Perform an operation to remove the fibroids. Abdominal surgery to remove uterine fibroids. What to do after removal of the uterus and appendages

Description

Myoma (syn. - leiomyoma, fibroma) of the uterus is the most common benign neoplasm of the female reproductive system, originating from the smooth muscle cells of the uterus (myometrium). Etiology - dishormonal disorders. The frequency of occurrence is 50% in women after 45 years. The size of fibroids is determined in centimeters and weeks of gestation (similar to the increase in the uterus during pregnancy). According to the localization of the node relative to the uterus, submucosal, subserous, intramural, atypical (cervical) and fibroids of a mixed location are distinguished.

Symptoms of the disease appear when the formation increases to a certain size. The most common signs of leiomyoma are:

infertility

heavy bleeding and painful menstruation

increase in the duration of menstruation, prolonged smearing marks

irregular cycle

failure to conceive when ovulating

miscarriages

with large fibroids - frequent urination (due to pressure on the bladder), feeling of heaviness in the lower abdomen

hydronephrosis due to compression of the ureters

with prolonged compression, a violation of the concentration-excretory function of the kidneys is possible

Laparoscopic myomectomy is the treatment of choice for fertility preservation. The operation has advantages over abdominal myomectomy in the form of low blood loss, minimal trauma and invasion, and the absence of extensive postoperative scars. Patients recover faster and return to daily life.

The maximum size of fibroids that can be removed laparoscopically without violating the integrity of the endometrium is determined by the experience and qualifications of the surgeon. The main indications for surgical treatment:

rapid tumor growth

suspected malignant nodule

dysfunction of other organs

severe pain symptoms

infertility

preparation for IVF in women with uterine fibroids

bleeding anemic patient

large node size

The use of laparoscopic techniques for the removal of large and giant fibroids remains controversial due to the increase in the duration of the ectomy, the difficulty of removing the tumor from the abdominal cavity. The uterine defect is large and may be difficult to close. Laparoscopic removal of subserous and intramural fibroids, mixed.

The question of which access for myomectomy to choose is decided by the operating gynecologist. General anesthesia for laparoscopic myomectomy eliminates any discomfort or pain. Positive feedback from gynecologists confirms the benefits of a minimally invasive and highly effective laparoscopic treatment method.

Removal of uterine fibroids by laparoscopic method

Preoperative preparation reduces the risk of intervention and the likelihood of complications. They do standard tests (blood, urine, cytology of uterine scrapings and smears for vaginal microflora), studies (ultrasound, ECG, chest x-ray), hysteroscopy to clarify the contact of the node with the uterine cavity and the health of the endometrium. It is necessary to identify all the points that potentially affect the course of the operation and the prognosis of cure: concomitant chronic diseases, taking any drugs. Identification of infection and violation of the blood count should be accompanied by adequate therapy

The main areas of preparation: sanitation of foci of infection and hormone therapy according to indications (large formations and multiple myomatous nodes).

For 8 hours before surgery, it is necessary to exclude food and liquid intake. The current intake of any pharmacological drugs should be agreed with the attending gynecologist. The day before, the anesthesiologist examines the woman, assesses the likelihood of allergic reactions, and then agrees on the type of anesthesia (general or spinal), the estimated volume and duration of the operation.

How does the removal of fibroids and how long does it take, the gynecologist will tell. The procedure for enucleation of submucosal, subserous (submucosal type of formation protruding into the uterine cavity) or intramural fibroids with preservation of the subserous layer of the endometrium has an average duration of 90-140 minutes. Preservation of the integrity of the endometrium and non-interference in the uterine cavity is necessary to preserve further reproductive function.

While the woman is under anesthesia, the surgeon makes 3-4 punctures in the lower abdomen. The abdominal cavity is filled with gas, creating space for operational maneuvers. A laparoscope equipped with a lamp and video equipment, surgical manipulators are introduced. To reduce the risk of blood loss, they block the blood flow in the uterine arteries and inject drugs locally that cause spasm of the uterine vessels. Removal of formation structures occurs with the help of a morcellator and sterile endoscopic pockets. Pieces of fibroids are removed from the abdominal cavity. if the fibroid is small, it is removed entirely. Tumor tissue samples are sent for histological examination to exclude atypical structures. The myometrial defect is repaired with special continuous sutures. Do an audit of the abdominal cavity for accumulation of blood, clots in the physiological spaces, damage to other organs. Gas is pumped out of the abdominal cavity as much as possible. The abdominal wall incisions are sutured with cosmetic sutures that are as invisible to the eye as possible.

After laparoscopy of uterine fibroids

Like any surgical intervention, the removal of uterine fibroids by laparoscopy has real, albeit low, risks. The more complete the preoperative examination, the more accurate the prognosis for recovery. In the rehabilitation period, ultrasound control is recommended, repeated examinations by a gynecologist to identify hidden complications. Urgent and long-term undesirable consequences of the postoperative period include:

increased blood loss

risk of damage to the bladder and ureters when removing large leiomyomas

suture infection

inflammatory complications of the pelvic organs

risk of scarring and periuterine adhesions

obstruction of the fallopian tubes

recurrence of the disease (or growth of previously undetected small myomatous nodes)

Important! With the appearance of abundant discharge from the genital tract (more than 2 pads per hour), an increase in body temperature, you should immediately contact your doctor. With increased pain after surgery, you can take painkillers according to the instructions.

The postoperative period of laparoscopic removal of leiomyoma is easier for a woman than after abdominal surgery. Most patients can return home the same day. On the first day, postoperative pain, poor discharge from surgical wounds may disturb. You will need to take care of the stitches, the features of which will be explained in detail in the clinic. The residual amount of gas introduced into the abdominal cavity during laparoscopy can cause discomfort. Exercises that facilitate the absorption of gas are recommended.

Full recovery time can take from a week to a month, individually for each patient. As soon as a woman feels really strong to return to physical activity, it is necessary to start getting out of bed and walking. This improves circulation and reduces the risk of thrombosis. Early dosed physical activity and a balanced diet shorten the rehabilitation period. An important role is played by a positive attitude towards recovery, emotional support of loved ones. A full-fledged long sleep and rest are needed, breathing exercises are recommended. Improves blood circulation and healing special massage. Wearing a special medical bandage is encouraged. Within 5-6 months, you can not lift and carry loads of more than 4 kg, actively squat.

The first menstruation can come as expected. It is recommended to resume sexual intercourse no earlier than 4-6 weeks after laparoscopy.

The diet after this surgical intervention involves a sparing intake of easily digestible food. On the first day, food should be without excessive fat content, in liquid form and in small portions. Further nutrition must be balanced in terms of protein, carbohydrate and fat components, avoid fatty, fried and smoked foods. Be sure to exclude products that slow down peristalsis and cause gas formation. The accumulation of intestinal contents can increase postoperative pain due to increased intra-abdominal pressure. It is necessary to observe the liquid regime, without reducing the amount of water you usually drink, to exclude carbonated drinks.

The result of laparoscopic treatment will be relief of the symptoms of the disease: the normalization of menstruation, the absence of pelvic pain and heaviness. According to statistics, 78% of operated women have pain symptoms, 83% note the normalization of menstruation and the regularity of the cycle. Removal of uterine fibroids by laparoscopic access is recognized as a sparing, preserving the organ and its function, an operative procedure. Numerous studies have proven an increase in the percentage of healthy fetus bearing after myoma infertility and myomectomy.

Often a woman diagnosed with uterine fibroids by doctors begins to panic or become depressed. There is an opinion that fibroids are a benign tumor that degenerates into cancer, and it can be treated only by removing the uterus. If you have a problem with fibroids, please contact the Uterine Fibroids Clinic of the Perinatal Medical Center.

Please note that this text was prepared without the support of our.

Why do women develop fibroids?

Today, gynecologists agree that fibroids have nothing to do with neoplasms, and in most cases there is no need to remove the organ. Scientists compare it with a wen in the subcutaneous tissue or atheroma. It is believed that fibroids develop from normal cells of the muscular layer of the uterine wall, which are in the same condition as during pregnancy.

Of these, as a result of repeated menstruation, myomatous nodes develop. The reason for this is a change in hormonal levels. They are initially small in diameter, then begin to increase in size. How fast the nodes will grow, no one can say for sure: some can grow slowly, others will become large quickly, and still others will completely reverse development. The rapid growth of myomatous nodes occurs under the influence of such damaging factors:

multiple abortions;
frequent traumatic surgical interventions;
endometriosis;
inflammatory processes.

But many doctors often observe girls no older than 25 who have myomatous formations. We believe that in these cases, muscle cells are damaged during fetal development, and growth begins due to hormonal changes when menstruation occurs. At the same time, the first symptoms of the disease appear: pain, prolonged uterine bleeding, and a year later, signs of anemia.

How does fibroids manifest?

Until some time, the disease does not manifest itself in any way, a woman may not suspect that she has problems. When the formation increases to a large size, the following symptoms appear:

In the presence of a large submucosal node, menstruation becomes abundant, painful, prolonged. A feature of a large tumor, bleeding can begin outside of menstruation.
A subserous neoplasm presses on the internal organs, a woman develops persistent constipation or urination disorders. If it is located next to the uterine appendages, then the function of the ovaries is disturbed, obstruction of the fallopian tubes develops.
Discomfort and pain in the abdomen, aggravated during intercourse, are characteristic of the formation of any localization.
Frequent bleeding leads to anemia: causeless weakness, palpitations, nausea, chills appear. A large tumor causes an increase in the circumference of the abdomen.
If the knot deforms the uterine cavity, frequent miscarriages occur.

In the presence of a large tumor, we perform uterine artery embolization. It can be a preparation for a major operation - a hysterectomy.

Methods for diagnosing uterine fibroids

Diagnosis of the disease is quite simple. In the presence of large nodes, doctors diagnose the disease during the gynecological chair. Small lesions are often asymptomatic and can only be identified during an ultrasound scan. Our specialists prefer to do ultrasound using a vaginal probe. We consider this method to be more informative.

Hysteroscopy is one of the modern and effective methods for diagnosing fibroids. It allows not only to identify the disease, but also to remove it with a small size of the formation. We do not perform this operation for all patients, since it has contraindications, is performed under general anesthesia and, therefore, can have a very negative impact on their health.

In the presence of large fibroids and the need to distinguish it from other neoplasms, we perform computed tomography and magnetic resonance imaging. Sometimes we recommend performing a diagnostic laparoscopy, during which it becomes possible to examine the outer surface of the organ. This is especially true when the tumor is large and compresses the internal organs. During the operation, operating gynecologists can remove several large and small nodes.

Modern views on the treatment of fibroids

Doctors have different approaches to the treatment of fibroids. Sometimes they believe that if the formation in the uterus is small, then it is possible to observe for some time whether it will grow. But this is tantamount to not treating a patient who coughs for a long time. Our specialists prescribe conservative treatment for women even if the size of the formation is 2-2.5 cm.

For a long time it was believed that since a fibroid is a tumor, it must be removed along with the organ. After such a major operation, the woman's quality of life deteriorated significantly: she could not live a full sexual life, become pregnant, and had to constantly take hormonal drugs. At the same time, such a large operation is a traumatic factor that often caused mental imbalance.

Young women who planned pregnancy in the future were offered a different method of surgical treatment - myomectomy. This operation could give a woman a chance to get pregnant. Initially, it was performed by laparotomy access, that is, through the anterior abdominal wall. The operation was then started laparoscopically.

If there are several large or small nodes in the uterus, then large blood loss is possible during the operation. There is a high probability that the organ will have to be removed. Scars remain on the uterus after myomectomy, and no one can say for sure how they will behave during pregnancy, whether they will withstand the load during childbirth.

There are few operating gynecologists who are fluent in the technique of such a large operation. And no one can guarantee that a new formation will not appear in a year. As a result, the woman will have to undergo a hysterectomy - a major operation to remove the uterus.

When choosing a treatment method, our specialists take into account the individual characteristics of the patient, the results of ultrasound, histological examination and laboratory tests. They pay attention to the following factors:

health and complaints of the patient;
age;
state of the endocrine system;
the presence of chronic pathology of internal organs;
whether the size of the formation is increasing;
where the nodes are located;
severity of iron deficiency in the blood.

The doctors of the clinic discuss together all the results of the research and make a collegial decision on the method of treatment, but the doctor guides the patient from the beginning of the examination to discharge from the clinic. If a decision is made to embolize the uterine arteries, then this procedure is performed in our clinic by an endovascular surgeon with extensive practical experience.

In most cases, we offer our patients not surgery, but uterine artery embolization. This procedure is easier to tolerate and does not require general anesthesia. After it, a relapse of the disease develops extremely rarely, and rehabilitation takes place as soon as possible - seven days are enough for a woman to recover. After embolization, no follow-up treatment is required. A woman can become pregnant after 6 months.

If during the operation the doctor can act only on visible and accessible foci, then after embolization, the growth of both large and small formations stops. In women who have undergone uterine artery embolization, adhesions do not develop, there is no risk of developing tubal infertility, and there are no scars on the uterus.

Indications for surgical interventions for myoma

At a time when ultrasonography was not available or the quality of diagnosis was desirous of being better, physicians were unable to detect small uterine masses. Basically, gynecologists dealt with large fibroids when a major operation was inevitable. There are two subjective criteria by which it was determined whether a woman should have an operation or not:

the uterus is larger than at 12 weeks of gestation;
rapid growth of fibroids.

Our experts believe that it is not objective to assess the size of fibroids in weeks of pregnancy. The uterus with large and small nodes increases unevenly. The assessment of the size of the uterus is influenced by the thickness of the subcutaneous fat layer and the height of the uterus. One doctor, after examining a woman on a chair, may conclude that she has an eight-week fibroid, and another that a twelve-week formation. At the operation, it may turn out that the uterus is no larger than at 6 weeks of pregnancy.

The concept of "rapid growth" is the same subjective criterion. It is directly related to the ability or desire to correctly determine the size of the uterus in weeks of pregnancy. This criterion was introduced due to the fact that doctors feared that an increase in volumetric formations could be evidence of their malignancy. But as a result of the analysis, it was proved that the nodes quickly become large due to the development of degenerative secondary changes.

With this choice of indications for surgical treatment of fibroids, a major operation was performed without any reasons. Today, in our clinic, all women suffering from gynecological diseases, doctors on modern devices perform an ultrasound examination, which allows you to determine the exact size, location and structure of the node. This allows in each case to carry out the treatment that is most appropriate.

How do we treat large fibroids?

A large fibroid is a formation whose diameter is more than 60mm. The presence of a large node can be dangerous:

the woman's health worsens;
as a result of heavy bleeding, anemia develops;
immunity decreases.

If a large fibroid is located in the lumen of the female reproductive organ, it interferes with conception and pregnancy. When the pathological process develops in the outer layer of the uterus, a large volume formation eventually begins to compress the bladder and intestines, as a result of which their function is impaired. Blood can flow into the wall of the organ, which will cause an inflammatory process. In this case, medical treatment cannot be carried out. When there is a large uterine fibroids, surgery becomes inevitable.

Several methods of operations for large fibroids have been developed:

laparotomic hysterectomy - an operation during which a large fibroid is removed through an incision in the anterior abdominal wall;
laparoscopic surgery - to remove large fibroids, doctors use special instruments that are inserted into the abdominal cavity through small punctures in the anterior abdominal wall;
Hysteroscopy is an operation performed through the vagina.

In the event that, as a result of drug treatment, the diameter of the formation has not decreased to 6 cm, a large fibroid is removed along with the uterus. Despite the high morbidity of laparotomy, we consider this approach more preferable than laparoscopic. Modern surgery allows you to save the cervix.

If the formation has decreased to a size of 6 cm, then the operation can be performed using one of two methods:

laparoscopic, with the location of fibroids under the mucous membrane or in the wall of the uterus;
hysteroscopic, in case of submucosal localization of the node.

But after such an operation, the risk of recurrence of fibroids remains. We believe that even in the presence of large fibroids, uterine artery embolization is the best treatment option. After it, the blood supply to the myomatous nodes stops, their growth stops, and their size decreases. If the fibroid is more than 25 weeks of pregnancy and there are signs of compression of the internal organs, then it is advisable to conduct an additional examination and perform a hysterectomy.

Bibliography

Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
Androutopoulos G., Decavalas G. Recent advances in the treatment of uterine fibroids. Translation from English. N. D. Firsova (2018).
Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of the mass of tumor nodes in uterine myoma // Obstetrics and gynecology. - 1983. - T. 4. - S. 13-16.

Uterine fibroids is a gynecological disease, which is a hormonal dependent tumor characterized by a benign course. For the treatment of fibroids, conservative methods are used, and, in addition, surgical methods associated with the removal of a pathological formation. The therapy is based on drug hormone replacement therapy, but it is far from always possible to cure fibroids without surgical intervention. It is in connection with this that in the presence of uterine fibroids, the most appropriate, and at the same time effective, method is to perform an operation. The cost of breast cancer surgery depends on several factors.

Indications

Uterine fibroids, like any neoplasm, can vary in size, ranging from a small pea to a large knot that can weigh about one kilogram. This disease can be manifested by only one focus, or immediately multiple or distributed over the surface of the uterus, or they can be grouped together.

Often, fibroids differ in nodular growth and can be located in any layers of the organ, for example, in the muscle wall, and, in addition, under and above the mucosa. Only a doctor can answer the question of whether it is necessary to remove fibroids. The method of treating fibroids is prescribed by a gynecologist after basic laboratory and instrumental studies. Indications for surgery to remove fibroids are the following factors:

The presence of intensive progressive growth of myomatous nodes.
The development of menometrorrhagia, leading to the appearance of anemia, which requires urgent treatment and correction.
Activation of tumor growth during menopause.
The process of degeneration of a benign formation into cancer.
The presence of intense pain.
The presence of concomitant endometriosis and ovarian tumors.
The development of necrotic lesions of the nodes.
Inability to bear a fetus (frequent miscarriages) or infertility.
Submucosal nature of the location of the pathological focus.
The position of the fibroids is not far from the cervix, and, in addition, directly on it.
Failure of the functioning of nearby organs due to compression by their pathogenic node.

Despite the great effectiveness of conservative methods, surgery in the presence of fibroids is the main method of treatment.

Operation types

In modern surgery, there are two types of operations to remove fibroids:

Types of surgical therapy

In the treatment of this disease, preference is always given to organ-preserving operations, but, unfortunately, they are not always effective. In which cases is it necessary to completely remove the organ? This can only be determined by the attending physician. This kind of intervention is prescribed mainly to patients who are in reproductive age.

In addition to age, the location of the pathological focus along with its size and degree of neglect plays an important role. Modern operative gynecology offers various ways to remove uterine fibroids.

Among the most commonly used methods are abdominal surgery, laparoscopy, hysteroscopy and total abdominal hysterectomy.

Abdominal surgery to remove fibroids

Cavity removal is indicated in case of torsion of the pedicle, which usually holds the tumor. In addition, such an operation can be prescribed for necrotic lesions or in the presence of large fibroids. Another indication for abdominal surgery to remove uterine fibroids is a significant degree of deformation of the organ.

The essence of surgical intervention is to remove lesions through an incision that is made on the abdomen. Specialists resort to abdominal surgery to remove fibroids only as a last resort because of the severity of the postoperative period and the high likelihood of complications.

True, laparotomy of uterine fibroids also has undeniable advantages. This technique allows surgeons to control bleeding at the stages of exfoliation of myoma nodes. In addition, it is possible to quickly apply several stitches to the patient at once, which is important for large tumors. During abdominal surgery to remove uterine fibroids, only general anesthesia is used.

Carrying out laparoscopy

Such an intervention is carried out in order to remove a small tumor. Laparoscopic surgery to remove fibroids is done through several small punctures in the abdomen, into which a laparoscope with a special nozzle is inserted. The advantage of this treatment technique is minimal tissue and organ trauma along with a low risk of postoperative adhesions. The rehabilitation period, as a rule, proceeds quite safely and quickly. Fibroids in the presence of pregnancy are mainly removed laparoscopically.

Surgery to remove fibroids can be done in any major clinic.

Carrying out hysteroscopy

Such an operation is a gentle surgical removal of fibroids, which is done using a hysteroscope. This operation is performed in order to remove small single fibroids, while the nodes that are located on the front or rear walls of the organ are operated on. Indications for such an operation are strictly individual.

Performing a total abdominal hysterectomy

This procedure is a complex operation, with it sometimes a radical section of the organ is performed. This is the most traumatic operation, which is used in very rare cases. Usually it is done when the fibroid is located in the thickness of the uterine muscles and is difficult to access. In addition, this technique is used in the presence of progressive growth of an already large node, and, in addition, during the climacteric age of the patient and against the background of "malignancy" of the tumor. This operation is performed under anesthesia.

Ways to remove fibroids

In modern gynecological practice, a minimally invasive method of treating fibroids is widely used, which does not require removal of the uterus. Thus, it is customary to distinguish:

Preoperative preparation

Immediately before each treatment, including the removal of fibroids, patients must undergo a series of instrumental and laboratory examinations to assess the risks and possibilities of performing a particular type of operation. Preparation for a surgical operation to remove fibroids, as a rule, includes the following activities:

Blood and urine donation along with biochemical analysis and coagulogram.
Conducting a blood group test.
Performing an electrocardiogram.
Passing an examination by a gynecologist and consulting a specialist with the obligatory taking of a smear from the vagina, and, in addition, from the cervical canal.
Performing a cytological study of biological material, which is taken from the neck of the cervical canal.
Carrying out a polymerase chain reaction.
Performing a histological examination (endometrium).
Conducting a colposcopic examination.
Performing an ultrasound examination of the pelvic organs. In this case, doctors conduct a transvaginal or transabdominal examination.
Examination and consultation with a dentist and therapist.
Performing a chest x-ray.

When large ones are present during preoperative preparation, it is mandatory to undergo a three-month course of hormonal treatment aimed at inhibiting the growth of formations. Consultations with a psychologist are also included in the preliminary preparation before a surgical operation aimed at removing fibroids. It is also important not to forget that ten days before the planned date of surgical intervention, patients taking antiplatelet drugs on an ongoing basis are required to stop taking the medication.

Immediately three days before the operation, only easily digestible and liquid food should be consumed. And in the morning before the operation, you need to clean the intestines with a cleansing enema. In order to make it easier to transfer anesthesia, it is forbidden to eat or drink anything eight hours before the operation.

How long does a fibroid removal surgery take? The answer to this question can be found below.

Performing an operation

The course of the operation associated with the removal of fibroids, exactly as well as the method of anesthesia, is determined by the surgeon and the anesthesiologist, who will directly deal with the treatment. The best option for pain relief is general anesthesia.

Now we will describe in detail how exactly the operation to remove fibroids of large and small sizes takes place. During the intervention through the vagina, the patient's legs are bent at the knees, parted to the sides, anesthesia is administered. With laparotomy or laparoscopy, this is not necessary. Legs and arms are fixed with special straps. Then the patient is given anesthesia, and the doctor begins to treat the surgical field with antiseptic agents.

During laparotomy, the surgeon cuts the abdominal tissue in layers with a scalpel, after which a thorough revision is carried out and an assessment is made of the condition of the myomatous nodes and uterus. Next, the doctor decides to remove some part or all of the organ. An organ with or without appendages can be removed. After removal of the uterus or part of it, hemostatic measures are carried out. Further, after the doctor makes sure that there are no bleeding areas left in the wound cavity, the incision is sutured in layers.

Surgery to remove fibroids is performed in different ways. Amputation of the uterus is a very complex operation, so various surgical procedures can be used in the process. In the event that the surgeon considers it necessary, he will put a drainage tube that will ensure the outflow of fluid that accumulates in the small pelvis.

When performing laparoscopy, a surgical instrument with a laparoscope camera is inserted into the punctures made in the abdomen. Before starting the operation, the patient's abdomen is inflated with air for better visibility, then the operation is performed in the same way as with an open abdomen. The removed organ is removed from the patient through the vagina. Sometimes the organ is removed after its previous division into small parts, through a tube (this is such a special laparoscopic tube).

Fibroids surgery time

How long the surgical operation will last depends largely on the type of access (cavitary or laparoscopic), as well as on the size of the uterus itself, the number of nodes, the presence of adhesions and cicatricial changes. On average, the duration of an uncomplicated operation is about an hour. In more severe cases, it can last up to three hours.

What happens after abdominal surgery to remove uterine fibroids?

Postoperative period

Any operation is extremely dangerous because of the risks of developing all sorts of complications. After surgery to remove uterine fibroids, much attention is paid to the prevention of the following complications:

Inflammatory and adhesive processes.
Restoration of blood composition, and, in addition, stabilization of the hemostasis system.
It is necessary to monitor the process of normalization of water and electrolyte balance.

For the full rehabilitation of women after abdominal surgery to remove fibroids, no more than one and a half months is needed. The rehabilitation period after laparoscopy usually takes about one month. As for the period of postoperative recovery, then after a vaginal hysterectomy it can very rarely last longer than four weeks.

After the operation to remove fibroids, women are issued a certificate of incapacity for work for a period of 25 to 45 calendar days. The cost of the operation largely depends on the methods used in the surgical intervention. Prices for surgical services can vary dramatically depending on the medical institution and its level of qualification, but on average the price will be from 35 to 75 thousand rubles.

Disadvantages of surgery for myoma

The main disadvantages of surgical removal of fibroids are the following negative factors:

Quite a high risk of relapse. In 7-14% of operated women, fibroids can be found again after one year.
After the operation, it is extremely difficult to plan a pregnancy, even in the long term. This will most likely require re-treatment.
To reduce the risk of relapse, women are forced to take hormonal medications, which does not always have a beneficial effect on the activity of some organs and systems of the body as a whole.
Any surgical intervention is always associated with various risks and entails negative consequences for the health of patients.
Sometimes there are situations in which, against the background of uncontrolled bleeding during operations, patients have to remove the uterus.
After the procedure, there is always a scar. Such a scar always creates an additional risk during pregnancy and may cause the need for a caesarean section, which is also an undesirable measure for women in labor.
Another possible complication is adhesions that occur in the pelvis, and as a result, this factor provokes tubal peritoneal infertility in women.

From 20-30% of women are familiar with the diagnosis of a benign tumor of the reproductive organs. Therefore, in order to avoid the occurrence of relapses and complications, you need to know what can not be done after removal of uterine fibroids.

When a neoplasm is detected at an early stage of development, doctors choose expectant tactics. In all other cases, the patient is prescribed conservative or surgical resolution.

The choice of treatment tactics for the patient is influenced by clinical symptoms, comorbidities, characteristics of the node, the desire of the woman to have children later.

The primary task for doctors is to preserve the reproductive function of the female organs. Surgical treatment can be gentle and radical:

Operations with preservation of the uterus and appendages - abdominal, laparoscopic and hysteroscopic myomectomy. They are a priority in nulliparous women.
A radical method is hysterectomy (removal of an organ with or without appendages). An indication for the appointment is the large size of the node against the background of the realized reproductive function.

Any of the methods can cause postoperative complications, recurrence of the disease or unforeseen reactions.

Dimensions for operation

With small sizes of fibroids or its slow growth, a conservative method of treatment is preferred. The presence of certain factors is an unconditional indication for surgery:

node size from 12 weeks of pregnancy;
concomitant gynecological diseases;
tumor necrosis that has developed due to torsion of the leg or as a result of other processes;
squeezing neighboring organs with a violation of their functions;
profuse uterine bleeding, not amenable to therapy;
rapid growth of fibroids;
node malignancy.

Classification of fibroids by size

The size of fibroids is determined in weeks of pregnancy. Myomatous nodes are:

Neoplasms larger than 12 weeks are indicated for surgical removal. Medium and small fibroids are removed in this way when the tumor necrosis, impossibility of conception due to its location.

Removal of fibroids by laparoscopy

The elimination of the myomatous node with a laparoscope is the most preferred method of surgical removal of the node. The elimination of pathological formation is carried out using an endoscope. The doctor makes punctures 12-15 mm long in certain areas of the anterior abdominal wall. The neoplasm is removed through the holes with a laparoscope. The operation is gentle, recovery is fast. In a week the patient can start work.

Indications for laparoscopy:

the size of the knots is not more than 0.8-1 cm;
uterus at 15-16 weeks;
the number of nodes is not more than 3-4 pieces;
the total diameter of the nodes is up to 1.5 cm.

The advantage of the method is low invasiveness, the uterine mucosa is practically not injured. This minimizes the risk of adhesion formation.

Abdominal removal of the tumor

This method is used if the patient has torsion of the tumor stem, the presence of adhesions, malignancy of the appendages, necrosis of the tissue of the nodes. Removal of pathological areas occurs through the cervical canal using an endoscope.

Before the operation, diet No. 1 is prescribed, cleansing enemas are given. Removal of fibroids occurs on an empty stomach. Due to the layer-by-layer suturing of tissues, the healing process is slow and painful.

Possible complications after abdominal surgery:

Another disadvantage is a visible cosmetic defect, which provokes the development of an inferiority complex in some women.

Hysterectomy

Using this method, doctors remove the uterus, sometimes along with the ovaries and tubes. The operation can be laparoscopic, abdominal and hysteroscopic. The choice of method is influenced by the location of the fibroids, the presence of node mobility, concomitant pathologies of the appendages and cervix.

After removal of the uterus by hysterectomy, brown discharge is observed for 2 months. This is a variant of the norm. Gradually, their intensity decreases until complete cessation. In the early rehabilitation period, subfebrile condition, body temperature up to 37.5 ° C can be observed.

The reason for going to the doctor should be prolonged bleeding, an admixture of purulent contents in the discharge.

You should know that when the uterus is removed along with the appendages, menopause occurs, provoked by surgical intervention. It is more difficult to tolerate biological, since there is no phase of adaptation of the organism to changes. To relieve symptoms, hormone replacement therapy is prescribed until natural menopause occurs.

After a cavitary hysterectomy, early and late complications may develop. In the first months, you may experience:

local inflammation of the surgical wound;
bleeding;
the development of an inflammatory process in the bladder and urethra due to mechanical damage to the mucous membrane of the organs;
thrombus formation.

To prevent the development of complications, you should strictly follow the recommendations of the doctor in the recovery period.

Removal of uterine fibroids with a laser

Laser removal of fibroids is a modern and non-invasive method of therapy. Among its obvious advantages is the absence of mechanical compression of tissues, their necrosis and twisting do not occur. The wound heals in a short period of time without scar formation.

During laser removal of a tumor, the device acts only on pathological areas for 1-2 minutes, without affecting healthy areas of the skin. The technique is absolutely bloodless, which reduces the risk of postoperative complications. The recovery time after surgery is no more than 3 days.

What to do after removal of the uterus and appendages

The success of late rehabilitation depends on the patient's compliance with medical recommendations throughout the entire time. Complications may occur after 6-12 months:

The onset of premature menopause is associated with the removal of the ovaries during a hysterectomy. To minimize discomfort, hormone replacement therapy, physiotherapy and regular exercise are used.
To prevent the descent of the walls of the vagina, you should wear a special support ring, do Kegel exercises to train muscle tone.
Urinary incontinence occurs due to weakening of the ligaments of the bladder, a decrease in estrogen levels. The defect is eliminated by muscle strengthening exercises and hormonal therapy.
It is necessary to control the formation of adhesions. There may be pain associated with the failure of the sutures.
With the formation of a fistulous tract, a secondary infection may develop. The problem is solved by sanitation and suturing the course.

If postoperative depression occurs, medical attention is needed. To avoid such a situation, the doctor convinces the woman of the expediency of the operation. The main prerogative is to save the patient's life, but doctors try to leave one ovary whenever possible to maintain the hormonal background.

What not to do after surgery

The time for complete rehabilitation may vary depending on the chosen method, concomitant diseases. Improvement of well-being occurs in 2-4 weeks with laparoscopy, from 4-6 with abdominal hysterectomy. There is a general set of measures that must be followed for approximately 2 months to prevent the development of complications.

After removal of uterine fibroids, it is prohibited:

Rehabilitation

Full recovery after removal of uterine fibroids requires 2-3 months, depending on the degree of invasiveness of the operation. To quickly restore the old quality of life, you need to follow simple recommendations:

To strengthen the muscles of the peritoneum, wear a special bandage. In the late recovery period, it is recommended to add Kegel therapeutic exercises to strengthen the pelvic muscles, daily walking.
Eliminate heavy physical activity for a while or forever.
Food should be sparing, rich in vegetables and fruits. Avoid overeating, indigestion or constipation.
Side effects after surgery are stopped by the doctor symptomatically: painkillers, wound healing ointments, sedatives.
To prevent the occurrence of a relapse, it is necessary, together with the attending physician, to control the hormonal background, adjusting it as necessary.
Being at risk, you should avoid provoking factors that affect, directly or indirectly, the appearance of fibroids.

Indications for removal of fibroids:

if pregnancy is planned with multiple myoma or large sizes;
with symptomatic fibroids - provokes anemia with heavy periods, pelvic pain.

Surgical treatment can be carried out in the following volumes:

the uterus and appendages are removed from one or both sides - this amount of treatment is used for suspected malignant growth, with altered ovaries, in menopause.

Myoma removal options, their advantages and disadvantages

Operation option	What is the point	pros	Minuses
Laparotomy	tissue incision on the anterior abdominal wall from the navel to the pubis or horizontally in the lower abdomen in the form of a "smile"	good visibility of tissues; you can remove fibroids of any size and location; when removing only nodes while preserving the body of the uterus, the sutures on the myometrium are stronger, you can become pregnant; endotracheal or spinal anesthesia can be used	a large scar on the skin of the abdomen after healing; long recovery period; severe pain after surgery; significant blood loss;
Hysteroscopy	the hysteroscope is inserted through the vagina and cervical canal into the uterine cavity	there are no cuts; additionally, you can remove polyps and carry out other diagnostic measures; the woman can go home the next day	only small nodes located in the uterine cavity (submucosal) can be removed
Laparoscopy	three small skin incisions (1-1.5 cm each) - near the navel and one on the right and left of the lower abdomen, through which the manipulators are inserted	minor cosmetic defect; quick recovery after surgery; mild pain after surgery; slight blood loss	technically difficult, sometimes it is impossible to remove large tumors; the sutures on the uterus are not always strong, which increases their rupture during a new pregnancy; only endotracheal anesthesia is used; requires special equipment and specialists
Through the vaginal access	access to the body of the uterus through the incision of the vagina	no scars on the body at all	the operation is technically complex; it is impossible to remove individual nodes - only the body of the uterus with them completely; recovery as after laparotomic surgery; long in time; performed only with the prolapse of the uterus and vagina,

The early postoperative period includes:

immediately after the operation, the woman is transferred to the intensive care unit (reanimation room), after normalization of the condition - to the normal one;
time of stay - from one to three days or more (look at the condition of the woman);
after laparoscopy and laparotomy, transvaginal removal of the uterus, it is not allowed to get out of bed during the day, bandage the legs with elastic bandages or use compression stockings;
on the first day - hunger, then it is allowed to drink yogurt, low-fat broths;
antibiotics, painkillers and others are prescribed symptomatically;
after hysteroscopy and sometimes laparoscopy (with a small amount of surgery), a woman is allowed to get up after a couple of hours and eat light, non-gas-forming food;
after removal of large fibroids, complicated operations, a woman can stay in the hospital for at least another week, if necessary, a catheter is installed, as there is severe weakness; temperature up to 38 in the first 3-5 days is allowed.

Vaginal hysterectomy

What not to do after myomectomy: physical activity - from 1 month after hysteroscopy to 3-6 months after laparoscopy and laparotomy; sexual intercourse - for at least 30 days, with laparotomic operations - up to 3 months or more.

Helpful for a speedy recovery: wear a bandage, start early activity, limit thermal procedures, properly treat the wound (do not wet, smear with antiseptics until complete healing).

Pregnancy can be planned only with the permission of the doctor and not earlier than six months later.

Removing nodes does not protect against their re-growth. If myomectomy is performed as a stage of preparation for pregnancy, it should not be postponed for a long time, the nodes may appear after 1.5-2 years and prevent the conception and bearing of the baby.

Read more in our article about abdominal surgery to remove uterine fibroids and the postoperative period.

📌 Read this article

Removal options and possible complications after them

Uterine fibroids is one of the most common gynecological pathologies that occurs in women of all ages. There is no such treatment. Medications can be used, but if they suppress the growth of nodes, then not for a long time. All treatment is reduced to the observation of women and the timely correction of emerging disorders.

Myoma is a benign tumor. It rarely becomes malignant, so surgical treatment is carried out only according to indications.. These include:

a rapid increase in the size of the tumor within 6-12 months;
malnutrition of myomatous nodes and the likelihood of their necrosis;
one of the nodes is more than 6 cm in diameter;
if a woman is planning a pregnancy with multiple myoma or with its large size;
with a subserous node on a thin stalk;
with symptomatic fibroids - if it is the cause of anemia due to heavy periods, causes constant pelvic pain.

Each case is considered individually and methods for removing nodes may be different.

Surgical treatment can be carried out in the following volumes:

only nodes are removed - if they are single, and the woman is still young;
the uterus with nodes is removed - if it is technically impossible to excise only fibroids and save the body of the uterus;
the uterus and appendages are removed from one or both sides - as a rule, this amount of treatment is used for suspected malignant growth, with altered ovaries, as well as in women in menopause.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Many experts believe that "there are no extra tissues" in a woman's body and the operation should be as sparing and organ-preserving as possible. Others are of the opinion that it is better to remove everything as a whole in order to avoid other complications and problems, as well as repeated interventions on the pelvic organs.

The intervention itself can also be carried out in several ways. It all depends on the volume of the operation, the goals pursued, the location and size of the nodes. The table shows the technical options for removing fibroids, their advantages and disadvantages.

Operation option	What is the point	pros	Minuses
Laparotomy	Tissue incision on the anterior abdominal wall longitudinally (from the navel to the pubis) or transversely (horizontally in the lower abdomen in the form of a “smile”)	Good visibility of tissues; - You can remove fibroids of any size and location; - when removing only the nodes while preserving the body of the uterus, the sutures on the myometrium are stronger, so the method is recommended for those planning a pregnancy; - You can use endotracheal or spinal anesthesia	Large scar on the skin of the abdomen after healing; - long recovery period; - severe pain after surgery; - significant blood loss;
Laparoscopy	Three small skin incisions (1-1.5 cm each) - near the navel and one on the right and left of the lower abdomen, through which manipulators are inserted	Minor cosmetic defect; - quick recovery after surgery; - not pronounced pain after surgery; - slight blood loss;	It is technically difficult and sometimes not possible to remove large tumors; - the sutures on the uterus (if it persists) are not always strong, which increases their rupture during a new pregnancy; - only endotracheal anesthesia is used; - requires special equipment and specialists
Hysteroscopy	The hysteroscope is inserted through the vagina and cervical canal into the uterine cavity	There are no incisions on the abdomen; - additionally, you can remove polyps and carry out other diagnostic measures; - the woman can go home the next day	Only small nodes located in the uterine cavity (submucosal) can be removed
Through the vaginal access	Through the incision of the vagina, access to the body of the uterus is made	No scars on the body at all;	The operation is technically complex; - you can not remove individual nodes - only the body of the uterus with them completely; - recovery, as after laparotomic surgery; - long in time; - performed only with the prolapse of the uterus and vagina.

Early postoperative period

Immediately after the operation, the woman is transferred to the intensive care unit (reanimation room) for observation. The usual stay is from one to three days or more - it all depends on the severity of the woman's condition. It is assumed that after laparoscopy after staying in the awakening room for two hours, the woman is transferred to the ward in the department. After hysteroscopy, if it passed without complications, transfer is allowed immediately to the ward in the gynecology department.

After laparoscopy and laparotomy, as well as after transvaginal removal of the uterus, it is not allowed to get out of bed for a day, if necessary, longer. For this period, to prevent vascular complications, and thromboembolism in particular, it is recommended to bandage the lower limbs with elastic bandages or use compression stockings.

During the first day or three, the following activities are carried out:

sufficient infusion therapy with the help of intravenous administration of various solutions;
on the first day - hunger, then it is allowed to drink yogurt, low-fat broths;
drug therapy is prescribed - antibacterial, analgesic and other symptomatic.

After hysteroscopy and sometimes after laparoscopy (if the volume of intervention was not very large), a woman is allowed to get up after a couple of hours and eat light, non-gas-forming food.

Features of hospital stay

After a simple laparoscopy and hysteroscopy, a woman can be discharged home under the supervision of a local doctor already on the second or third day. She is at home, visiting the gynecologist with a given regularity.

After removal of large fibroids, complicated operations (for example, with large blood loss or purulent complications), a woman can stay in the hospital for at least another week. At this time, symptomatic therapy is carried out (painkillers, if necessary - transfusion of blood components, antibacterial, for the prevention of thrombosis).

Prevention of thromboembolism

During the first days, a woman feels very weak - even trying to go to the toilet seems like a serious victory. If necessary, a urinary catheter may be placed. It is allowed to rise in temperature for 3-5 days to 38 degrees, especially in the first three days. Later fevers should alert the development of purulent postoperative complications.

Every day a woman should feel better - it becomes easier to walk, strength and a desire to do something else appear.

Nutrition rules

After a simple laparoscopy and hysteroscopy, a light dinner is allowed on the day of the intervention. After laparotomy and complex laparoscopy, hunger must be observed on the first day. This is necessary in order not to burden the body, and he could give all his strength to recovery. It is only allowed to drink purified non-carbonated water.

If no complications are observed during the observation during the day, it is gradually allowed to start introducing dishes into the diet. In the early days, this may be the following:

low-fat broths;
decoctions of oatmeal;
yogurts;
Birch juice.

Gradually, you can add boiled lean meat, boiled and stewed vegetables, cereals, bread. Passing gas is a good sign that the intestines are "working". After the appearance of the first stool, you can not be afraid and eat everything that is offered in the hospital.

In no case should you consume the following products during the first week (and in case of a complicated postoperative period and longer):

smoked,
pickles,
seaming,
sausages,
fatty,
soda,
sweet.

What not to do after abdominal surgery to remove uterine fibroids

The list of restrictions after myomectomy depends on the complexity of the operation and is always specified by the attending physician. The timing of full recovery also depends on the individual characteristics of the woman. The general restrictions are as follows:

refusal of physical activity - from 1 month after hysteroscopy to 3-6 months after laparoscopy and laparotomy;
refusal of sexual intercourse - for at least 30 days, with laparotomy operations - up to 3 months or more;

It is necessary to provide the right diet, sufficient sleep, regularly walk in the fresh air, avoid stress, mental overload.

Recovery time depends on the type of operation. They will be maximum after laparotomy and removal of the uterus with nodes, minimum - after hysteroresectoscopy. If a woman has had abdominal surgery and there are wounds on the skin, the recommendations for recovery in the early postoperative period will be as follows:

it is useful to wear a bandage - it will reduce the severity of pain;
early activation is the prevention of the formation of adhesions in the pelvis, and also helps to prevent thrombosis;
thermal procedures should be limited - hot showers, baths and saunas, ultraviolet baths will have to be abandoned for 3-6 months;
properly treat the wound - you can’t wet it, you need to treat it with antiseptics until it heals completely and remove the sutures (if they are not made of absorbable material) on time.

Pregnancy can be planned only with the permission of the doctor and not earlier than six months after the intervention. It is important to control your periods, visit a doctor regularly.

Drug therapy after removal of fibroids

The list of necessary drugs in the early and late postoperative period is determined by the doctor. In the first week, the main list includes the following drugs:

antibacterial - for the prevention of infectious complications;
painkillers and antispasmodics;
antiplatelet agents and anticoagulants - for the prevention of thrombosis.

If the operation is laparoscopic

Laparoscopic surgeries are increasingly being used by surgeons due to their many benefits. Modern equipment allows you to remove fibroids of any size and location, as well as together with the uterus and appendages.

Recovery after laparoscopy takes a period two times less than after laparotomy. And since fewer nerve endings are damaged, pain is less pronounced in the postoperative period, there is no need to use narcotic analgesics. A special technique allows not to affect the vessels, which are always injured during laparotomy, so blood loss is many times less and blood transfusion is not required.

And the most pleasant “bonus” is that the scars are so small that over time they cannot be found on a woman’s skin.

The manipulator is placed into the uterine cavity through the cervical canal. On the monitor, the doctor sees everything that happens inside the uterus. Knots can be removed with a special “knife”, and its bed can be burned with a coagulator.

Recovery after surgery is fast. After two hours, you can try to get up, eat light food. On the third day, a woman can already be discharged under the supervision of an antenatal clinic doctor with a continuation of the sick leave there.

Watch this video about uterine artery embolization (UAE) in the treatment of uterine fibroids:

Is it possible for myoma to recur?

Removal of nodes does not protect against their re-growth, because this is a hormonally dependent formation, and the operation only removes the consequences of violations, without in any way affecting the process of their formation. Therefore, women who have had fibroids removed while preserving the body of the uterus should be regularly observed by a doctor for the timely detection of still small nodules.

If myomectomy is performed as a stage of preparation for pregnancy, it should not be postponed for a long time. Otherwise, new nodes, which may appear after 1.5-2 years, may interfere with the conception and delivery of the baby.

Myomectomy is an operation that can be performed by various techniques. The choice of treatment methods depends on the size of the nodes, their number, the age of the woman and other factors. In addition to laparotomy, laparoscopy, hysteroresectoscopy, there are other new methods. For example, uterine artery embolization, as well as some other options. The most suitable option in each case can only be chosen by a doctor.

Useful video

Watch this video about the symptoms and drug treatment of uterine fibroids: