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Extirpation of the uterus is a radical measure that saves the life of a woman suffering from some serious diseases of the reproductive system. In medical terminology, such a surgical intervention is called a total hysterectomy.
The meaning of the manipulation lies in the complete removal of not only the uterine body itself, but also its neck. In case of particularly serious and extensive pathologies, the surgeon may decide to remove the fallopian tubes along the way. Since the presented technology of saving a woman is very traumatic, the patient will have to come to terms with the loss of menstrual and reproductive function in the future.
Medical classification
In clinical practice, there are several versions of extirpation. They all differ in the volume of future work on excision, since the most complete removal of all tissues of the reproductive system is not always required.
Schematically, all types of intervention can be divided into three camps. The first involves the extraction of the uterine body with or without appendages. The second version is based on the intrafascial or intrafascial system. The final subdivision is an extended view of the standard removal, which includes the removal of the lymph nodes surrounding the organ with tissue. This is characteristic of extensive inflammatory processes at an advanced stage, when a woman endured to the last, without seeking qualified help.
In most cases, everything is managed by a classic total hysterectomy, which is suitable for patients only with damage to the uterine body itself. But if the territory of inflammation turned out to be expanded, then it is necessary to remove the formations from neighboring reproductive parts, up to the regional lymph nodes and ovaries. If during the intervention the sacro-uterine ligaments do not intersect, then this indicates the extirpation of the intrafascial format.
In addition to the traditional classification, physicians have a separate division for types of surgical intervention on issues of surgical access. We are talking about the ability to get to the problem area from different sides, which greatly facilitates the manipulation itself, and also increases the percentage probability of success.
The abdominal solution is accompanied by an incision along the anterior wall of the abdominal cavity. If the laparoscopic version is chosen, then a system of precisely made punctures, which are carried out with endoscopic instruments, is taken as the basis. The vaginal variation, as the name implies, requires penetration through the vagina. All three items have their own distinctive features and medical indications. Because of this, the victim herself will not be able to choose the type of excision. You will have to rely on the experience of practicing gynecologist and surgeon.
Common Indications
Since the presented operation of even the mildest variety will bring some inconvenience in everyday life, the doctor must first make sure that alternative methods are powerless.
To do this, the patient is first sent to undergo an initial examination, take standard tests, and is also given a referral for an ultrasound or computed tomography with contrast. Based on the information provided, the final verdict is made.
The fundamental medical indications for the removal of the uterus, its cervix and some other parts are:
- oncological neoplasm of a benign or malignant nature;
- fibromyoma, the size of which is equivalent to a pregnancy of 12 weeks or more;
- rapid growth of the myomatous node;
- twisting of the tumor stem;
- submucosal localization of fibroids;
- prolapse of the uterus;
- perimenopausal age.
Separately, situations are considered when previously prescribed treatment options did not have the desired effect, or after their practice, the situation only continued to worsen. Laparotomy, like other types of hysterectomy, includes not only problems associated with gynecological pathologies, but also obstetric complications. Some of them are chronic conditions, while others represent an acute stage of inflammation.
If the doctor insists on performing a radical operation, then you should listen to a specialist. Any delay can backfire with serious consequences, or even take the life of the victim.
Contraindications for the procedure
Although amputation is almost always the last resort for treating an anomaly, it also has several limitations.
These are situations where the harm of the intervention far outweighs the potential benefit. In this scenario, it would be wiser to eliminate all deterrents, or try to influence the primary source of the disease in another way.
Removal will become impossible if a woman is diagnosed with an acute or exacerbation of a chronic infectious process, inflammation in the gynecological part, severe pathology of the extragenital type, pregnancy, which proceeds quite normally. The laparoscopic course of the operation deserves special attention, which has a number of individual contraindications due to the peculiarities of the penetration path.
Restrictions affect the large size of the uterine body, large ovarian tumors, adhesions with localization in the abdominal cavity, uterine prolapse.
The above is an insurmountable barrier to the technical spectrum. There are special contraindications if the intervention is planned to be performed through the vagina.
We are talking about malignant neoplasms both in the uterus itself and its neck. Among other prohibitions for the vaginal type of access, there are:
- adhesions;
- large fibroids;
- performed caesarean section.
To eliminate all the risks emanating from contraindications, you will need to devote time to a carefully conducted preparatory stage.
Safety measures
Regardless of whether the formation of a stump or complete excision is planned, the preparation algorithm remains identical. First, the patient needs to find an experienced surgeon who will agree to perform the manipulation. It is best to focus in his choice on the reviews of women who have already experienced such a difficult life period. You can find their responses on thematic sites or you will need to visit a specialized medical city forum.
Many people are concerned about the price, but all clinics follow their own strategy for setting the cost, taking into account the qualifications of the medical staff, the tools used, and the drugs. Before the final decision in favor of a radical measure, a woman needs to sign up for an ordinary gynecological examination. During the appointment, the doctor will write out directions for a number of tests, the standard package of which includes:
- clinical examination of blood, urine;
- analysis for blood group and Rh factor;
- smear from the vagina and cervix, which characterizes microscopy, PCR and oncocytology;
- colposcopy;
- ultrasound examination of the pelvic organs;
- radiography of the lungs;
- electrocardiogram.
A mandatory point of the plan is blood biochemistry, which allows you to determine the level of hormonal fullness of the body, as well as identify markers of the inflammatory process. Along the way, testing detects antibodies to infections.
Those representatives of the weaker sex who have not passed a coagulogram, liver and kidney tests, as well as an electrolyte test will not be allowed to operate.
Sometimes the condition of the victim is in a very neglected degree, which requires an auxiliary consultation of related specialists of a narrow profile. This may be a cardiologist who should help find out if the body can cope with the burden of general anesthesia, or a pulmonologist with a vascular surgeon. The risk group included victims with a high probability of developing thrombosis.
They will have to sign up for dopplerography, so that the doctor can assess the condition of the veins of the lower extremities. Additionally, antispasmodics and other medicinal pharmacological products can be prescribed. When, during preparation, it turns out that the body is defeated by an infectious disease, you will first have to get rid of the focus of the disease with the help of antimicrobial drugs.
Only such a thorough approach will guarantee final success, and the consequences of what has been done will not hit women’s health too hard.
Scheme of the
Extirpation is performed exclusively in a surgical hospital with all the necessary equipment in the full collection of medical personnel. To alleviate the plight of a patient who is indicated for hysterectomy without appendages or with them, she is given adequate anesthesia: general, endotracheal or intravenous type, regional, epidural or spinal model, combined.
The exact mechanism of conduction is determined depending on whether excision is required with tubes or other parts of the reproductive system. The algorithm is influenced by the access route, whether it be the supravaginal system or any other. The general points for a successful intervention, regardless of the type of operation, are:
- intersection and ligation of the round ligaments;
- mobilization followed by removal of the appendages when the diagnosis requires it;
- mobilization with displacement of the bladder;
- intersection of vascular bundles;
- dissection of the prevesical fascia;
- intersection of ligaments with ligation;
- opening of the vaginal fornix;
- hemostasis of the vagina;
- peritonization.
The last point provides for restrictions on the operating area from the main abdominal cavity. The plan can vary, be supplemented, or swap points depending on the modification of the manipulation.
Consequences and complications
The risks of extirpation directly depend on how a particular organism behaves, as well as on the professionalism of the medical team. But even an experienced surgeon can touch the bladder or ureter. There are frequent cases of accumulation of blood in the parameters, which indicates a hematoma of the parauterine tissue.
An important step towards a healthy life is a properly conducted postoperative period, which is also often accompanied by some typical and not very complications. Most often, patients are forced to deal with wound infections.
Not less often fix suppuration of a hematoma. But peritonitis or sepsis are much more serious scenarios that can almost always be avoided.
Sometimes rehabilitation is not complete without bleeding, thromboembolism, necrosis of the vaginal fornix, and even prolapse of intestinal loops through the vagina. All of the above will be neutralized if the doctor sounds the alarm in time.
I am glad that severe postoperative pathologies are found in scanty quantities, and then, for the most part, due to the fact that the woman already suffers from some kind of chronic illness. Difficulties on the way to recovery are added by anemia, exhaustion of the body and diabetes mellitus.
But constipation with a violation of the usual regimen, such as physical activity and intimacy, is quite normal consequences. For the period of stay in the hospital, you can ask the attending physician to provide the victim with a sick leave.
At the same time, it is worth throwing all your efforts into high-quality rehabilitation, strictly following medical recommendations. And after discharge, you should regularly undergo preventive examinations to control the risks of possible hidden complications.