Ovarian resection: indications and consequences. Laparoscopy of the ovary. Diagnostic laparoscopy of the ovaries, removal of the ovary by laparoscopy, removal of an ovarian cyst. Indications, contraindications, advantages of the method and rehabilitation Laparoscopic wedge

Content

An effective method of combating polycystic disease is ovarian resection. But the operation, during which ovarian tissue is partially removed, is also performed for other pathologies. It can be used to remove cystic formations, adhesions, tumors, and foci of endometriosis.

What is ovarian resection in women?

Ovarian resection is a surgical procedure in which the tissue of the reproductive gland is partially removed. To do this, several punctures are made in the abdominal wall. Although previously the operation was performed through an incision in the abdomen.

During surgical procedures, the doctor must excise the affected part of the ovarian tissue. But the gonads are not completely removed. In polycystic disease, surgery is needed to facilitate the release of the egg from the follicles. After all, with the disease, the capsule of the gonads thickens, and the oocyte cannot break through this membrane. In place of the follicles that did not burst, multiple cysts appear. Over time, in the absence of treatment, the situation only gets worse.

When performing a wedge resection, part of the ovary is cut out in the form of an acute triangle. Thanks to this type of operation, it is possible to eliminate the associated factors of infertility. The likelihood of pregnancy after surgical procedures increases by 70-80%.

Indications and contraindications for the procedure

Most often, resection is prescribed for patients diagnosed with polycystic disease. But surgical intervention is indicated in cases where conservative therapy is ineffective.

Resection can also be performed if:

• ovarian apoplexy;
• cystic formations;
• benign tumors;
• foci of endometriosis;
• purulent inflammation of the appendages;
• rupture of the cyst or torsion of its stem;
• ectopic pregnancy attached in the area of ​​the appendages.

All cystic formations, tumors, and ectopic pregnancies are removed in such a way as to preserve the ovarian tissue as much as possible. In polycystic disease, the surgeon cuts out overgrown tissue. In some cases, it can remove 2/3 of the volume of the gonad.

• exacerbation of infectious and inflammatory diseases of the genitourinary system;
• fever;
• disruption of the blood coagulation system.

Once the condition has returned to normal, a date for resection can be set. Ovarian tissue should not be excised if there is a suspicion that the tumors on them are malignant.

Ovarian resection methods

Before performing surgery, the surgeon must tell the patient what surgical method will be used. Depending on the situation, a unilateral resection is performed or the tissue of two ovaries is excised.

Reference! With polycystic disease, doctors operate on both sex glands at the same time.

The doctor can perform resection using laparoscopic or laparotomy access. The choice of method depends on the equipment located in the clinic and the woman’s health condition.

Laparotomy resection of the ovary

Laparotomy is performed on patients if urgent surgery is required. It is carried out when:

• ovarian apoplexy;
• rupture of the cyst or twisting of its legs;
• emergency condition arising from a diagnosed ovarian pregnancy.

Planned laparotomy in modern clinics is performed only on those patients who have a pronounced adhesive process in the pelvic area. Laparoscopy is contraindicated in this situation.

During laparotomy, the surgeon makes an incision from top to bottom along the midline of the abdomen or in the suprapubic region in the transverse direction. Through the incision, he gains access to the appendages, can examine them, remove identified adhesions, isolate the gonad and operate on it.

Laparoscopic ovarian resection

Most elective pelvic surgeries are performed laparoscopically. This type of access has many advantages:

• minor tissue trauma;
• reduction of the recovery period;
• reducing the period of incapacity.

Attention! Thanks to the organization of laparoscopic access, it is possible to reduce the likelihood of developing postoperative complications. Adhesions in the pelvic area after laparoscopy occur much less frequently than after laparotomy.

During laparoscopy, 3-4 punctures are made in the patient’s abdominal wall, through one of them the cavity is pumped with gas to move the organs away from the abdominal walls and from each other. This allows you to conduct a full examination and determine the required volume of surgical intervention.

A laparoscope is inserted into the abdominal cavity through a puncture. This is a special endoscopic instrument equipped with a video camera and a light source. Surgical instruments are inserted through other openings. The parenchyma of the gonad is dissected with an electrocoagulator using high-frequency electric current. A high temperature is created in the area of ​​its action, thanks to which small vessels are sealed, the risk of postoperative bleeding is minimized.

Technique of wedge resection of the ovary

If it is necessary to perform a resection, the gynecologist, having gained access to the ovary, compresses the pedicle of the gonad, in which the arteries pass. After this, the ovarian tissue is excised in the shape of a wedge, the tip of which is directed inward.

It is important to cut out part of the ovary so as not to disrupt blood circulation in this organ. The doctor must remove a minimum amount of ovarian tissue, cut out sclerotic formations and the immature follicles remaining in them.

After removing the desired fragment, the ovary is sutured with self-absorbing threads using thin needles. All manipulations must be done so that thin tissues are not injured. All bleeding vessels are bandaged.

Types of surgery

Depending on the established diagnosis, the condition of the gonads and the goals set, the doctor selects the type of operation. In case of polycystic disease, resection of both ovaries is performed. If cystic formations are detected on one side, resection of the right or left ovary may be prescribed. In some cases, partial resection is sufficient. But there are situations when it is necessary to completely remove the gonad or all appendages.

Partial resection

In women of reproductive age, if possible, only partial resection is performed. This operation is less traumatic, and it is possible to preserve reproductive function.

This method is mainly used to identify single cysts, polycystic disease, inflammatory changes in tissues, ruptures, and torsion of cysts. After the operation, after some time, the operated organ is completely restored and begins to perform its functions again.

Resection of the left ovary

Removal of tissue from the left gonad is necessary if there are formations on it that need to be removed. The left ovaries in most women are smaller than the right ones, and they have fewer follicles. Therefore, the likelihood of impaired reproductive function during operations on them is lower than during resection of the right gonad.

Resection of the right ovary

According to statistics, resection of the right gonads is performed more often. This is due to the fact that many patients have better blood circulation on the right side, so problems on this side arise more often.

If a large cyst, tumor, or ectopic pregnancy is detected on the right ovary, the doctor can cut out part of its tissue. The probability of maintaining reproductive health after such work by surgeons reaches 70%.

Resection of both ovaries

Most often, surgery on both sex glands is performed on patients diagnosed with polycystic disease, which is not amenable to drug therapy. After all, sclerotic tissue must be removed from both sides. This will increase the chances of ovulation and pregnancy.

Bilateral resection is performed both for polycystic disease and for detection of bilateral pseudomucinous or endometrioid cysts.

Rehabilitation

The recovery period after laparoscopy is much shorter. Patients recover in 2 weeks; after laparotomy, the rehabilitation period extends to 2 months.

When performing laparoscopy, the patient is recommended to start walking and perform simple movements in the evening of the operating day. This is necessary to prevent the occurrence of complications in the form of adhesions, thrombosis, and intestinal dysfunction.

You can prevent the occurrence of negative consequences after ovarian resection if you continue to follow the doctor’s recommendations after discharge:

• refuse sexual intercourse for 2-4 weeks;
• do not lift more than 3 kg;
• exclude herbs, spices, smoked food, and alcohol from the menu.

Medications are often prescribed to help prevent the pathology from returning. For many, the menstrual cycle recovers on its own after surgery.

Why is part of the ovary left during surgery?

In the absence of indications for oophorectomy (complete removal of the ovaries), their tissue is only partially excised. This is necessary so that the sex hormonal glands can continue to work. Otherwise, irreversible changes begin in the female body.

The ovaries are a source of estrogens; a woman needs these hormones to maintain a normal physical and emotional state. When the gonads are removed, changes in the body begin that are similar to menopause. The difference is that the process of fading of their function in women after 45 years is gradual. And after the operation, hormones suddenly stop being produced, as a result the body experiences enormous stress.

Important! Partial preservation of the ovarian tissue in which the follicles are located helps the body continue to function as usual.

Is the ovary restored after resection?

When ovarian tissue is excised, its volume decreases. During the operation, the surgeon cuts out part of the follicles. Their number is formed in girls in utero, so there is no hope for complete restoration of the ovary after resection. Some people experience a process of stromal proliferation, but this does not affect reproductive function.

The decisive factor is not the size of the remaining part of the gonad, but the follicular reserve located in it. An approximate assessment of the condition of the gonad after surgery can be made by measuring its volume.

How long do the ovaries last after resection?

It is impossible to predict how long the reproductive glands will function after resection. Situations are possible when a woman calmly gives birth to several children and waits until menopause after 40 years, even if she had a resection at the age of 17. In some patients, the gonads may immediately refuse to function after surgery. As a result, the woman experiences an unplanned early menopause.

The duration of their work will depend on what part of the gland was cut out and how many follicles were removed. With a small follicular reserve remaining, doctors often prescribe hormonal drugs to patients; they are needed to delay menopause.

What complications can there be?

After any surgical procedure, patients may experience the following problems:

• damage to abdominal organs;
• the occurrence of adhesions;
• development of bleeding;
• wound infection;
• allergy to drugs used in anesthesia.

Among the long-term complications of resection is the appearance of infertility. Therefore, a woman is recommended to start planning a pregnancy 1-2 months after the operation or is prescribed hormonal drugs that can help preserve the remaining follicles. Infertility can be caused by the development of adhesions in the pelvis, a decrease in the supply of eggs, and a deterioration in the production of sex hormones.

Ovarian resection: consequences, reviews from doctors

Resection is often recommended for women with polycystic disease to normalize ovulation. In the vast majority of patients, the operation is effective. But about 20% of women face negative consequences of the operation, one of which is infertility.

In some cases, resection is the only way to achieve ovulation or remove tumors on the appendages. Doctors do not prescribe surgery unless necessary.

Raisa Vladimirovna Pelek, Magnitogorsk, gynecologist

If over a long period it is not possible to normalize the condition of polycystic disease using conservative methods, then I recommend surgery. It is important to immediately warn the woman about the benefits and possible consequences of resection of the right ovary. Almost all of my patients were able to get pregnant and give birth after surgery.

Igor Pavlovich Oladenko, Kirov, gynecologist

For patients who are afraid of surgery, I recommend finding and watching how ovarian resection is performed on video. Seeing clearly that the doctor is trying to leave the ovary and not cut out too much, many calm down. After all, most patients are afraid that all their female organs will be removed at once.

Ovarian resection is a necessary procedure for patients with cystic formations, benign tumors or polycystic changes that do not respond to conservative treatment. In almost 80% of women, after partial removal of ovarian tissue, their reproductive health status returns to normal.

You can see how laparoscopic resection is performed in the video:

Ovarian resection is one of the most common gynecological operations, which involves partial or complete removal of an organ. The type of operation is selected depending on the severity and type of disease, and the woman’s desire to have children in the future. Resection is carried out using two methods, which have their own advantages and disadvantages. This operation poses a risk of complications, so proper recovery measures are required.

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What is ovarian resection?

Ovarian resection is a surgical procedure performed to remove a damaged area in one or both organs. This operation does not necessarily involve complete excision of the reproductive glands, therefore, in certain cases, the woman retains the opportunity to conceive a child in the future. Ovarian resection may be performed to increase the chances of pregnancy.

Surgical intervention is carried out only after a comprehensive examination of the patient. This is necessary to reduce the likelihood of postoperative complications. If after the procedure a woman wants to conceive a child, then the female reproductive glands are encouraged to increase the production of eggs with appropriate therapy.

The volume and type of the upcoming operation is determined by the patient’s age, her general health and the severity of the disease. Indications for ovarian resection are:

• benign tumors;
• injuries;
• ovarian endometriosis;
• polycystic ovary syndrome;
• single cyst.

But there are also contraindications, which are divided into absolute and relative. The presence of malignant neoplasms is considered absolute. Relative contraindications are:

• blood clotting disorder;
• acute infectious diseases of the urinary and reproductive systems;
• intolerance to anesthetic medications.

Types of surgery

Removal of the ovary is carried out in several types. Resection is distinguished:

• total (both ovaries);
• subtotal (partial);
• repeat.

Each of these types has its own characteristics and indications for implementation. When choosing the type of operation, the doctor relies not only on the patient’s disease and condition, but also on her desire to become pregnant in the future.



Total

When both ovaries are removed, the operation is called an oophorectomy. It is usually carried out in the following cases:

• malignant organ damage (resection of the uterus and ovaries is possible - removal of the ovaries, fallopian tubes and part of the uterus);
• glandular abscesses;
• total endometriosis;
• significant sizes of cystic formations.

Resection of both ovaries is carried out unscheduled if a rush is required. It may be due to the diagnosis of another, less serious disease before laparoscopy. Typically, this type of operation is performed for women over 40 years of age to prevent malignant tumors in the affected ovaries.

Resection of both ovaries is most often performed for bilateral endometrioid and pseudomucinous cysts. Removal of the ovaries and part of the uterus is carried out for papillary cystoma, since this tumor has a high probability of degenerating into a malignant formation.



Subtotal

Subtotal resection of the ovary is less traumatic. It allows you to maintain a normal ovarian reserve, due to which the organ retains the ability to ovulate.

This type of operation is usually used for single cysts, compaction of ovarian tissue, and inflammatory changes in them. Indications for partial resection are rupture and torsion of cysts.

This type of operation allows the organs to quickly recover, thereby resuming their functions. One of the methods for partial excision of the ovary is wedge resection. With minor damage to the ovary, it is possible to use ovarian cauterization. This method is very effective and allows a woman to become pregnant in the first cycle after the procedure.



Technique for performing wedge resection

Repeated

Repeated surgery is usually prescribed for polycystic disease. It is carried out no earlier than six months to a year after the first surgical intervention. Recurrence of the cyst is also an indication.

Some women have a tendency to form cysts, which is explained by hereditary predisposition. In such cases, the disease relapses, which requires additional surgical intervention. Repeated resection is especially important when a dermoid cyst larger than 20 mm is detected or when a woman has been unable to become pregnant for a long time.

Laparoscopy for polycystic disease with repeated resection allows a woman to increase her chances of conceiving a child.

Methods

Surgery on the ovaries is performed under general anesthesia. Resection is done in two ways:

1. 1. Laparoscopic resection. Three punctures are made in the abdomen - one in the navel area, and the rest in the projection area of ​​the ovaries. The incisions are small, no more than 1.5 cm. This method of operation is less traumatic, requires a shorter postoperative recovery period, and no cosmetic defects are created in the abdominal area.
2. 2. Laparotomy resection. Access to the organ is achieved by making a relatively small incision, which is at least 6 cm, in the anterior abdominal wall. This is a common method of operation using standard surgical instruments (scalpel, tweezers, clamps). Visualization of the actions performed is immediate. Laparotomy increases the risk of complications and brings mental trauma and stress to the woman. This method leaves noticeable scars on the skin.

Full recovery with laparoscopic access occurs after a month, and with laparotomy - after 1.5-2 months.



Laparoscopic surgery

Today, the most popular is the laparoscopic method. It is widely used. The operation technique is as follows:

1. 1. Punctures are made in three places through which laparoscopic devices are inserted.
2. 2. The operated organ is freed from adhesions and nearby organs for resection.
3. 3. The required resection option is carried out (partial or complete).
4. 4. Damaged vessels are cauterized and sutured.
5. 5. Damaged tissues are sutured.
6. 6. An audit of the remaining organs is carried out, their condition is assessed.
7. 7. If necessary, additional measures are taken to eliminate other problems in the pelvic cavity.
8. 8. A drainage tube is installed to drain fluid from the surgical wound.
9. 9. Laparoscopic devices are removed, external tissues are sutured.

During surgery, the laparoscopic method can be replaced by laparotomy. This may be necessary if you cannot use the pre-selected access to perform a successful operation.

Treatment after surgery

After ovarian resection is performed, the patient is transferred to the recovery room. She is under the supervision of doctors for one to two days, depending on her condition. On the day of surgery, she can only get up and walk in the late afternoon or the next morning.

The next day, the drainage tubes are removed. After this, a short course of antibiotic therapy is carried out, which is necessary to prevent infectious complications.

The sutures are removed by the surgeon after a week. For a month after the operation, the doctor prescribes the use of shapewear and a bandage belt. All this time you need to maintain sexual rest and minimize physical activity.

For two to three weeks, a woman is shown a certain diet. Alcoholic drinks, herbs, salty foods and spices should be excluded from the diet.

Complications

With partial resection, rehabilitation can take up to two weeks. If the ovary is completely removed, the recovery stage can last up to two months.

As with other types of surgical interventions, the following complications may occur:

• allergic reaction to anesthesia;
• bleeding;
• formation of adhesions;
• wound infection.

After surgery, a woman often experiences tingling in the ovarian area. They arise due to impaired blood circulation in the organ after surgery. Such sensations should go away on their own after a few days. If this does not happen, then an additional ultrasound examination by a specialist is needed.

The laparoscopic method of surgery can cause pain in the chest, which persists for the first three to four days. This is due to the nature of access, which is considered an absolutely normal reaction. Usually the discomfort disappears on its own without the use of medications.

Pain in the ovary can persist for two weeks, after which it should go away. In some cases, a month passes and the pain persists. This is a signal of possible inflammation in the ovary, the formation of adhesions, or polycystic ovary syndrome. Sometimes pain occurs during ovulation. If it is unbearable, then you should definitely consult a doctor.

Reproductive functions after surgery

Any type of operation involves the removal of part of the glandular tissue. It contains a supply of eggs, which is strictly determined by the female body. Removing this part results in a decrease in the number of cells that mature during ovulation. As a result, a woman's reproductive period decreases - this is the time when she is capable of conceiving and bearing a child.

After resection of the ovaries, a woman’s blood levels of hormones initially decrease, which is a consequence of some kind of damage to the organ. Ovarian function is restored within 8-12 weeks, so during this period the patient can be prescribed maintenance hormonal drugs for replacement treatment.

Menstruation can resume on the second or third day after surgery. Vaginal discharge occurs due to a peculiar stress reaction of the reproductive organs - this is the norm. The first menstrual cycle can occur anovulatory or in the usual form with ovulation. Cyclicity is completely restored after a few weeks.

Women are advised to refrain from planning pregnancy for two months after surgery. Although, even if desired, the probability of conceiving a child during this period is practically zero, because the monthly cycle will not be completely restored. If the indication for resection is a cyst, then the best time to fertilize the eggs is the first six months after the operation.

Ovarian resection and pregnancy are completely compatible concepts. Some women of reproductive age who dream of having children face various problems with conception. These can be benign tumors on the ovaries, cysts, polycystic disease, endometriosis and a number of other pathologies. In cases where conservative therapy in the form of drug treatment is powerless, they resort to.

Ovarian resection is the surgical removal of part of the ovary and pathology in it, for example, a cyst. The remaining part of the organ is carefully sutured to preserve, if possible, reproductive function.

Resection is carried out using several methods:

1. Laparoscopy. This is a modern and safe technique, the essence of which boils down to the following. Several punctures are made in the woman's abdomen using special equipment. Devices are inserted into the holes: one to carry out excision of part of the affected organ, the other with a special sensor that transmits all actions to the monitor. Thus, it avoids an aesthetically unattractive scar on a woman’s abdomen, the recovery period is much faster, and the pain that is usually observed during standard abdominal surgery can be minimized.
2. . Abdominal surgery, in which a longitudinal incision is made in the abdomen (at least 10 cm), and through this incision part of the ovary is removed. Abdominal surgery is more traumatic and dangerous than laparoscopy, not to mention the fact that it leaves a scar on the abdomen, which can only be removed later with a laser (and not always).

Whatever the method of surgical intervention, its goal is to eliminate the pathology that prevents pregnancy. The doctor tries to carry out the procedure in such a way as to preserve as much ovarian tissue as possible so that the ovary subsequently functions normally. Bleeding vessels are not sutured after the incision; they are cauterized with a special device (coagulation method).

Why pregnancy does not occur and what to do

If a woman cannot get pregnant due to the presence of a large number of follicles that interfere with the normal course of ovulation or lead to its complete absence, they speak of the presence. Resection of the ovaries for polycystic disease is carried out in order to stimulate ovulation. To do this, several incisions are made on the organ (usually no more than 8), or part of the dense membrane, consisting of an excess number of follicles, is removed. Sometimes the procedure is performed in a wedge-shaped manner - a triangular piece of the membrane is removed, and the reproductive part of the ovary is preserved.

In gynecological practice, there have been cases where a woman is healthy, but pregnancy does not occur due to the fact that the ovaries have too dense a membrane. In this case, a decision may also be made to perform resection. But here the woman must decide for herself whether she is ready for surgery, because surgical intervention is always a last resort, which should be resorted to if there are no other methods of treatment, or they turn out to be ineffective.

Resection of the ovary to enable further pregnancy must be distinguished from oophorectomy (oophorectomy) - complete removal of the ovary. This operation is a last resort and is performed in the following cases:

• malignant tumors in the ovaries and/or uterus;
• for large cysts, provided that the patient is 40 years old or more, and also if the neoplasm puts strong pressure on neighboring organs or there is a high risk of rupture;
• with ovarian abscess;
• with widespread endometriosis, if other treatment methods have not brought the desired result.

How to get pregnant after ovarian resection

If a woman wants to become pregnant after ovarian resection, she should understand that certain difficulties may arise with this. The fact is that a healthy organ produces from 400 to 600 eggs during the entire time a woman is able to have children. When part of the organ is removed, the number of eggs produced decreases. In addition, the reproductive period is shortened. But if the operation was performed at a young age (before 30 years), then there is nothing to worry about, since the ovarian reserve is still quite large.

After resection, ovarian stimulation may be performed to restore and increase egg production. This procedure increases the chances of conception, but is performed only when indicated (if pregnancy does not occur for a long time). Stimulation is carried out with hormonal drugs (Puregon, Gonal, etc.) or folk remedies (for example, hogweed, sage, plantain, rose).

Menstruation after resection usually occurs without complications. The first period after surgery may come within a few days. This period can be extended to two weeks. The first menstruation is more painful than usual. This is due to the fact that both internal and external tissues have not yet fully healed. Ovulation is restored during the first cycle, even if resection was performed to treat polycystic disease.

Despite the restoration of ovulation and the menstrual cycle, hormonal imbalance often appears. This is another reason why pregnancy may not occur. An ovary that is reduced in size is anatomically unable to produce the same amount of sex hormones as before surgery. Therefore, a woman may be prescribed hormone therapy to artificially replace follicle-stimulating and luteinizing hormones. Under the influence of synthetic hormones, the ovaries begin to produce their own over several cycles.

Pregnancy after ovarian resection often does not occur due to adhesions. These are connective tissue fibers that form after surgery. Adhesions are caused by the body’s ability to self-heal. Damaged tissues rush to recover faster, so adhesions form. They prevent the fertilized egg from entering the uterus. Therefore, there is both a risk of ectopic tubal pregnancy and even problems with conception.

The adhesive process is reversible in most cases. There are special absorbable drugs, and if they are ineffective, they again resort to laparoscopy to excise adhesions.

When to plan conception after resection

Pregnancy after ovarian resection should be planned no earlier than six months later, this is how long the late recovery period lasts.

The chances of conceiving a child are much higher if the resection was unilateral, with normal functioning of the second ovary. It does not matter how much ovarian tissue remains in the operated organ. In case of bilateral resection, the chances of conception are significantly reduced. When resection of two ovaries, the number of eggs and ovarian tissue remains in very small quantities, so you should start trying to conceive a child as early as possible. Also, pregnancy should not be delayed if resection was performed to treat polycystic disease. This measure is temporary and the disease may return soon.

Ovarian resection and pregnancy are quite compatible. If a woman plans to have children after surgery, she should be regularly observed not only by a gynecologist, but also have her thyroid gland and liver examined, and all infectious and inflammatory diseases treated in a timely manner.

If, in the absence of complications from resection, it is not possible to conceive a child naturally within a year after the operation, you should examine your partner, or look for other methods of conception (for example, in vitro fertilization).

Ovarian resection is not an obstacle to pregnancy, but a way to speed up conception. Many women do not even know what difficulties can arise after surgery, so they successfully become pregnant after many futile attempts. Therefore, if resection is necessary according to indications, it must be carried out in order to have healthy offspring.

The ovaries in the female body are the basis of its ability to conceive a child. Their constant activity in the form of maturation, descent through the fallopian tubes into the uterus and excretion of eggs after fertilization has not occurred, ensures the menstrual cycle. This also explains the fluctuations in hormonal levels that are observed naturally in women until menopause.

The ovaries constantly produce estrogen hormones, which form the female background. But they can also get sick both for reasons that cause any organs of the body to get sick (injuries, infections), and because of their own “disagreements” with other organs that synthesize sex hormones. For example, in addition to the main glands (in men these are the testes), both sexes also have the adrenal cortex in their bodies - the producer of many corticosteroids, including hormones of the opposite sex.

Testosterone serves the female body in the same capacity as estrogen serves the male body. Namely, as an estrogen antagonist and stimulator of ovarian activity. When testosterone levels rise, they respond by increasing their activity. In addition, the presence of “opposite” hormones allows us not to turn into asexual creatures after menopause.

However, if during puberty the balance of these two scales is disturbed, the consequences are reflected primarily on them. That is why problems with procreation are among the most stubborn to all attempts to cure them.

What is ovarian resection?

Any diseased organ is a source of constant complications in the body. And the gonads are especially dangerous due to their ability to form cysts - initially benign tumors, which can then undergo malignancy (degeneration into cancer) under the influence of hormones.

Cysts are troublesome tumors. In addition to the tendency to malignancy, they often produce hormone-like substances themselves or accumulate hormones of the opposite sex from the blood. They also fester, grow and throw out a lot of other dangerous “things”. From a medical point of view, the only good thing about them is their susceptibility to therapy with the same hormones, even after degeneration into cancer.

Therefore, it would be safest to remove ovaries that cannot function normally. But now such a decision is made less and less often. Modern monitoring systems give gynecologists a certain confidence that a life-threatening process will be noticed on time. This means that it will always be possible to completely deprive a woman of her chances of having another or even her first child - for example, after an unsuccessful attempt to preserve reproductive function. For this purpose, the resection method was developed - cutting them off, so to speak, instead of completely removing them.

Of course, they “cut off” everything that poses a threat to the patient’s life or an obstacle to the normal activities of the rest of them. Healthy tissue and intact eggs are preserved as much as possible.

Ovarian resection is indicated for the following diseases:

• Extensive adhesions resulting from inflammation;
• Single cyst (only this will be removed);
• Multiple cysts (polycystic), usually appearing either due to obstruction of the fallopian tubes or under the influence of high testosterone;
• Other benign tumors;
• Ovarian apoplexy (urgent surgery, performed due to the onset of bleeding due to rupture of blood vessels);
• Injuries, especially local or affecting only the right/left ovary.

But it is contraindicated in the following cases:

• If malignant foci are present/identified during surgery;
• If there are indications for removal of the fallopian tubes or uterus (preserving them after this is pointless and dangerous);
• With an ectopic pregnancy.

There are two types of resection based on the method of intervention.

1. Laparoscopic. This is the least traumatic way for surrounding tissues, in which an incomplete opening of the abdominal cavity is performed in the area above the pubis, and the work is carried out using 3-4 very small (up to 1.5 cm long) incisions. A set of hollow tubes called trocars are then inserted through these incisions. One of them is always used to inject gas into the abdominal cavity. The surgeon needs space to manipulate, and to do this, he must first lift the abdominal wall, which is what happens when gas is pumped into the working area. The remaining trocars are used to introduce a light source, video camera and surgical instruments through them into the abdominal cavity. The surgeon works while looking only at the monitor;
2. Laparotomy, in which the surgeon gains access to them in a standard way - through a wide (up to 8 cm) incision, followed by removal of the ovaries themselves. This method is much more traumatic, but it allows you to examine them in more detail and notice what can be missed during laparoscopy. In this case, only tissues affected by the pathological process are also excised.

What is wedge resection of the ovaries

This special type of resection of the right or left ovary (and more often, both) is usually performed for polycystic disease - a symptom and at the same time a result of too high testosterone. In such cases, initially they formed quite normally and even try to work as they should. But the constantly elevated “opposite” background subsequently forced the eggs to protect themselves from it by increasing the density of their membranes. As a result, a completely healthy and mature egg, as they say, like clockwork, cannot “hatch” and descend into the uterus for fertilization.

As we have already understood, resection of the ovaries for polycystic disease is intended to at least temporarily help the eggs to mature and descend into the uterus normally. Then this period can be used to conceive a child, even if it does not last long, and after it ends it will become impossible to get pregnant again. In such cases, the surgeon gains access to the ovaries by laparoscopy or laparotomy, and then makes wedge-shaped incisions (“with the point toward the egg”) in the membranes of the immature eggs.

It is assumed that after this the path of the eggs out will be facilitated simply by the exit made with a scalpel through the compacted membranes. And to stimulate their rapid ripening and balance high testosterone, estrogen therapy is carried out. Usually it is recommended to start trying to get pregnant after 3 months. after operation. The optimal period for pregnancy is the first six months after it. If it was not possible to get pregnant within 1 year after the intervention, the chances of conceiving a child in the future are already equal to the same as they were before it.

Disadvantages of ovarian resection

In principle, it has no more disadvantages than any other intervention. But they exist, and the main one is that some of the existing eggs inevitably have to be removed.

As you know, the female body contains a certain number of eggs, and new ones do not appear in them during life - only the existing ones mature. Therefore, although the resection is intended to improve a woman's chances of pregnancy in the immediate future, it significantly reduces them in the long term. This happens because it involves removing a certain percentage of eggs that could hypothetically still mature and be fertilized later. Due to this, menopause is also approaching - after resection it should be expected before 45 years.

Pathologies in the organs of the female reproductive system cause hormonal imbalances, which affects the general state of health. The nature of the consequences largely depends on how timely and adequate the treatment was. In the most serious cases, when drug therapy does not save the situation, surgical operations are performed. Resection is a gentle method that allows you to save the organ. In particular, after such an operation on the ovary, a woman is often able to conceive and give birth to a healthy child.

Content:

What is the operation

Resection of the ovary consists of removing a certain part of it affected by any pathology. A woman’s ability to bear children depends entirely on the condition of the organs of the reproductive system. The ovaries store a supply of eggs and regularly mature them. Female sex hormones that control the functioning of the entire body are produced here. Therefore, it is very important to monitor the condition of these organs, and carry out any interventions using the most gentle methods possible, especially if the woman is young and intends to have children.

Indications for resection

The extent of surgical intervention and the method of ovarian resection depend on the nature and severity of the pathology. Partial removal is indicated in the following cases:

1. If the examination determines that the pathology is benign.
2. There are isolated neoplasms. This operation is indicated in the presence of non-functional cysts (dermoid, endometrioid) or benign tumors (cystadenoma, carcinoma).
3. Treatment is being carried out for infertility caused by polycystic disease.
4. There is a rupture of the organ membrane (apoplexy), and injury occurs.
5. An ectopic pregnancy occurs, in which the fetus begins to develop in the ovary.

Contraindications for surgery

Operations are not performed in cases where the patient has a bleeding disorder (thrombophilia or hemophilia). If it is confirmed that there are cancer cells in the tumor, then the ovary is not resected, but completely removed.

In the presence of infectious or acute diseases of the genital organs, surgery is performed only after complete elimination of such processes. Contraindications to the operation are impaired kidney function, severe diseases of the heart, respiratory system and liver.

Types of operations

Depending on the type of pathology being eliminated, one of the following types of surgical intervention is used: partial resection, wedge resection or oophorectomy (removal of the entire organ).

Partial resection

Part of the ovary is cut off when an inflammatory process occurs in it (spread of pus is possible) or a large single cyst or benign tumor forms in its body.

This type of resection is used if there is hemorrhage in the ovarian tissue, or if the ovary is damaged during operations on other pelvic organs. A similar resection of the epididymis is performed if it is necessary to remove a large ovarian cyst when it ruptures and bleeding occurs into the abdominal cavity or when the pedicle of the ovarian cyst is twisted.

Dissection and partial removal of ovarian tissue is possible if it is necessary to remove the fertilized egg if an ectopic pregnancy occurs.

Wedge resection

This type of surgery is usually used when it is necessary to take a tissue sample from a tumor for histological analysis (biopsy). In addition, wedge resection is used as a way to stimulate ovulation in the treatment of infertility caused by polycystic ovary syndrome. With this disease, disruption of the tissue structure as a result of the formation of many small cysts makes it difficult for a mature egg to leave the organ. In this case, fertilization becomes impossible.

During the operation, a “wedge” of ovarian tissue above the capsule with follicles is removed. As a result, the egg can move into the fallopian tube and meet the sperm. After such an operation, a woman has a chance to conceive a child within 0.5-1 year. The effectiveness of infertility treatment is approximately 85%.

Addition: Another method of “releasing” eggs is also used. Instead of resection of the ovary, several incisions (up to 25 pieces) are made on its shell using a laser beam or an electric knife. This allows the eggs to be released through the incisions. In 72% of cases, such an operation helps relieve a woman of infertility.

Oophorectomy

This is the name for complete removal of the ovaries (sometimes along with the uterus). The method is used for ovarian cancer, the presence of an extensive purulent process, as well as in the presence of large neoplasms of a dubious nature in women over 45 years of age.

Resection methods, possible complications

Ovarian resection can be performed through an incision in the lower abdomen (laparotomy) or through punctures in the abdominal wall (laparoscopy).

Laparotomy

To remove the affected ovarian tissue, an incision about 5 cm long is made in the abdominal wall. It is visually determined where the tumor is located, and then it is excised with a scalpel. A clamp is used to stop bleeding, and tweezers are used to remove tissue.

The disadvantages of this operation are:

• increased risk of formation of adhesions between the ovaries and peritoneum;
• the presence of a postoperative suture;
• organ damage can lead to infertility;
• long period of postoperative recovery.

The woman needs to stay in the hospital for about 2 weeks. Complete healing occurs after 3 months.

Laparoscopy

During ovarian resection using laparoscopy, 3 punctures with a diameter of 1.5 cm are made in the lower abdomen. Through one of the holes, carbon dioxide is pumped into the abdominal cavity to separate the organs. A video camera is connected through the second, which allows you to display the image on the screen and monitor the progress of the operation. The third puncture is made to insert instruments.

After the operation is completed, the gas is removed and the holes are sutured. They heal much faster than a regular incision. Only pinpoint marks remain at the puncture site. The risk of adhesions is much lower than with laparotomy. The likelihood of infection during manipulation is extremely low.

Video: How laparoscopic removal of an ovarian cyst is performed

Before the operation, blood and urine tests are taken to ensure that there are no inflammatory processes. The blood is tested for HIV and the presence of antibodies to various types of infection. A fluorographic examination is carried out, and a cardiogram is taken.

The evening before surgery, the patient should stop taking liquids and food. In the morning they do a cleansing enema.

When performing ovarian resection, general anesthesia is usually used. In some cases, if the scope of the operation is small, local anesthesia may be used.

Possible consequences of the operation

The consequence of surgery, as a rule, is the occurrence of hormonal disorders. If a significant part of the organ is removed, the woman may experience amenorrhea (absence of menstruation). Hormonal imbalance leads to the appearance of hair on the face and body, and other signs of a lack of estrogen in the body. Therefore, after such operations, a course of treatment with hormonal drugs is usually carried out to restore the background.

Due to a significant reduction in the size of the ovary and, accordingly, an artificial reduction in the ovarian supply of eggs, a woman’s chance of pregnancy is reduced. The formation of postoperative adhesions also negatively affects reproductive ability. They disrupt the location of organs in the abdominal cavity, which can become an obstacle to conception.

Possible complications are infection in the abdominal cavity during surgery, damage to neighboring organs, internal bleeding and hematomas. After resection of the ovaries, a woman may develop abdominal hernia.

Re-development of neoplasms is possible.

Postoperative recovery

After the anesthesia wears off, the woman feels pain in the lower abdomen. She is given injections of painkillers for 3-4 days. After 7-10 days, the sutures are removed.

During the period after ovarian resection, a woman should follow the following rules:

1. For 1 month you cannot have sexual intercourse, play sports, lift heavy objects (weighing more than 3 kg), bathe in the bathroom or go to the pool.
2. You will need to wear compression garments and a support bandage for 3-4 weeks.
3. It is necessary to urgently consult a doctor if there is redness of the suture, body temperature rises, pain intensifies, bleeding does not disappear and even intensifies.

Bloody discharge may appear for 3-5 days after surgery. If the damage to the ovary is minor, then menstruation occurs on normal days (sometimes there is a delay of up to 3 weeks).

Pregnancy after surgery

If a woman has undergone ovarian resection, ovulation can occur within 2 weeks. This happens when most of the organ is preserved, and the woman does not take hormonal medications as prescribed by the doctor. However, you should not plan a pregnancy in the next 2 months after surgery; you must use oral contraceptives.

To prevent infertility due to the formation of adhesions, the woman is prescribed physiotherapy, and light walks are recommended. To avoid intestinal bloating, its proximity to the ovaries and the occurrence of adhesions, it is necessary to consume foods high in fiber.

Pregnancy is most likely to occur 6-12 months after surgery. If conception does not occur for more than 1 year, you should consult a doctor to find other possible causes of infertility.

Video: Features of postoperative recovery