterine formations are cut out.

Preparing for surgery

The surgical method of removing uterine fibroids requires preparatory procedures. The preparation is as follows:

• study of the clinical picture and medical history;
• study of the age indicators of women;
• general condition of the body;
• determination of the size and location of the tumor;
• blood and urine tests;
• examination of scraping from the uterus;
• testing for infections;
• colposcopic examination;
• hysteroscopic diagnostics;
• ultrasound procedure;
• if necessary, treatment of diseases of the cardiovascular system;

• hormone therapy.

Direct preparation for the operation to remove the uterus is to observe hygiene procedures: taking a bath or shower and removing pubic hair. The day before, a light dinner is recommended, preferably on the basis of liquid food, then taking sleeping pills in order to get enough sleep before surgical treatment.

Important! It is necessary to adhere to a light fasting diet a week before surgery. Eat fermented milk products, take sedatives, and treat the genitals with antiseptics.

Also, in the evening before the operation, the intestines are cleansed with an enema. To use anesthesia, it is necessary to refuse to take food and drink on the day of surgery. In the morning, sedatives are recommended.

For young women, fertility-preserving surgery remains a priority. Women of more respectable age undergo radical surgery, with complete removal of the uterus. The doctor makes a conclusion, but the patient makes the final choice of the method of surgical treatment.

Contraindications

In case of an urgent need for surgical intervention, it is unacceptable only for a cold, accompanied by a high fever and shortness of breath. With a planned operation, there are the following contraindications:

• a state of shock or coma;
• diseases of the heart and blood vessels;
• hernia of the abdominal cavity;
• diaphragmatic hernia;
• poor blood clotting;
• respiratory system diseases;
• depletion of the body;
• the presence of an infection in the body;
• boils on the skin in the abdomen;
• various dermatitis;
• exacerbation of chronic kidney and liver disease;

The presence of any of the listed factors requires the cancellation or postponing of the operation until the period of improvement in the patient's condition. The specialist will prescribe surgery only if the health indicators are satisfactory. Neglecting them can lead to serious complications.

After the operation, prolonged bed rest is not recommended, the rise is carried out after 12 hours. If symptoms such as nausea and vomiting are absent, then liquid can be consumed. It is necessary to carry out prophylaxis to exclude thrombohemorrhagic complications. If required, anti-inflammatory and antimicrobial therapy is performed.

After a woman has had uterine fibroids removed, it is necessary to follow some rules in everyday life:

• it is forbidden to push, as this can provoke a rupture of the seams;
• it is recommended to exclude products from wheat flour from the diet, and include jelly, cereals, vegetables and fruits;
• limiting physical activity;
• limit yourself to household chores;
• try not to overheat;

You can return to your usual way of life only after 3 - 4 months. But the time for full recovery of the body is determined individually.

Rehabilitation also includes:

• remedial gymnastics;
• physiotherapy;
• hormonal drugs;
• iron preparations;
• walks in the open air.

Possible complications

Any kind of surgery can cause complications, but hysteroscopy and laparoscopy are the least. Their appearance can begin during or after surgery.

The most common consequences during the operation:

• bleeding;
• injury to neighboring organs.

After operation:

• inflammatory process in the abdominal cavity;
• thromboembolism;
• long wound healing;
• bleeding;
• intestinal obstruction;
• adhesion formation;
• infertility;
• increased risk of breast cancer;
• decreased sex drive;
• early menopause;
• a feeling of discomfort during sexual intercourse.

Advice! In order to diagnose the disease on time, it is necessary to be regularly monitored by a doctor. Timely started treatment will make it possible to avoid the intervention of surgeons, conservative therapy will help.

In each case, removal of uterine fibroids requires an individual approach. If possible, specialists try to leave the reproductive organ and preserve its functions.

The operation itself is not a contraindication to having sex for a woman. Sometimes pain and discomfort may occur, but this is a sign that the body has not yet recovered and is not ready for sex. After surgery, a fairly long healing period follows.

Since this is a natural process, you should not hesitate, on this issue you can consult with your doctor - gynecologist or surgeon who performed the operation.

Perhaps you should use special lubricants that facilitate penetration during sexual intercourse, or you just need to wait until the body recovers and undergoes rehabilitation.

About contraceptives, you should also consult your doctor. If the uterus is removed, there is no possibility of getting pregnant and menopause occurs, then there is nothing to worry about.

It is possible to resume sexual activity after an operation to remove fibroids after 1.5 months. It is recommended to plan a pregnancy after 9 to 12 months.

Rehabilitation

The rehabilitation period after surgery is as follows:

1. In the first week after the removal of the nodes, it is recommended to eat food saturated with proteins and iron. It can be meat, fish, pomegranate juice, liver.
2. A course of vitamins must be prescribed.
3. Sauna and steam bath are contraindicated for six months, as well as fitness and swimming pool.
4. It is necessary to monitor the state of the body and to prevent hormonal disruptions, breast cancer, ischemia and other heart diseases.

Removal of benign formations in the uterus is a difficult operation for a woman's body, burdening with consequences. To avoid which, it is necessary to diagnose the disease in time and begin treatment.

It is necessary to monitor the food consumed in order to avoid constipation. Since they can put pressure on the uterine appendages and provoke rupture of seams and inflammation of the appendages. Physical activity can also cause the seams to diverge, and the incision made will take longer to tighten.

For problems with urination, constipation or vaginal prolapse, Kegel gymnastics will help. The body is completely regenerated not earlier than after 4 months.

Following the recommendations and advice of your doctor will help you return to your normal lifestyle much faster. Carrying out preventive measures will help to avoid serious complications and consequences. Many women report an improvement in their condition and quality of life after removal of fibroids. Therefore, when appointing an operation by a specialist according to indications, one should overcome fear and go for it.

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Video: surgery to remove uterine fibroids

Myoma of the uterus is the most common gynecological disease. According to medical statistics, it is diagnosed in at least 25-30% of women aged 35-50 years.

Moreover, in the last decade all over the world there has been a tendency towards "rejuvenation" of this disease. Increasingly, fibroids are detected in 25-30-year-old patients, which negatively affects their reproductive health and fertility. And the frequent neglect of regular gynecological examinations leads to a rather late diagnosis of myomatosis, already at the stage of development of complications.

Treatment can be conservative or surgical. In this case, the operation to remove uterine fibroids is performed only if there are certain indications. The choice of the surgical technique and the determination of the scope of the intervention depend on many factors.

What is myoma and what is it like?

Myoma is a benign hormone-dependent nodular neoplasm originating from the myometrium - the muscular layer of the uterus. In this case, the serous membrane of the organ (peritoneum) and the internal mucous membrane (endometrium) are not involved in the pathological process, but cover the surface of the tumor.

Such a neoplasm does not germinate, but pushes the surrounding healthy tissue apart. This feature makes it technically possible to remove relatively small myomatous nodes while maintaining the integrity and functional usefulness of the uterine wall.

Tumor tissue may consist only of hypertrophied muscle fibers or include additional layers of connective tissue. In the latter case, the term "fibroids" is valid. Soft enough homogeneous muscle tissue formations are called leiomyomas.

The growth of such a tumor of the uterus can occur in several directions:

• with prolapse into the lumen of the organ, while the myoma is called submucosa or;
• with stratification of the muscle layer, thickening and deformation of the uterine wall (interstitial variant);
• with protrusion of the node into the abdominal cavity ();
• with stratification of the sheets of the broad ligament of the uterus (intraligamentary myomatous node).

The nodes protruding beyond the contours of the organ can have a leg of various diameters or "sit" on a broad base, sometimes immersed in the middle muscle layer.

Fibroids rarely undergo malignancy, malignancy is diagnosed in less than 1% of patients. But in many cases, such a tumor of the uterus is accompanied by various complications. They are usually the basis for making a decision about surgical treatment.

When is uterine fibroid removal required?

Removal of uterine fibroids (myomectomy) refers to organ-preserving operations. Therefore, women of reproductive age with unrealized reproductive function give preference, if possible, to this option of surgical treatment.

In some cases, surgery even becomes a key step in fertility treatment. This is possible if the difficulties with conception or prolongation of the onset of pregnancy are due to deformation of the uterine cavity by submucous or large interstitial nodes.

Indications

Removal of fibroids is necessary when conservative therapy does not lead to a decrease in the size of the tumor and does not allow it to restrain its growth. Also indications for surgery are:

• recurrent uterine bleeding;
• persistent pain syndrome;
• signs of displacement and dysfunction of adjacent organs;
• with submucous and subserous nodes, especially prone to ischemic necrosis and having a risk of torsion of the leg.

Contraindications

Myomectomy is not performed under the following conditions:

• in the presence of large or multiple myomatous nodes;
• with the cervical location of the tumor;
• profuse and uncorrected uterine bleeding (menometrorrhagia), which leads to severe anemization of the patient and even threatens her life;
• with massive tumor necrosis, especially if it is accompanied by the addition of a secondary bacterial infection, septic, thrombosis or threatens the development of peritonitis;
• active growth of fibroids in a patient in;
• severe disruption of the functioning of neighboring organs (bladder, ureters, intestines), due to their displacement and compression by a large myomatous node or the entire enlarged uterus.

All these conditions are indications for radical surgical treatment of fibroids. This is done.

Limitations for myomectomy are also the severe physical condition of the patient, the presence of current infectious and septic diseases, and the identification of contraindications for general anesthesia. In such cases, surgery can be temporarily postponed or replaced with alternative treatments in combination with active conservative therapy.

Ways to remove uterine fibroids

Surgical removal of fibroids can be done in several ways. Their fundamental difference is the type of online access. In accordance with this, laparotomy, laparoscopic and hysteroscopic myomectomy are distinguished.

• Laparotomy

This is a classic abdominal surgery to remove uterine fibroids. It is accompanied by the imposition of incisions on the anterior abdominal wall of the patient using a scalpel or modern instruments - for example, an electric knife. This access gives the operating doctor the opportunity to have a fairly wide direct view of the abdominal cavity, but is the most traumatic for the patient.

• Laparoscopy

A much more gentle method that requires endoscopic equipment. Manipulations are performed through punctures placed in certain places of the anterior abdominal wall. Recovery after such an operation is much faster than with classical laparotomy.

• Hysteroscopy

A minimally invasive technique that also requires special endoscopic equipment. At the same time, the doctor does not need to impose incisions and punctures; he uses the cervical canal to access the uterine cavity.

The choice of the method of surgery depends on the specific clinical situation. This takes into account the size, number and localization of myomatous nodes, the presence and severity of complications, the patient's age and the risk of tumor malignancy. The qualifications and experience of the operating doctor, the equipment of the medical institution with endoscopic equipment is also of great importance.

How long the operation to remove uterine fibroids takes depends on the chosen technique, the amount of intervention and the presence of intraoperative complications and complications.

How is the operation performed using the lapartome method

The operation using the laparotomic approach is indicated for interstitial and deeply embedded subserous nodes. It is used for multiple myomatosis, complicated course of the disease, adhesive disease, in the presence of rough or insufficiently wealthy scars of the uterus. Removal of large uterine fibroids and cervical tumors is also usually performed laparotomically.

Incisions for laparotomy surgery to remove the uterus

To access the myomatous nodes on the anterior abdominal wall, a vertical or horizontal incision is applied, followed by layer-by-layer dissection and tissue expansion. The affected organ is removed outside the abdominal cavity. Only in the presence of well-visualized nodes on the anterior wall can the doctor decide to perform manipulations on the submerged uterus.

The serous membrane (visceral layer of the peritoneum) is dissected and stupidly exfoliated, the myomatous node is isolated with the least possible trauma to the surrounding healthy myometrium. The tumor is shed and removed. Sutures are applied to her bed, while serosa is sutured separately. Bleeding vessels are carefully ligated; it is also possible to use an electrocoagulator. The abdominal cavity is drained, and the quality of hemostasis is controlled. After that, all layers of the abdominal wall are sutured in layers.

Possible complications during laparotomy removal of fibroids are associated with technical difficulties or errors during the operation. Massive intraoperative bleeding, accidental damage to adjacent organs is possible.

Removal of uterine fibroids by laparoscopic method

Laparoscopic surgery is a gentle and at the same time highly effective way to remove subserous fibroids on a pedicle or on a wide base. It is performed under general anesthesia in a specially equipped operating room.

Access to the uterus during laparoscopy is through small punctures of the anterior abdominal wall in both iliac regions. The camera is inserted through the umbilical ring. The same puncture is used to inject carbon dioxide into the abdominal cavity, which is necessary to expand the spaces between the walls of the internal organs, to obtain sufficient visibility and space for the safe introduction of manipulators and instruments.

Laparoscopic surgery is a more gentle way to remove fibroids

The thin leg of subserous myoma is coagulated and cut off close to the uterine wall. In this case, sutures are usually not required on the serous membrane; the use of an electrocoagulator is sufficient.

If a node is removed on an interstitial base, the doctor decapsulates and enucleates it. Such manipulations are necessarily complemented by a step-by-step thorough hemostasis by electrocoagulation of all intersected vessels, regardless of their diameter.

The process of removing the node on the base ends with the imposition of double-row endoscopic sutures on its bed. This is not only an additional method of hemostasis, but also contributes to the formation of a full-fledged scar in the future, which will retain its integrity in the process of enlarging the pregnant uterus. Suturing the defect of the serous membrane also helps to reduce the risk of postoperative.

The cut off myomatous node is removed with the help of morcellators through the existing punctures. Sometimes an additional colpotomy hole is required.

After a control revision of the operation area and the entire abdominal cavity, the doctor removes the instruments and the camera, and, if necessary, evacuates the excess carbon dioxide. The operation is completed by suturing the laparotomy holes. The patient usually does not need to stay in the intensive care unit and, after recovering from anesthesia, can be transferred to the recovery room under the supervision of a doctor and medical staff.

Currently, only subserous nodes are removed laparoscopically. But if the wide base of the fibroid (its interstitial component) is more than 50% of the total tumor volume, such an operation is not performed. In this case, a laparotomy is required.

Hysteroscopic myomectomy

Removal of uterine fibroids by hysteroscopy is a modern, low-invasive method of surgical treatment of submucous nodes. Such an intervention does not violate the integrity of the uterine wall and surrounding tissues and does not provoke the scarring process.

In most cases, hysteroscopic myomectomy is not accompanied by clinically significant blood loss with the development of postoperative anemia. A woman who has undergone such an operation does not lose the ability to deliver naturally. It is also usually not considered a risk group for miscarriage.

Hysteroscopic variant of uterine fibroid removal

All manipulations with the hysteroscopic variant of the operation are performed transcervically using a hysteroscope. This is a special device with a camera, a source of local illumination and instruments, which is inserted into the uterine cavity through an artificially dilated cervical canal. At the same time, the doctor has the ability to accurately control the manipulations performed by him on the monitor, to accurately examine suspicious areas of the mucous membrane and, if necessary, take a biopsy, to quickly stop the incipient bleeding.

Hysteroscopy is performed under general anesthesia, although spinal anesthesia is possible. To cut off the myomatous node, instruments for mechanical transection of tissues (analogous to a scalpel), an electrocoagulator or a medical laser can be used. It depends on the technical equipment of the operating room, the skills and preferences of the operating doctor.

Laser removal of uterine fibroids is the most modern and gentle option for hysteroscopic myomectomy. Indeed, in this case, there is no squeezing, twisting and deep necrosis of the surrounding tissues, no special measures are required to stop bleeding. Healing takes place quickly and without the formation of rough scars.

Transcervical hysteroscopic myomectomy is not used for nodes larger than 5 cm in diameter, which are difficult to evacuate through the cervical canal. Dense postoperative scars on the uterine wall, internal adhesions (synechiae) also significantly limit the use of this method.

Supporting operating technologies

To improve the effectiveness of the surgical intervention and reduce the risk of intraoperative complications, the doctor may use some additional techniques. For example, laparoscopic and laparotomy removal of fibroids is sometimes combined with preliminary ligation, clearing, or embolization of the uterine arteries. Such preparation for the operation is carried out several weeks before the main surgical treatment.

Forced restriction of blood supply to myomatous nodes is aimed not only at reducing their size. The conditions of artificially created ischemia lead to a reduction in the healthy myometrium, which is accompanied by the contouring of tumors and their partial isolation from the thickness of the uterine wall. In addition, surgical manipulations in the blood-depleted area significantly reduce the volume of intraoperative blood loss.

Preliminary temporary clamping and ligation (ligation) of the uterine arteries are performed from the transvaginal approach. After the completion of the main operation, the superimposed clamps and ligatures are usually removed, although sometimes with multiple myomas, a decision is made to permanently ligate the supply vessels.

Postoperative and recovery period

The postoperative period usually proceeds with pain syndrome of varying intensity, which may require the use of non-narcotic and even narcotic analgesics. The severity of pain depends on the type of operation performed, the amount of intervention and the individual characteristics of the patient.

With significant intraoperative blood loss in the first hours after the transfer of a woman to a ward of intense blood loss, transfusion of blood and blood substitutes, the introduction of colloidal and crystalloid solutions, the use of funds to maintain an adequate level of blood pressure may be required. But the need for such measures is rare, usually myomectomy passes without clinically significant acute blood loss.

In the first 2 days, the doctor must monitor the functioning of the intestines, because any operation on the abdominal organs can be complicated by paralytic intestinal obstruction. It is also important to prevent the development of constipation, since excessive straining during bowel movements is fraught with failure of the stitches. That is why much attention is paid to the nutrition of the patient, getting up early and the rapid expansion of motor activity.

What can you eat after your surgery?

It depends on the type of surgical treatment, the presence of anemia and concomitant diseases of the digestive tract.

The diet after removal of fibroids by the laparotomy method does not differ from the diet of persons who have undergone other abdominal operations. On the first day, the patient is offered liquid and semi-liquid easily digestible food, in the subsequent menu they quickly expand. And by 5-7 days a woman is usually already on the common table, if she does not need to comply with the so-called "gastric" diet.

But laparoscopic and hysteroscopic myomectomy does not impose such strict restrictions even in the early postoperative period. In good condition, the patient can eat from a common table by the evening of the first day.

If the fibroid caused the development of chronic iron deficiency anemia or if the operation was accompanied by a large blood loss, iron-rich foods must be introduced into the woman's diet. Additionally, antianemic iron-containing drugs can be prescribed.

Myomectomy allows you to remove existing nodes, but is not a prevention of the appearance of new uterine tumors. The fact is that myoma has a hormone-dependent development mechanism, and the operation does not affect the patient's endocrine profile. Therefore, in the absence of proper preventive therapy, a relapse of the disease is possible. So what treatment is prescribed after removal of uterine fibroids? The therapeutic regimen is selected individually, it often includes the use of hormonal drugs.

Removal of fibroids imposes some restrictions. It is advisable for a woman not to visit baths, saunas and solariums during the first few months, to avoid increased physical exertion.

In general, rehabilitation after removal of uterine fibroids takes about 6 months, then the woman returns to her usual lifestyle. But at the same time, she also needs to undergo a gynecological examination every six months, as prescribed by a doctor, to conduct an ultrasound of the pelvic organs.

Consequences of the operation

Is it possible to get pregnant after removal of uterine fibroids is the main question that worries patients of reproductive age. Myomectomy does not entail the disappearance of menstruation and the onset.

In the first few days, bloody discharge is possible, which cannot be considered monthly. When determining the length of the cycle, it is necessary to take into account only the date of the beginning of the previous menstruation. Menstruation after this operation usually returns within 35-40 days. In this case, lengthening or shortening of 1-2 subsequent cycles is permissible.

Preserving the patient's ovaries and uterus allows her to maintain her reproductive function. Therefore, pregnancy after removal of uterine fibroids is possible soon after the restoration of the functional usefulness of the endometrium.

But it is advisable for a woman who underwent such an operation to think about conception no earlier than 3 months after surgical treatment. And sexual intercourse is permissible only after 4-6 weeks. Compliance with these deadlines is especially important if laparotomy myomectomy with suturing of the uterine wall was performed.

The possible consequences of the operation include the risk of premature termination of pregnancy in the future, the pathological course of labor, the development of adhesive disease.

Alternatives to surgery

The possibilities of modern medicine allow the use of alternative methods of eliminating uterine fibroids. They can be minimally invasive or even non-invasive, that is, they go away without surgery.

These include:

• ... Malnutrition of tumor tissues leads to its aseptic lysis with replacement of muscle cells with connective tissue. Embolization is performed using a catheter inserted under X-ray control through the femoral artery.
• (focused ultrasound ablation) of fibroids, causing local thermal necrosis of tumor tissue. But this technique can only be used to get rid of fibromyomatous and fibrous nodes. But leiomyoma is insensitive to FUS-ablation.

In some cases, such techniques are combined with laparoscopic myomectomy, which is necessary for multiple myomatosis and subserous nodes on the pedicle.

You should not refuse to remove uterine fibroids. This organ-preserving operation does not lead to irreversible consequences for the woman's body and allows you to get rid of all the complications associated with the presence of myomatous nodes.

Uterine fibroids are the response of the female body to injury. Menstruation is such a damaging factor. It causes the formation of myoma rudiments in the muscle layer of the uterus, from which myomatous nodes subsequently develop.

The first reaction of a woman after she is diagnosed with uterine fibroids is confusion and fear. Don't despair. and you will immediately receive expert advice. We will make an appointment over the phone and arrange for a consultation with the leading specialists of the best clinics for the treatment of fibroids. For a list of clinics we work with, check out this link.

Please note that this text was prepared without our support.

Myoma of the uterus. Operation. Postoperative period

Currently, the gynecologists of the clinics with which we cooperate are of the opinion: myoma is not a tumor, it rarely degenerates into a malignant neoplasm. In this regard, they reject the generally accepted tactics of managing patients with uterine fibroids. We believe that surgery for fibroids should only be performed in rare cases and when absolutely indicated.

Removal of uterine fibroids does not solve the main problem: it does not remove the cause of the disease and does not stop the growth of new myoma nodes. In the postoperative period, no matter what methods this surgical intervention is performed, complications may develop. In 7-14% after surgery, a relapse of the disease occurs within a year. If the fibroid is removed, the postoperative period may be complicated by the formation of adhesions, which are a factor in tubal infertility.

A more traumatic operation is the removal of the uterus - hysterectomy. As a result of surgery, a woman loses her reproductive organ. During the amputation, surgeons leave the cervix, and the procedure is performed with or without the removal of the uterine appendages. A woman develops hormonal dysfunction, infertility.

We believe that it is advisable to perform this operation if there is a myomatous node for more than 25 weeks of pregnancy, which compresses nearby organs and causes a violation of their function. In other cases, our specialists offer uterine artery embolization. After it, the formations in the uterus undergo reverse development, the rudiments of the fibroids dissolve, and large nodes can be removed in a year under more favorable conditions by the laparoscopic method. In this case, the postoperative period proceeds smoothly, and complications develop less.

Doctors perform hysteroresection of myoma nodes in the presence of a submucous myomatous node. For this they use a hysteroscope apparatus, which is inserted into the organ cavity through the vagina and the cervical canal. The postoperative period proceeds more smoothly, the woman can subsequently give birth. The risk of disease recurrence remains.

When removing fibroids, doctors act on the formation with laser beams that do not damage the surrounding tissues. If they performed the removal of fibroids, the postoperative period is short, the functions of the female body are restored quickly. This intervention also does not solve the problem of the growth of myomatous formations in the future.

Removal of uterine fibroids. Postoperative period

The early postoperative period begins with the placement of the last suture. The patient is transported from the operating room to the intensive care unit. This is necessary in order to control the functions of the body in the postoperative period.

After the drugs that were used for anesthesia cease to work, the patient may experience pain at the incision site and in the abdominal cavity. She needs to be allowed to rest, so in the early postoperative period, doctors prescribe pain medications.

The patient stays in a regular ward for 7 to 10 days. On the second or third day, doctors allow her to get out of bed, turning on her side and leaning on her elbow. The postoperative period after removal of uterine fibroids can be shortened by moving more. An active lifestyle is the prevention of the formation of adhesions in the abdominal cavity, but the load should be dosed.

In the early postoperative period, the body temperature may rise to subfebrile numbers. In this case, doctors prescribe antipyretic drugs, and after a couple of days the temperature will return to normal. In most cases, a mimectomy is an abdominal operation. The first 2 days, the patient is allowed to drink a non-rich broth from dietary meat, weakly brewed tea, low-fat lactic acid products.

Then the diet is expanded, white bread crumbs, steam cutlets, boiled minced meat, vegetable soups whipped with a blender are added. Subsequently, the diet should be rich in fiber and heavy carbohydrates, which are found in vegetables and cereals.

After laparoscopic myomectomy, the postoperative period is less problematic, shorter. Doctors allow a woman to get up by the end of the first day after surgery. In the first days of the postoperative period, follow the exercises that allow the carbon dioxide, which the doctors injected during the operation, to quickly dissolve from the abdominal cavity. Contraception is an important point in the postoperative period. A woman can plan a pregnancy one year after surgery.

Postoperative period after hysterectomy

A hysterectomy, or removal of the uterus, is a major operation. After her, the woman is deprived of her reproductive organ and the opportunity to have a child. In some cases, surgeons remove the appendages at the same time as the uterus. The postoperative period after hysterectomy can be difficult. The patient from the operating room is transported, accompanied by an anesthesiologist, to the intensive care unit, where she will be under the supervision of doctors for several days. After her vital functions are restored, she will be transferred to a regular recovery room.

In the early postoperative period, doctors prescribe pain relievers and provide patient care. She is allowed to get out of bed no earlier than the third day. It is advisable after the patient leaves the anesthesia, turn her, do breathing exercises, back massage. All these measures reduce the duration of the postoperative period. After removing the stitches, the doctors discharge the patient under the outpatient supervision of a gynecologist.

She will need to see her doctor to monitor her hormone levels. After removal of the uterus with appendages, hormonal balance is disturbed. It must be restored with the help of special drugs that are prescribed by a gynecologist.

If in the postoperative period there are discomfort in the abdomen, the body temperature rises or pain appears, the woman must notify the doctor about this. After cavity hysterectomy, the postoperative period lasts about 6 months. A woman may have problems with urination, the upper vaginal fornix may go down. Her quality of life is deteriorating. In the postoperative period, the patient needs psychological help and support from her relatives. The help of a psychologist may also be required in the case when in the postoperative period the patient develops a depressive syndrome due to the fact that her uterus was removed.

Myoma. Rehabilitation after surgery

The postoperative period after each operation for fibroids is different. It depends on many factors:

• the prevalence of the pathological process;
• the volume of surgical intervention;
• type of pain relief;
• concomitant diseases;
• the age of the woman.

In order to avoid complications during the operating period, gynecologists recommend:

1. Follow a diet that ensures normal bowel evacuation function.
2. Avoid constipation, since if they are present, intra-abdominal pressure increases, which can provoke suture divergence in the early postoperative period.
3. Do not perform heavy physical work, do not lift a load weighing more than 3kg during the first six months. Over the next two years, it is necessary to limit the weight of the lifted loads to ten kilograms.
4. Observe the regime, alternate work with rest.
5. Avoid emotional stress.
6. Sexual life is allowed no earlier than 1.5-2 months after the operation.

Both in the early and in the long-term postoperative period, you should avoid direct sunlight, do not visit the solarium. If a woman has preserved reproductive function, she should take contraceptives and plan a pregnancy at the time recommended by the attending physician. In the postoperative period, it is useful for her to go to relax at the resort. During spa treatment, you should take radon baths and balneological procedures, avoiding excessive insolation.

The doctor decides whether to wear a bandage in the postoperative period. He also recommends which type of product is best suited for each specific case. In the early postoperative period, you should not engage in water sports. The gynecologist will tell the woman when to start swimming. You should not visit the bathhouse and sauna, take thermal procedures.

The main task of diet therapy in the postoperative period after surgery performed for fibroids is to avoid intestinal gas contamination, constipation and provide adequate nutrition. The diet should contain foods that contain proteins, vegetable fats and heavy carbohydrates.

The diet should consist of lean meat and fish, vegetables, fruits, fermented milk products. You can not eat foods that cause difficulty in the act of defecation:

• jelly;
• jelly;
• rice and semolina;
• rich pastries;
• sweets;
• strong coffee and tea;
• alcohol;
• carbonated drinks.

Gentle culinary technologies should be used in cooking. Products need to be boiled, baked in the oven or steamed. You should not eat fried foods, sausages, smoked meats.

In the postoperative period, a woman needs to move more, take daily walks. They contribute to the activation of metabolism, faster healing of postoperative wounds, strengthening the scar. The postoperative period proceeds smoothly if the patient adheres to the regimen and follows the recommendations of the attending physician.

In most cases, our specialists offer women diagnosed with fibroids to perform uterine artery embolization. After it, the restoration of all body functions occurs quickly, the restrictions are minimal, and the quality of life is not disturbed.

List of references

• Assessment of the quality of life in patients with uterine fibroids after various types of surgical treatment / D.V. Doletskaya, M.A. Botvin, N.M. Pobedinsky et al. // Obstetrics and gynecology. 2006. No. 1. S. 10-13.
• S.V. Nuzhnov Study of the quality of life of women before and after embolization of the uterine arteries in uterine myoma // Bulletin of the ChGPU. No. 8. 2011. P.245-251.
• Benign diseases of the uterus / A.N. Strizhakov, A.I. Davydov, V.M. Pashkov, V. A. Lebedev. M .: 2 Geotar-Media. 2010.S. 288.