Help on Tele2, tariffs, questions

Indications for fibroid removal:

• if you are planning a pregnancy with multiple or large fibroids;
• 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 if malignant growth is suspected, with altered ovaries, or in menopause.

Options for removing fibroids, their advantages and disadvantages

Operation option	What's 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; fibroids of any size and location can be removed; when only the nodes are removed 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 in the lower abdomen, through which manipulators are inserted	minor cosmetic defect; quick recovery after surgery; mild pain after surgery; slight blood loss	It is technically difficult and sometimes 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
Via vaginal access	access to the body of the uterus is made through a vaginal incision	no scars on the body at all	the operation is technically complex; You cannot remove individual nodes - only the entire body of the uterus with them; recovery as after laparotomy surgery; long-term; performed only when the uterus and vagina prolapse,

The early postoperative period includes:

• immediately after the operation, the woman is transferred to the intensive care ward (resuscitation room), and when her condition normalizes, she is transferred to a regular room;
• length of stay – from one to three days or more (depending on the woman’s condition);
• after laparoscopy and laparotomy, transvaginal removal of the uterus, you are not allowed to get out of bed for 24 hours, bandage your legs with elastic bandages or use compression stockings;
• on the first day - hunger, then you are allowed to drink yoghurts and low-fat broths;
• antibiotics, painkillers and others are prescribed symptomatically;
• after hysteroscopy and sometimes laparoscopy (with a small volume of surgery), after a couple of hours the woman is allowed to get up and eat light, non-gas-forming food;
• after removal of large fibroids or complicated operations, the woman can remain in the hospital for at least another week; if necessary, a catheter is installed, as there is severe weakness; Temperatures up to 38 are allowed in the first 3-5 days.

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, during laparotomy operations - up to 3 or more months.

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

Pregnancy can be planned only with a doctor’s permission and no earlier than six months later.

Removing nodes does not protect against their regrowth. If myomectomy is performed as a stage of preparation for pregnancy, it should not be postponed for a long time; nodes may appear within 1.5-2 years and interfere with conceiving and carrying a baby.

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

📌 Read in this article

Removal options and possible complications after them

Uterine fibroids are one of the most common gynecological pathologies and occur in women of all ages. There is no treatment as such. Medications can be used, but even if they suppress the growth of nodes, they do not do so for long. All treatment comes down to monitoring women and timely correction of emerging disorders.

Myoma is a benign tumor. It is extremely rare for it to become malignant, so surgical treatment is carried out only when indicated. These include:

• rapid increase in tumor size 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 fibroids or large sizes;
• with a subserous node on a thin stalk;
• with symptomatic fibroids - if it is the cause of anemia due to heavy periods, causing 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 remove only fibroids and preserve 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 when malignant growth is suspected, with altered ovaries, as well as in menopausal women.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Many experts believe that there is “no extra tissue” in a woman’s body and the operation should be as gentle and organ-preserving as possible. Others express 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 presents technical options for removing fibroids, their advantages and disadvantages.

Operation option	What's the point	pros	Minuses
Laparotomy	A tissue incision on the anterior abdominal wall is longitudinal (from the navel to the pubis) or transverse (horizontal in the lower abdomen in the form of a “smile”)	Good visibility of fabrics; - fibroids of any size and location can be removed; - 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; - endotracheal or spinal anesthesia can be used	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 in the lower abdomen, through which manipulators are inserted	Minor cosmetic defect; - quick recovery after surgery; - not at all expressed pain after surgery; - slight blood loss;	It is technically difficult and sometimes impossible to remove large tumors; - the sutures on the uterus (if it remains) 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.
Via vaginal access	Through a vaginal incision, access to the body of the uterus is made	There are no scars on the body at all;	The operation is technically complex; - individual nodes cannot be removed - only the entire body of the uterus with them; - recovery, as after laparotomy surgery; - long-term; - performed only when the uterus and vagina prolapse.

Early postoperative period

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

After laparoscopy and laparotomy, as well as after transvaginal removal of the uterus, you are not allowed to get out of bed for 24 hours, or longer if necessary. During 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 using intravenous administration of various solutions;
• on the first day - hunger, then you are allowed to drink yoghurts and low-fat broths;
• drug therapy is prescribed - antibacterial, analgesic and other symptomatic.

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

Features of hospital stay

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

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

Prevention of thromboembolism

During the first days, the woman feels very weak - even trying to go to the toilet seems like a serious victory. If necessary, a urinary catheter can be installed. Temperature rises to 38 degrees over 3-5 days are allowed, especially in the first three days. Later fevers should alert you to the development of purulent postoperative complications.

Every day a woman should feel an improvement in her health - walking becomes easier, strength and a desire to do something else appear.

Nutrition rules

After simple laparoscopy and hysteroscopy, a light dinner is allowed on the day of the intervention. After laparotomy and complex laparoscopy, fasting must be observed on the first day. This is necessary so as not to burden the body, and it can devote all its strength to recovery. You are only allowed to drink purified still water.

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

• low-fat broths;
• oatmeal decoctions;
• yoghurts;
• Birch juice.

Gradually you can add boiled lean meat, boiled and stewed vegetables, cereals, and bread. The passage of 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 during a complicated postoperative period, 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 discussed by the attending physician. The timing of complete recovery also depends on the individual characteristics of the woman. 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, for laparotomy operations - up to 3 months or more;

It is necessary to ensure a proper diet, adequate sleep, regular walks in the fresh air, and avoid stress and mental overload.

Recovery time depends on the type of surgery. They will be maximum after laparotomy and removal of the uterus with nodes, minimum - after hysteroresectoscopy. If a woman has undergone abdominal surgery and has wounds on the skin, 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 prevents the formation of adhesions in the pelvis and also helps prevent thrombosis;
• thermal procedures should be limited - hot showers, baths and saunas, ultraviolet baths will have to be abandoned for 3-6 months;
• treat the wound correctly - you cannot get it wet, you must treat it with antiseptics until it heals completely and remove the stitches (if they are not made of absorbable material) on time.

Pregnancy can be planned only with a doctor’s permission and no earlier than six months after the intervention. It is important to control your menstruation and visit your doctor regularly.

Drug therapy after fibroid removal

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

• antibacterial - to prevent infectious complications;
• painkillers and antispasmodics;
• antiplatelet agents and anticoagulants - to prevent thrombosis.

If the operation is laparoscopic

Laparoscopic surgery is increasingly being used by surgeons due to its many benefits. Modern equipment allows you to remove fibroids of any size and location, as well as along with the uterus and appendages.

Recovery after laparoscopy takes half as long as after laparotomy. And since fewer nerve endings are damaged, pain is less pronounced in the postoperative period, and there is no need to use narcotic analgesics. A special technique allows you to avoid affecting the vessels, which are always injured during laparotomy, so blood loss is several times less and no blood transfusion is required.

And the most pleasant “bonus” is that the scars are so small that over time they will not 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. The nodes can be removed with a special “knife”, and its bed can be cauterized with a coagulator.

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

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

Is it possible for fibroids to recur?

Removing nodes does not protect against their re-growth, because this is a hormonally dependent formation, and the operation only allows you to remove the consequences of the disorders, without in any way affecting the process of their formation. Therefore, women who have had fibroids removed while preserving the uterine body should be regularly observed by a doctor for 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 in 1.5-2 years, may interfere with conceiving and carrying a baby.

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

Useful video

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

Often a woman who has been diagnosed with uterine fibroids by doctors begins to panic or becomes depressed. There is an opinion that fibroids are a benign tumor that degenerates into cancer, and it can only be treated by removing the uterus. If you are faced with a fibroid problem, contact the Uterine Fibroid Treatment Clinic of the Perinatal Medical Center..

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

Why do women develop fibroids?

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

Of these, myomatous nodes develop as a result of repeated menstruation. The reason for this is hormonal changes. They are initially small in diameter, then begin to increase in size. No one can say for sure how quickly the nodes will grow: some may grow slowly, others will become large quickly, and others will even undergo 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 years old who have myomatous formations. We believe that in these cases, the muscle cells are damaged during fetal development, and growth begins due to changes in hormonal levels 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 fibroid manifest?

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

1. In the presence of a large submucosal node, menstruation becomes profuse, painful, and prolonged. A feature of a large tumor is that bleeding may begin outside of menstruation.
2. The subserous neoplasm puts pressure on the internal organs, and the woman experiences persistent constipation or urinary problems. If it is located next to the uterine appendages, then the function of the ovaries is disrupted and obstruction of the fallopian tubes develops.
3. Discomfort and pain in the abdomen, which intensify during sexual intercourse, are characteristic of the formation of any localization.
4. Frequent bleeding leads to anemia: causeless weakness, palpitations, nausea, and chills appear. A large tumor causes an increase in abdominal circumference.
5. If the node deforms the uterine cavity, frequent miscarriages occur.

If there is a large tumor, we perform uterine artery embolization. It may be a preparation for a major operation - a hysterectomy.

Methods for diagnosing uterine fibroids

Diagnosis of the disease is quite simple. If large nodes are present, doctors diagnose the disease during a gynecological examination. Small formations are often asymptomatic and can only be detected during ultrasound examination. Our specialists prefer to perform 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 if the formation is small. We do not perform this operation on all patients, since it has contraindications, is performed under general anesthesia and, therefore, can have a very negative impact on their health.

If there are large fibroids and it is necessary to distinguish them from other neoplasms, we do 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 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 treating fibroids. Sometimes they believe that if the formation in the uterus is small, then they can observe for a while whether it will grow. But this is equivalent 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 fibroids are a tumor, they should 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 sex life, become pregnant, and was forced to constantly take hormonal medications. At the same time, such a large operation is a psychologically traumatic factor, which often caused mental imbalance.

Young women who were planning a pregnancy in the future were offered a different method of surgical treatment - myomectomy. This operation could give the woman a chance to become pregnant. Initially, it was performed via laparotomy, that is, through the anterior abdominal wall. Then the operation began to be performed 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 and whether they will withstand the stress of childbirth.

There are few operating gynecologists who are fluent in the technique of such a major operation. And no one can guarantee that a year later no new formation will appear. 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:

• the patient’s well-being and complaints;
• age;
• state of the endocrine system;
• the presence of chronic pathology of internal organs;
• whether the size of education is increasing;
• where are the nodes located?
• severity of iron deficiency in the blood.

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

In most cases, we offer patients not surgery, but embolization of the uterine arteries. 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 in the shortest possible time - seven days are enough for a woman to recover. After embolization, no further treatment is required. A woman can become pregnant after 6 months.

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

Indications for surgical interventions for fibroids

At a time when ultrasound was not available or the diagnostic quality was poor, doctors were unable to detect small uterine masses. Mostly gynecologists dealt with large fibroids when major surgery was unavoidable. There are two subjective criteria by which it was determined whether a woman should undergo surgery or not:

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

Our experts believe that assessing the size of fibroids in weeks of pregnancy is biased. The uterus with large and small nodes increases unevenly. The assessment of the size of the uterus is influenced by both the thickness of the subcutaneous fat layer and the height of the uterus. One doctor, after examining a woman in a chair, may conclude that she has an eight-week fibroid, and another may conclude that she has a twelve-week fibroid. During the operation, it may turn out that the uterus is no larger than at 6 weeks of pregnancy.

The concept of “fast 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 because doctors were afraid that an increase in space-occupying formations could be evidence of their malignancy. But as a result of the analysis, it was proven that the nodes quickly become large due to the development of degenerative secondary changes.

With this choice of indications for surgical treatment of fibroids, major surgery was performed without any reason. Today, in our clinic, all women suffering from gynecological diseases, doctors using modern devices, perform an ultrasound examination, which allows us to determine the exact size, location and structure of the node. This allows for each specific 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 greater than 60mm. The presence of a large node can be dangerous:

• the woman’s well-being deteriorates;
• 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 a pathological process develops in the outer layer of the uterus, a large volumetric formation over time begins to compress the bladder and intestines, as a result of which their function is disrupted. Blood may leak into the wall of the organ, causing an inflammatory process. In this case, drug treatment cannot be carried out. When there is a large uterine fibroid, surgery becomes inevitable.

Several surgical techniques have been developed for large fibroids:

• laparotomy 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 case when, as a result of drug treatment, the diameter of the formation has not decreased to 6 cm, the large fibroid is removed along with the uterus. Despite the high traumatic nature 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, when fibroids are located 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 there remains a danger of fibroid recurrence. We believe that even in the presence of large fibroids, the optimal treatment option is uterine artery embolization. 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 pregnant 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 the book: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Androutopoulos G., Dekavalas 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 tumor nodes in uterine fibroids // Obstetrics and Gynecology. – 1983. – T. 4. – P. 13-16.

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

Moreover, in the last decade, there has been a trend towards “rejuvenation” of this disease throughout the world. Increasingly, fibroids are being detected in 25-30 year old patients, which negatively affects their reproductive health and ability to bear children. And the frequent neglect of regular gynecological examinations leads to a rather late diagnosis of myomatosis, already at the stage of development of complications.

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

What is fibroid and what types does it happen?

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

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

Tumor tissue may consist only of hypertrophied muscle fibers or include additional layers of connective tissue. In the latter case, the term “fibromyoma” is appropriate. Soft, fairly homogeneous muscle tissue formations are called leiomyomas.

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

• with prolapse into the lumen of the organ, the fibroid is called submucosal or;
• with separation of the muscle layer, thickening and deformation of the uterine wall (interstitial variant);
• with protrusion of the node into the abdominal cavity ();
• with dissection of the broad ligament of the uterus (intraligamentary myomatous node).

The nodes protruding beyond the contours of the organ can have a stalk of different diameters or “sit” on a wide base, sometimes immersed in the middle muscle layer.

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

When is uterine fibroid removal required?

Removal of uterine fibroids (myomectomy) is an organ-saving operation. Therefore, in women of reproductive age with unrealized reproductive function, whenever possible, preference is given to this type of surgical treatment.

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

Indications

Removal of fibroids is necessary when conservative therapy does not reduce the size of the tumor and does not allow its growth to be controlled. Also indications for surgical intervention are:

• recurrent uterine bleeding;
• persistent pain syndrome;
• signs of displacement and dysfunction of adjacent organs;
• for submucosal and subserous nodes, especially susceptible to ischemic necrosis and having a risk of pedicle torsion.

Contraindications

Myomectomy is not performed in the following conditions:

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

All these conditions are indications for radical surgical treatment of fibroids. At the same time it is produced.

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

Methods for removing uterine fibroids

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

• Laparotomy

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

• Laparoscopy

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

• Hysteroscopy

A minimally invasive technique that also requires special endoscopic equipment. In this case, the doctor does not need to make incisions and punctures; he uses the cervical canal to access the uterine cavity.

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

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

How is the operation performed using the laparotomy method?

Surgery using laparotomy access is indicated for interstitial and deeply buried subserous nodes. It is used for multiple myomatosis, complicated course of the disease, adhesive disease, and in the presence of rough or insufficiently strong scars of the uterine body. Removal of large uterine fibroids and cervical tumors is also usually performed laparotomy.

Incisions during the laparotomy method of hysterectomy surgery

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

The serous membrane (visceral layer of the peritoneum) is dissected and bluntly peeled off, and the myomatous node is isolated with minimal possible trauma to the surrounding healthy myometrium. The tumor is enucleated and removed. Sutures are placed on its bed, and the serosa is sutured separately. Bleeding vessels are carefully ligated, and it is also possible to use an electrocoagulator. The abdominal cavity is drained, and the quality of hemostasis is monitored. After this, all layers of the abdominal wall are sutured layer by layer.

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

Removal of uterine fibroids using laparoscopic method

Laparoscopic surgery is a gentle and at the same time highly effective way to remove pedunculated or broad-based subserous fibroids. It is performed under general anesthesia in a specially equipped operating room.

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

Laparoscopic surgery is a more gentle way to remove fibroids

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

If a node on an interstitial basis is removed, the doctor performs decapsulation and enucleation. Such manipulations are necessarily complemented by step-by-step thorough hemostasis by electrocoagulation of all crossed vessels, regardless of their diameter.

The process of removing the node at the base is completed by applying double-row endoscopic sutures to its bed. This is not only an additional method of hemostasis, but also contributes to the further formation of a full-fledged scar, which will retain its integrity during the process of enlargement of the pregnant uterus. Suturing the serous membrane defect also helps reduce the risk of postoperative complications.

The severed myomatous node is removed using morcellators through the existing punctures. Sometimes it is necessary to apply an additional colpotome hole.

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

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

Hysteroscopic myomectomy

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

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

Hysteroscopic option for removal of uterine fibroids

All manipulations during the hysteroscopic version of the operation are performed transcervically using a hysteroscope. This is a special device with a camera, a local lighting source and instruments, which is inserted into the uterine cavity through an artificially dilated cervical canal. At the same time, the doctor has the opportunity to accurately control the manipulations he performs on the monitor, specifically examine suspicious areas of the mucous membrane and, if necessary, take a biopsy, quickly stop the bleeding that begins.

Hysteroscopy is performed under general anesthesia, although the possibility of using spinal anesthesia is not excluded. To cut off the myomatous node, instruments for mechanical intersection of tissues (analogue of a scalpel), an electrocoagulator or a medical laser can be used. This depends on the technical equipment of the operating room, the skills and preferences of the operating doctor.

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

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

Assistive operating technologies

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

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

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

Postoperative and recovery period

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

If there is significant intraoperative blood loss in the first hours after the woman is transferred to the intensive blood loss ward, blood transfusions and blood substitutes, the introduction of colloid and crystalloid solutions, and the use of drugs to maintain an adequate level of blood pressure may be required. But the need for such measures rarely arises; myomectomy usually takes place without clinically significant acute blood loss.

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

What can you eat after surgery?

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

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

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

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

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

Removing fibroids imposes some restrictions. During the first few months, it is advisable for a woman not to visit baths, saunas and solariums, and to avoid increased physical activity.

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

Consequences of the operation

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

In the first few days, bloody discharge is possible, which cannot be considered menstruation. When determining the length of the cycle, it is necessary to take into account only the start date of the previous menstruation. After this operation, periods usually resume within 35-40 days. In this case, it is permissible to lengthen or shorten 1-2 subsequent cycles.

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

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

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

Alternatives to surgery

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

These include:

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

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

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

Many women's diseases are treated with surgery. Surgery to remove uterine fibroids is performed more often than others. More than 40 percent of all surgical interventions that take place in gynecology departments are performed for uterine fibroids.

Indications for surgery

Uterine fibroids are among the most common pathologies of the female reproductive system. The disease is detected in every third woman of reproductive age. Uterine fibroids have several names. In the medical literature you can also find the terms “leiomyoma” or “fibromyoma” of the uterus.

Fibroids are benign formations in the uterus, which consist of smooth muscle fibers of the myometrium. Uterine fibroids can be multiple or single, usually have a round or oval shape, and sometimes grow as a pedunculated mass.

In the early stages, the neoplasm most often does not manifest itself. After the appearance of symptoms, when a woman consults a doctor about the manifestations of the disease that are troubling her, it is already too late to treat myoma conservatively - surgery is needed.

The size of fibroids can vary. At the earliest stages of its detection, these are nodes no larger than 2-3 millimeters in size. During an ultrasound examination or magnetic resonance imaging, a diagnostician can determine the exact size of the tumor and its location. During a routine examination by a gynecologist, the size of fibroids is usually determined according to the increase in the size of the uterus. The rate of uterine enlargement during pregnancy in weeks is taken as a basis.

Small tumors are up to 25 mm in size, medium tumors are 50 mm in size, large and giant nodes are 80 mm or more. The size of uterine fibroids is essential for the choice of treatment tactics. For average leiomyoma sizes over 30 mm, surgery is often necessary.

Large and small uterine fibroids can have the following localization options:

Treatment tactics are also determined not only by the size of the fibroid, but also by its ability to grow. Simple tumors grow the slowest, while proliferating tumors progress somewhat faster. This is due to the histological structure of fibroids.

Simple and proliferating tumors are benign pathologies. In presarcoma, giant cells with several nuclei are found. With rapidly growing fibroids, it is often necessary to undergo surgery, since such tumors can reach several tens of millimeters in size in a short period.

Typically, symptoms appear with uterine fibroids larger than 3 cm. If the size of leiomyoma exceeds 80 mm, compression of internal organs is possible. When the bladder and intestines are compressed by a large tumor, a constant urge to urinate and constipation occur. If the functioning of internal organs is impaired, it is necessary to undergo surgery.

Surgical method is the main method of treating fibroids. With uterine fibroids, the dimensions for surgery are important, although not of paramount importance. Among the indications for surgery for fibroids are:

• rapid growth of the tumor to a large size, which contributes to compression of internal organs and disrupts their functioning;
• bleeding due to fibroids of significant size;
• anemia that cannot be controlled with drug therapy;
• tumors larger than 3 cm;
• torsion of the leg and necrosis of fibroids;
• severe pain;
• concomitant pathologies of the ovaries or uterine body;
• reproductive dysfunction due to leiomyoma;
• oncological alertness.

Despite the large size of the nodes, surgery is not always possible. Doctors identify the following contraindications to undergoing surgery:

• acute inflammatory diseases;
• some cardiovascular diseases and liver diseases in the stage of sub- and decompensation;
• unrealized reproductive function (radical methods);
• intolerance to anesthesia.

When choosing a type of operation, the doctor must take into account:

• fibroid size;
• localization of education;
• patient's age;
• type of tumor;
• results of histology and other tests;
• the presence of concomitant diseases.

A few decades ago, the discovery of pathology could mean not only surgery, but also removal of the uterus. In modern gynecology, gentle operations are performed that allow effective removal of fibroids while preserving the uterus.

Types of operations

In the presence of uterine fibroids, doctors perform both organ-preserving and radical operations. Interventions to remove uterine fibroids include:

• myomectomy;
• UAE or uterine artery embolization;
• FUS ablation;
• hysterectomy and extirpation.

Myomectomy means removal of leiomyoma using one of three methods.

1. Laparoscopy. This operation is performed using a laparoscope and small punctures to place equipment and a video camera into the abdominal cavity. The advantages of the method include the absence of a pronounced adhesive process. However, stopping the bleeding that can occur during laparoscopy is quite difficult. Laparoscopy is often performed for medium-sized subserous leiomyomas.
2. Laparotomy. The operation is done through an incision in the lower abdomen. This is one of the most traumatic and outdated methods.
3. Hysteroscopy. The operation is a minimally invasive intervention in which a hysteroscope is inserted into the uterine cavity through the vagina to perform manipulation. The method is suitable for removing submucosal fibroids.

Uterine artery embolization can be done for submucosal fibroids. During the minimally invasive intervention, the patient is injected through the femoral artery with a substance that disrupts the nutrition of the leiomyoma. As a result of circulatory disorders, the node disappears or decreases in size over time.

FUS ablation involves a minimally invasive procedure performed using ultrasound waves. The manipulation is carried out under MRI control and is indicated for medium-sized fibroids. The treatment has certain contraindications, for example, signs of tumor malignancy.

Hysterectomy and hysterectomy are performed when there is an associated risk of malignant pathology or uterine prolapse. Gynecologists often recommend this operation for women who have large fibroids after menopause. The operation has many long-term complications, and therefore it is performed only in exceptional cases.

The operation is complemented by conservative therapy, including the use of hormonal drugs. An integrated approach helps minimize the risk of relapse.

Preparatory stage

Preparation for fibroid removal includes studies that a woman undergoes before the intervention:

• gynecological examination (two-handed and using mirrors);
• taking anamnesis;
• vaginal smears for genital infections and microflora;
• ultrasound examination of the uterus, cervix and ovaries;
• general and clinical blood test;
• general urine analysis;
• electrocardiogram;
• coagulogram.

Additionally, the doctor may prescribe hysteroscopy and magnetic resonance imaging of the pelvic organs. In some cases, consultation with narrow specialists is required, which the patient undergoes to obtain an opinion.

Features and duration

The volume of manipulations during operations, the time period during which the intervention lasts, and the duration of the recovery period depend on the specific type of surgical tactics.

Laparoscopy

Laparoscopy is the most modern and gentle way to remove fibroids. Before the operation, standard preparation is carried out, which includes passing all the necessary tests. The day before surgery, you must follow a diet and not eat for at least 12 hours before surgery.

Laparoscopy is performed in a hospital setting under general or epidural anesthesia. General anesthesia - drug-induced sleep. Epidural anesthesia provides only loss of sensation in the lower part of the body, therefore it has fewer contraindications and avoids classic side effects after use.

Gas is injected through a small incision in the belly button to expand the abdominal cavity. During the operation, several small incisions are made on the front wall of the abdomen to place the equipment. Nodes are removed through them using a laparoscope.

The operation usually takes no more than two hours. At the end of the operation, the procedure of suturing micro-incisions in the uterus and abdominal cavity is performed.

Laparoscopy requires a hospital stay of three to five days. After discharge, the woman remains on home treatment for about ten more days.

Hysteroscopy

Hysteroscopy is the most gentle way to remove myomatous nodes. Using a minimally invasive hysteroscopic method, only fibroids no larger than two centimeters in diameter can be removed. Preparation for removal involves passing all the tests as for a regular gynecological operation.

The woman is seated on a gynecological chair and the inner thighs, vagina and cervix are treated with a special antiseptic. Then a speculum is inserted into the vagina and anesthesia is performed. After some time, the cervical canal is dilated and the hysteroscope is inserted into the uterine cavity.

Hysteroscopy usually takes no more than one hour including preparation and is rarely accompanied by any complications. Hospitalization lasts from two to 24 hours. In a few days the woman can go to work.

Laparotomy

Laparotomy is often performed in emergency cases and situations. This is the only way to remove fibroids that grow deep into the muscle tissue and are large in size (more than 20 weeks), multiple formations, fibroids with torsion of the stem, causing bleeding and tissue necrosis.

Abdominal surgery is performed under general anesthesia (medicated sleep), as it lasts at least 1.5 hours. During the operation, an incision is made in the abdominal wall and uterus. After removing fibroids, the doctor conducts a follow-up examination and places sutures on the uterus and abdominal wall.

Despite the high risk and fairly long rehabilitation period, laparotomy is performed quite often, since only this type of operation allows the surgeon to fully control the process of removing complex fibroids, prevent the possible development of bleeding and suture the uterus as carefully as possible.

Hospitalization for laparotomy lasts 5-7 days, after which the woman can remain on sick leave for another two weeks.

Hysterectomy

A hysterectomy involves removing the uterus. This is a radical method that provides lifelong relief from recurrent fibroids. The risk of degeneration into a malignant formation during the postmenopausal period is an indication for removal of the uterus.

There are two types of hysterectomy:

• supravaginal (subtotal) amputation;
• extirpation (complete removal of the uterus and its cervix).

Regardless of the type of hysterectomy, the operation is performed under general anesthesia through an incision in the abdominal wall. A hysterectomy lasts 1.5-2 hours.

Surgery for fibroids is prescribed in approximately thirty percent of cases. The choice of technique depends on many factors, including the location of tumors, their number, the patient’s age, and the need to preserve reproductive function.

If a woman is scheduled for surgery, it should not be postponed. Myoma is a formation that is prone to growth. The sooner the removal takes place, the less traumatic and more gentle it will be.

Surgery to remove uterine fibroids: which method is the most effective and safe?

Currently, no group of medications, with the exception of a progesterone receptor blocker, has proven effectiveness against uterine fibroids. The main method of treatment is surgical. But is surgery always necessary? And, if necessary, what type of surgical intervention should be preferred?

Until recently, many gynecologists adhered to approximately the same tactics when dealing with patients with fibroids. The woman was under observation for some time and periodically underwent ultrasound examinations of the pelvic organs. When the nodes reached large sizes, the doctor suggested removing them or the entire uterus.

Currently, views on the nature of fibroids have changed, new minimally invasive treatment methods have appeared, one of which is uterine artery embolization. The principles of choosing treatment tactics have also changed.

According to modern concepts, fibroids need to be treated in the following cases:

• There are symptoms: heavy periods, signs of compression of neighboring organs by fibroids (impaired urination), abdominal enlargement.
• The nodes are growing according to the last 2-3 ultrasounds, which were performed every 4-6 months.
• In the future, a woman plans to become pregnant, and fibroids may interfere with the onset or pregnancy.

When deciding whether to treat fibroids, the doctor must take into account the woman’s age. During menopause, myomatous nodes stop growing, so it is not advisable to treat them during this period.

Laparoscopic and abdominal surgeries to remove uterine fibroids (myomectomy)

The classic method of treating fibroids is myomectomy - surgical removal of the node. Currently, the list of indications for surgery has been significantly reduced due to the spread of minimally invasive treatment methods, including uterine artery embolization.

Myomectomy is performed under general anesthesia (for abdominal and laparoscopic operations) or under epidural anesthesia.

The surgeon may perform the operation in one of the following ways:

• Open abdominal surgery : with open myomectomy it is performed horizontal section(8–10 cm or more in length) approximately 2.5 cm above the symphysis pubis. The incision line follows a natural fold of skin, so the scar after surgery will be almost invisible.
  Can also be done vertical section, which starts approximately from the middle of the abdomen and ends below the navel, above the pubic symphysis. Currently, operations of this type for uterine fibroids are becoming a thing of the past.
• Laparoscopic surgery to remove uterine fibroids is performed through holes in the anterior abdominal wall. The surgeon inserts a laparoscope with a video camera into one of them, and special instruments into the others.
• Robotic Myomectomy is similar to laparoscopic (holes in the anterior abdominal wall are also required), but the surgeon controls the instruments through a special robotic console. Robotic operations require expensive equipment and trained medical specialists, so they are performed only in a few large clinics.
• Hysteroscopic myomectomy is performed through vagina. This operation can be performed for submucosal fibroids, those that are located under the mucous membrane and grow towards the uterine cavity. The doctor inserts a resectoscope into the vagina, an instrument that uses high-frequency alternating current or a laser beam to cut tissue. The fibroid is destroyed, its fragments are washed out of the uterus using a glucose solution.

Advantages

Myomectomy is an organ-saving operation. The uterus remains in place, which means that the woman has a chance to have children in the future. In this case, surgery is a radical method of treatment - myomatous nodes are removed from the uterus.

Flaws

The main disadvantages of surgical removal of fibroids:

• The risk of relapse is quite high, especially with multiple nodes. According to the Russian Ministry of Health, with a single node it is 27%, and with multiple ones - 59%.
• In order to reduce the risk of relapse, a woman is forced to take hormonal medications.
• Any surgical procedure involves certain risks. Sometimes, if bleeding is uncontrollable, the uterus must be removed during surgery.
• After surgery, a scar remains on the uterus. It creates additional risks during pregnancy and can cause a caesarean section.
• Another possible complication is adhesions in the pelvis and, as a result, tubo-peritoneal infertility.

Indications for surgery

Due to the disadvantages and possible complications of myomectomy, this method of treatment is indicated only if a number of conditions are met:

• There is no risk of removing the entire uterus during surgery.
• There is no risk of opening the uterine cavity.
• It is expected that there will not be much scarring on the uterus.
• A woman is planning a pregnancy in the near future, not in the distant future.

Uterine artery embolization (UAE) as an alternative to surgical removal of uterine fibroids

Uterine artery embolization (UAE) is a modern minimally invasive procedure that can be called surgical only with reservations. The doctor makes just one small puncture in the groin area under local anesthesia. Through it, a thin catheter is inserted into the femoral artery, and then into the uterine arteries, which supply blood to the myomatous nodes. The manipulation is performed under X-ray television control, the doctor sees the catheter and blood vessels on the monitor.

A special embolic drug is injected through the catheter, which consists of spherical calibrated particles of a certain size. They block the lumen of the arteries and disrupt blood flow to the myomatous node, without affecting the blood flow in healthy tissues of the uterus. As a result, the node dies, decreases in size and is replaced by connective tissue.

The modern embolic drug (Embozene) used for UAE does not cause inflammatory or allergic reactions.

Advantages

Uterine artery embolization has many advantages over surgical treatment:

• There are no risks associated with surgery and anesthesia.
• The procedure most often lasts only 20 minutes (but depending on various factors it can take from 10 minutes to 1.5 hours). As a rule, the patient is discharged from the clinic within 2–3 days.
• The uterus remains in place.
• The recovery period is much shorter than after surgery.

Flaws

There are not many disadvantages of uterine artery embolization, they are quite conventional:

• It is not always possible to resort to EMA. Sometimes this method may be redundant, or, unfortunately, the disease is so advanced that the procedure will not bring the necessary results.
• During uterine artery embolization, the doctor does not remove the fibroids. The node dies and remains inside the uterus. True, it can no longer be called a fibroid: the place of muscle tissue is taken by connective tissue, separated from healthy tissue by a capsule. Recovery is coming. But some women and gynecologists are confused by the very fact that “there is something left in the uterus.”

Indications for UAE

Uterine artery embolization is the optimal method in the following cases:

• Myoma leads to heavy menstruation, symptoms of compression of the pelvic organs.
• Myoma is growing significantly (according to the last 2-3 ultrasounds of the pelvic organs).
• A woman is planning a pregnancy in the long term: after UAE there is no risk of relapse (growth of new myomatous nodes), unlike myomectomy.
• Myomectomy is technically difficult to perform and can cause great harm to the uterus, which makes the operation impractical.

Removal of the uterus (hysterectomy)

Modern medicine strives to preserve the patient's organs whenever possible. This is also true in the case of uterine fibroids. The approach in which a woman had her uterus removed if she did not intend to give birth again was long outdated. The thing is that the complications that arise after a hysterectomy are often more severe than the symptoms of fibroids:

• Metabolic disorders and weight gain.
• Sweating and hot flashes, increased blood pressure and arrhythmias.
• Sleep disorders, depression.
• Decreased quality of sexual life.

This picture is called posthysterectomy syndrome. It resembles what is observed during menopause.

The uterus should not be perceived as an organ that is intended only for childbirth. It is an important part of the reproductive system and the entire woman’s body. Removing the uterus for fibroids is possible only in extreme, advanced cases, when the entire organ is a cluster of huge nodes. In order to prevent post-hysterectomy syndrome, after surgery you will have to take hormone replacement therapy - a synthetic hormonal drug, the principle of action of which is similar to the work of female sex hormones (gestagens and estrogens).

Comparison of surgical treatment methods for fibroids

A brief comparative description of the main types of surgical interventions for the treatment of uterine fibroids is given in Table 1.

Table 1. Comparison of types of operations for the treatment of fibroids

Features of abdominal surgery to remove uterine fibroids

Abdominal surgery to remove uterine fibroids is an open surgical procedure in which benign tumors of the uterus are removed under general anesthesia through a small incision in the abdominal cavity. Surgery is associated with a high risk of relapses and complications. However, with abdominal surgery, according to recent studies, much less scarring is left than with other types.

General information about pathology

Myoma is a benign neoplasm that is located in the muscular layer of the uterus (myometrium). It is the most common benign tumor in women. In Europe, between 2 and 5 women of childbearing age suffer from fibroids. Although benign tumors are not life-threatening, they can significantly affect the quality of life.

Mostly, neoplasms develop between 25 and 50 years of life. Myomas form in the form of single muscle nodules or numerous ones in the wall of the uterus - then doctors talk about uterine myomatosis. The size of fibroids can vary: some grow up to 20 centimeters, while others grow to the size of a fetus.

Approximately half of affected women experience no symptoms and therefore do not need any treatment. Otherwise, the most common bleeding disorders are heavy, prolonged and painful menstruation or intermenstrual bleeding. Patients with fibroids rarely complain of nonspecific pain in the lower abdomen, pressure on the bladder, frequent urination, constipation, lower back pain, or discomfort during sexual intercourse.

Symptoms occur when fibroids push through nearby organs or nerve endings, affecting organ function or causing pain. This can lead to secondary diseases such as urinary tract infections or anemia. In some cases, fibroids are also associated with infertility.

If significant discomfort occurs, fibroids can be treated in a variety of ways. The type of therapy depends on symptoms, the size and location of the fibroids, the woman's age, and family planning.

For pregnant women, fibroids are sometimes a problem. Symptoms during pregnancy vary from case to case. Sometimes it stimulates fibroid growth by increasing hormone production. Therefore, the tumor can grow quickly and cause health problems. Research shows that miscarriage and premature birth are more common in pregnant patients with fibroids than in others.

Indications for surgery

A prerequisite for performing abdominal surgery to remove uterine fibroids is good health. The procedure is almost always performed under general anesthesia. To obtain a good view of the pelvis, the patient is placed in a supine position. Massive obesity, severe lung and heart disease, and extensive abdominal adhesions can make abdominal hysterectomy impossible.

Obesity may make abdominal surgery to remove fibroids impossible

Laparoscopic interventions are today largely standardized. But sometimes they place high demands on tools and workers. The instruments used, such as ultrasonic scalpels for precise cutting with simultaneous hemostasis, are largely disposable devices, making the procedure expensive.

Surgery on fibroids is performed under general anesthesia. Depending on the results, one of several different surgical techniques and routes of access may be chosen. Intervention can be achieved by laparoscopy with hysteroscopy or (for large fibroids) through an incision in the abdominal wall (laparotomy). An agent is often injected into the uterus to constrict the blood vessels so that heavy bleeding is prevented as much as possible.

During laparoscopy surgery, an optical device (laparoscope) with a small video camera is inserted into a small incision in the belly button. CO2 gas is injected to widen the abdominal arch and improve visibility. The necessary instruments are inserted through additional incisions in the abdominal cavity. On the monitor, the surgeon sees the operating area in real time and can take the necessary measures. Often the instrument is also inserted into the uterus through the vagina.

During hysteroscopy, a special optical device (hysteroscope) is inserted through the vagina and cervix into the uterine cavity. The cavity is kept open by gas or liquid. The inside of the uterus can be accurately assessed. For further interventions, various instruments can be inserted through the hysteroscope.

Depending on the route of access, the fibroid is removed from the abdominal cavity or other places. New growths are cleaned and cut out at the root. To do this, you can use scissors, as well as electric current or laser technology. At the end of the procedure, drainage procedures are performed through the abdominal cavity. The drainage can be removed after a few days.

Complications and unexpected results may require extension or modification of the surgical procedure. In selected cases, it may be necessary to switch from uterine endoscopy to laparoscopy or open surgery. Rarely, it may be necessary to remove the entire uterus (hysterectomy). If possible, the doctor tries to leave the uterus, especially if the woman wants to have children.

Contraindications

Absolute contraindications to laparotomy:

• High risk of blood loss;
• Congenital disorders of the blood coagulation system;
• Severe hematomas in the abdominal area;
• Wound healing disorders;
• Acute infectious diseases;
• Damage to abdominal organs;
• Severe injury in the abdominal area.

Congenital disorders of the blood coagulation system are a contraindication to abdominal surgery to remove fibroids

Before the procedure, the patient undergoes a preliminary examination in accordance with current rules. Most examinations are carried out before entering the hospital. If further investigations are necessary, they will be performed on the day of admission. The patient will be informed of all risks associated with the procedure in advance.

Features of the operation process

If necessary, medications that reduce blood clotting, such as Marcumar or Aspirin, should be excluded. The laparoscopy technique used today in all areas of surgery has its origins in gynecology. As early as 1910, laparoscopy was used for diagnosis in Sweden, and therapeutic interventions followed for the first time in Germany in 1930. Soon after, they were performed regularly, especially on the fallopian tube. The first laparoscopic complete hysterectomy occurred in the United States in 1988.

Any abdominal surgery performed on the open abdomen can also be performed laparoscopically. However, the choice of therapy should be made only based on the disease and its symptoms. Just because a laparoscopic procedure does not leave many visible scars does not mean it is suitable for every woman.

Often a transverse abdominal incision is made above the pubic border (called a bikini incision or "transverse laparotomy"). Sometimes a vertical incision is made instead ("longitudinal laparotomy"). Which type of incision is used depends on the type of surgery and the size of the uterus or tumor, as well as any previous procedures.

Common treatments include vascular embolization (vascular occlusion) and antihormonal therapy. In everyday gynecological practice, circulatory disorders are the most common indication for embolization. In addition to diagnosis, in most cases additional conservative measures are used - the administration of hormones.

Rehabilitation

If the operation is performed on an outpatient basis, the patient should be aware that he is prohibited from driving a car, other vehicles or machines for 24 hours. Important decisions must also be postponed. Proper rehabilitation is recommended for all patients. Recovery after removal of uterine fibroids can take 1 month.

Recovery after abdominal surgery to remove uterine fibroids can take about a month

After abdominal surgery to remove uterine fibroids, various medical devices, such as physical protection, may be required. Prescribed medications should be taken regularly. Medical checks should not be skipped.

Although bleeding may not occur with drug therapy, it can still lead to pregnancy, so birth control may be helpful in some cases. If abnormalities occur that could be signs of complications, you should contact your doctor as soon as possible.

Possible complications

With hormonal treatment, estrogen concentrations decrease. As a result, young patients experience absence of menstruation, increased sweating and a feeling of heat, mood disorders and loss of libido. This practically corresponds to artificial entry into menopause. A woman may gain weight due to treatment. These effects usually disappear again after treatment ends.

If active ingredients are administered, pain and swelling may occur, and very rarely inflammation, bleeding, nerve damage, or tissue destruction (necrosis). GnRH analogues cause temporary symptoms similar to the effects of menopause.

Progestins can cause muscle spasms. Due to the accumulation of fluid, the load on the heart increases. Cases of thrombosis (blood clots) have also been reported.

Damage to blood vessels can lead to bleeding in all surgeries. Less severe bleeding usually goes away on its own. Nerve damage leads to, among other things, numbness or loss of bladder function.

Bladder emptying disorders are not usually permanent conditions. After the procedure, life-threatening peritonitis or other consequences of damage to the abdominal organs occur. Infections and wound healing problems occur due to excessive scarring. Allergies also cannot be ruled out.

Both with treatment with hormonal drugs and with surgical treatment of fibroids, complaints can be reduced or completely eliminated. In particular, a combination of the two methods may be beneficial for patients. It is impossible to predict whether pregnancy will occur after surgery.

Embolization leads to disruption of the blood supply and, therefore, to a slight reduction in fibroids. However, they are only possible in a few places and very rarely bring the desired success. In women who want to have children, the fibroid node can be removed individually laparoscopically. However, this procedure is more complex and leads to more complications. It should only be used in patients for whom pregnancy is realistic based on their results and age.

The proportion of incomplete removal of the uterus (subtotal hysterectomy) for benign diseases is increasing. However, none of the available studies prove that this procedure is superior to complete hysterectomy. Before undergoing surgery, you should consult your doctor.

Removal of uterine fibroids

Uterine fibroids are a tumor-like neoplasm that is benign in nature and localized on the walls of the uterus. Gynecological disease occurs at any age and worries 40% of the female population. The causes of the disease are still unknown, but there are a number of theoretical assumptions on this matter. It is believed that the disease rarely transforms into cancer if the patient is regularly monitored by the attending physician. But due to the absence of symptoms at an early stage of development and rapid growth, a woman turns to a gynecologist with fibroid nodes that are already of a decent size, and then surgical intervention becomes relevant.

Indications for removal of uterine pathology

Most often, fibroids are discovered accidentally during a profile examination of the patient. Gynecologists use a wait-and-see approach, explaining that it is undesirable to disturb the uterine nodes at the initial stage of development. The following patient symptoms lead to surgical intervention:

• heavy bleeding before, during and after the menstrual cycle;
• pain in the pelvic area;
• large pathologies that create a feeling of fullness in the lower abdomen and interfere with the functioning of internal organs;
• the occurrence of anemia due to regular and significant blood loss;
• problems with urination and frequent constipation;
• headaches, weakness, nausea, dizziness;
• the tumor causes deformation of the reproductive organs;
• yellow or brown discharge after menstruation.

The presence of all of the above symptoms in the patient forces urgent surgical intervention. When making a serious decision, the doctor should take into account the patient’s age, the size of the pathology, individual intolerance to drugs, the location of uterine formations and postoperative complications.

Removal of fibroids surgically

Surgical intervention for fibroids has been used in medical practice for a long time and is a budget option. You should choose a surgeon carefully, since the patient’s fertility and quality of life depend on the quality of the operation. A common method of surgical intervention is open abdominal surgery, which has two types: laparotomy and hysterectomy. Tumor sizes for surgery are measured in millimeters or centimeters.

There are several types of surgical intervention.

Removal of fibroids using laparoscopic method

It is aimed at removing tumor-like formations on the walls of the uterus and completely preserving the reproductive organ, since the absence of a uterus will not make it possible to have children in the future. Preparation for surgery involves completing a six-month course of medication. Common drugs are Goserelin and Gestrinone, which reduce the size of the pathology and reduce heavy bleeding during surgery. The subserous localization of the uterine tumor eliminates the preparatory stage and the operation begins immediately.

Laparoscopy is performed only in the following cases:

• the dimensions of one node reach four or five centimeters;
• the contractility of the uterus is impaired and the cavity is deformed;
• inability to bear children and bear a child;
• anemia due to numerous blood losses;
• the pathology interferes with the functioning of neighboring internal organs, causing frequent constipation, problems with urination and intestinal dysfunction;
• rapid growth of pathology.

The operation is life-threatening for the patient in the following cases:

• the size of myomatous nodes did not change after preparatory therapy;
• the presence of malignant diseases of the reproductive organs;
• diseases of the respiratory system and liver failure;
• multiple uterine fibroids;
• the patient is overweight.

The type, size and location of the tumor plays a huge role during the operation. The procedure consists of four steps: enucleation of the uterine nodes, restoration of myometrial deficiencies, removal of pathology and homeostasis of the abdominal cavity. The operation is considered traumatic and leaves scars.

The postoperative period lasts from three to seven days, and complete recovery of the body and resumption of physical activity occurs after four weeks. After laparoscopy, patients are prohibited from sexual activity for six weeks. There may be further complications after the procedure, including damage to the bladder, bowel and ureters due to low position of the uterine nodes, abdominal hernia and difficulties during pregnancy.

Laparotomy

It is a more gentle option for surgical intervention, since during this operation the surgeon is able to better control bleeding during the process of enucleating the uterine node, especially if the pathology is located at a depth of ten centimeters or more.

Preparation for surgery plays an important role, since the outcome of the surgical intervention depends on this. The patient should undergo a cytological examination, a biopsy, determine the degree of vaginal cleanliness, perform excretory urography and take a blood test. The listed points help determine the method of surgical intervention, the size of the nodes, the location of the incisions and diseases of the reproductive organs.

If the patient is anemic, it is advisable to prepare donor blood for transfusion in advance in case of heavy blood loss. Indications for removal are the same as for laparoscopy. It is advisable to use this method in case of multiple myomatous nodes and in the presence of anemia in the patient. If the tumor is giant, surgeons prefer laparotomy, while preserving the uterus.

The operation takes place in several stages: the abdominal cavity is incised, the nodular capsule is discovered, on which an incision is also made and the uterine tumor is removed. The surgeon puts two or three stitches to remove large nodes. After the operation, the patient takes sick leave for two weeks and limits physical activity as much as possible. The procedure eliminates further complications such as damage to internal organs or uterine rupture during pregnancy.

Hysterectomy

This is a radical removal of the uterus, used in severe cases. This method is used for abnormal bleeding, acute pain in the lower abdomen, uterine prolapse and endometriosis. Benign and malignant tumors that have reached a substantial size and are eliminated along with the uterus are subject to removal.

The procedure is performed through an incision in the abdominal cavity, through the vagina, or using a laparoscopic technique. Rehabilitation lasts three weeks, during which the patient is prescribed antibiotics and painkillers. Consequences of the operation include infection, numbness of the skin, scarring at the incision site, and adhesions in the abdominal area. If the ovaries, uterus and fallopian tubes are removed along with the fibroids, women enter menopause early. After removal of the uterus, sex hormones cease to be synthesized in the female body and the patient is prescribed hormonal therapy.

Hysteroscopy

The method is used to remove small myomatous nodes, reaching five centimeters in diameter. The presence of a pedicle and mobility of the intrauterine node are indications for the use of this method. The procedure is carried out by inserting a hysteroscope into the vagina, excising the node into separate parts.

Surgery to remove uterine fibroids is performed while preserving the reproductive organ, but reduces the chances of getting pregnant in the future. The surgeon operates in the first week of menstruation, injecting the patient with an anesthetic drug. The advantages of this method include the short duration of the procedure, minimal blood loss, rapid recovery of the reproductive organs after surgery and a small scar at the incision site, which quickly disappears. Patients stay in the hospital for five to seven days and spend the rest of the recovery period at home.

Myomectomy

During pregnancy, it is performed in the presence of small, medium and giant nodes on the uterine mucosa. Signs of pathology appear in the form of heavy bleeding, pain in the lower abdomen and the presence of blood clots during menstruation. The tumor is removed by caesarean section mainly in women over 30 years of age. The procedure is carried out with complete preservation of the uterus and fallopian tubes, if the size of the pathology does not reach impressive sizes and does not deform the internal organs.

Indications for the operation:

• many myomatous nodes appear on the submucous membrane of the uterus;
• the appearance of single nodes;
• necrosis of pathology;
• profuse bleeding with clots;
• bloating and pain in the lower abdomen.

After a cesarean section, the patient undergoes a long recovery period, including dietary nutrition and thorough bowel cleansing. It is recommended to treat the surgical site with antiseptic agents.

Alternatives to surgery

You can remove fibroids without surgery using medication, minimally invasive interventions, taking hormonal medications and folk remedies.

Uterine artery embolization

It is considered a progressive and effective method in medical circles. The operation is performed with punctures in the pelvic area, introducing emboli consisting of medical polymer into the uterine arteries. They interfere with the blood supply to the uterine nodes, causing the death of smooth muscle tissue of the pathology.

For the operation, doctors use a catheter placed in the abdominal aorta. First, embolization of the right and then the left uterine artery is performed. At the site of myomatous neoplasms, connective tissue grows. Deprived of its only source of nutrition and reduced by three to four times, the myomatous node loses contact with the uterine mucosa and is pushed out. This phenomenon is called expulsion, or birth of the uterine node.

Before the operation, the patient should stay in the clinic and take antibiotics to avoid infection after embolization. The operation is performed without anesthesia, since there are no nerve endings in the arteries. The patient feels warmth in the lower abdomen during the procedure. The process lasts a maximum of 15 minutes, but this depends on the surgeon.

This method is recognized as self-sufficient, since no additional medication or folk treatment is required during or after the operation. It is strictly forbidden to perform the procedure during pregnancy and in the presence of cancer and inflammatory processes of the reproductive organs.

Among the complications, doctors note rare cases of accumulation of purulent masses at the site of the operation, blockage of the arteries, damage to the internal organs of the pelvis by the catheter and the occurrence of hematomas in the area of ​​the operation. The possibility of relapse occurs only if technical difficulties arose during the procedure and the catheter was inserted incorrectly. During rehabilitation, which lasts eight hours, the patient experiences pain in the lower abdomen, minor bleeding and increased body temperature.

While at home, the patient should abstain from sexual intercourse, avoid physical activity and not take hot baths for a month. It is advisable to follow the recommendations of your doctor so that the recovery period passes quickly.

Drug treatment

It involves taking available pharmaceuticals, hormonal drugs as prescribed by a doctor and promotes the resorption of the uterine nodes without removal through surgery. Hormonal imbalance is considered a factor provoking the occurrence of pathology, therefore this type of drug is still actively used in medical practice. The described type of treatment is suitable for a small tumor that is not prone to rapid growth. This type of drug is used for multiple myomatosis to suppress the growth of remaining tumors.

Medicines are aimed at reducing the size of the pathology, stopping bleeding and reducing pain symptoms. Women who have undergone hysterectomy during menopause undergo a hormonal course to synthesize hormones artificially. In parallel with drug treatment, the daily intake of vitamins and minerals must be observed to improve the elasticity of blood vessels.

Unconventional methods

When completing the main course, patients use unconventional methods to achieve better results. To treat fibroids, herbal infusions and decoctions are used, taken orally and as a compress. Among the medicinal herbs, yarrow, celandine, boron uterus, wormwood and chamomile are popular, reducing the size of nodes. To relieve inflammation and swelling, you can make a compress from raw potatoes or aloe juice.

It is advisable not to remove uterine fibroids through surgery in order to avoid further complications during childbirth and diseases of the reproductive organs. But if the patient is faced with this disease, this option cannot be completely ruled out. The myomatous node behaves unpredictably and can change its growth rate or spread to the uterine mucosa in the form of multiple fibrosis at any time. To avoid such troubles, it is necessary to do regular examinations of the reproductive organs, which allows you to control the size and stage of development of the pathology.

If the myomatous node enlarges and heavy bleeding occurs, the patient should be operated on immediately and not try to get by with medication or folk remedies, since fibroids at a late stage of development pose a danger to a woman’s life. Doctors recommend treating fibroids comprehensively: combining medications, alternative methods, leading a healthy lifestyle and remembering to undergo regular examinations to identify the source of the disease at an early stage of development.

How is abdominal surgery to remove uterine fibroids performed?

Surgery is one of the most common treatment options for uterine fibroids. Abdominal surgery is performed according to indications: if possible, the doctor will use organ-preserving treatments (uterine artery embolization, FUS ablation), but in cases where the only effective method of getting rid of the disease is removal of the uterus, surgery is necessary. Reviews from doctors are unanimous - often conservative methods are unable to relieve complications and serious health problems, so abdominal surgery becomes the best option for treating uterine fibroids.

It is important to follow all doctor’s recommendations during the preparation stage to prevent complications. The extent of uterine removal depends on many factors, so the choice of surgical intervention technique is the prerogative of a specialist. The postoperative period takes about a month, during which you need to be regularly monitored by a doctor. As the reviews show, six months after a hysterectomy, most women do not experience any problems or discomfort due to the absence of a uterus.

Surgical options

Abdominal surgery in gynecology is any intervention involving entry into the abdominal cavity. Removal of uterine fibroids can be emergency or planned, conservative or radical, open or endoscopic, and all types of surgical interventions can be divided into the following groups:

The advantages of operations with access to the abdominal cavity are the following factors:

• technical convenience for the doctor to remove a benign tumor;
• the possibility of visual examination of the abdominal organs to identify diseases that are not diagnosed by conventional research methods;
• changing the scope of surgery when complications or undiagnosed tumors in the pelvis are detected;
• radical removal of the tumor at risk of malignant degeneration.

Prognostically and technically, abdominal surgery performed for uterine fibroids is more optimal than any other type of intervention, but the main disadvantages of open intervention are:

• greater risk of postoperative complications;
• long stay in hospital;
• cosmetic defects on the anterior abdominal wall.

The doctor will offer surgical options to a woman with uterine fibroids that require surgery. Usually the choice is small, either open or endoscopic, so you should trust the specialist and agree with the type of surgical access that the doctor offers.

Abdominal surgery will be required in the following cases:

• uterine fibroids of any size with severe uterine bleeding or heavy menstrual periods, against the background of which the woman experiences severe anemia;
• large leiomyoma, especially when manifestations of compression of neighboring organs occur;
• medium-sized uterine fibroids with one dominant large node;
• rapid increase in the size of a benign tumor (node ​​growth 2 times in 1 year);
• pedunculated subserous node with pain;
• necrosis of the muscle node;
• cervical isthmus leiomyoma;
• combination of leiomyoma with gynecological pathology requiring surgical treatment (ovarian cyst, endometriosis, recurrent hyperplastic processes of the endometrium, uterine prolapse);
• infertility caused by the presence of a myomatous node;
• any suspicion of malignant tumor degeneration.

For each woman, the choice of indications for surgical intervention is individual. In this case, the doctor will take into account contraindications for surgery.

Contraindications

In emergency situations, surgical intervention is unacceptable only in case of acute respiratory disease (influenza, acute respiratory viral infection) with high fever and impaired respiratory function. Elective abdominal surgery is contraindicated:

• for any acute or exacerbation of a chronic infectious process;
• if there are boils or pustules on the skin of the abdomen;
• if any type of rash is detected on the skin;
• against the background of serious pathology of the heart and blood vessels (uncontrolled arterial hypertension, heart attack, stroke, aneurysm, heart defects);
• against the background of liver and kidney diseases with worsening chronic pathology of these organs.

Underestimation or neglect of contraindications to surgery can be the main reason for postoperative complications.

Preparation

Before the operation, careful preparation is required, including the following laboratory and instrumental studies:

• blood and urine tests to assess the general condition of the body, detect inflammation and infections, detect diseases of internal organs;
• ECG with consultation with a therapist;
• ultrasound scanning of the abdomen and pelvis;
• taking smears from the vagina and oncocytology from the cervix;
• colposcopy and biopsy of the cervix in the presence of erosion;
• aspirate from the uterine cavity or hysteroscopy with separate diagnostic curettage of the cervical canal and endometrium;
• examination of the urinary tract (urography) for cervical nodes;
• consultations with a cardiologist, hepatologist, urologist and proctologist if necessary;
• in complex cases and with large uterine fibroids, tomography (MRI or CT with contrast) may be required.

Upon admission to the hospital, 1 day before surgery, a consultation with an anesthesiologist is required, who will choose the method of pain relief.

Scope of operation

Abdominal surgery can be conservative or radical. In the first case, the doctor performs an organ-preserving type of intervention, in which the woman preserves the uterus and the possibility of childbearing. In the second, the organ is removed.

Myomectomy

For young women who want to carry and give birth to a child in the near future, the doctor will perform conservative removal of the myomatous node. Possible options will be the following types of operation:

• enucleation of the interstitial node;
• removal of subserous uterine leiomyoma;
• conservative removal of the tumor without damaging the wall or opening the uterine cavity.

Abdominal surgery can be performed through an incision in the anterior abdominal wall, endoscopically or via vaginal access. In each case, the doctor will try to cause minimal trauma to the uterus so as not to create problems for reproductive function.

Hysterectomy

Complete or partial removal of the uterus is the only radical treatment for uterine fibroids. Hysterectomy will rid a woman of a benign tumor and will be an effective prevention of recurrence of leiomyoma. There are 2 operation options:

• subtotal hysterectomy (defundation, supravaginal amputation);
• complete removal of the uterus (extirpation).

Abdominal surgery is optimal, but in some cases the doctor will use vaginal or endoscopic access. For each method there are indications and contraindications. The main disadvantage of subtotal organ removal is the risk of future erosion and cervical cancer.

Surgical technique

Abdominal surgery consists of several stages.

Anesthesia

The optimal choice is general anesthesia. Spinal anesthesia is an option, but the choice of anesthesia technique is made by an anesthesiologist.

The skin is incised in the lower abdomen above the pubis. The size of the incision is about 15-25 cm and depends on the size of the uterus to be removed.

After entering the abdominal cavity, the doctor will perform all the necessary technical steps to remove the organ and prevent bleeding from the uterine vessels. The uterus is removed along with the tubes. The ovaries, as one of the main hormonal organs of the female body, are always preserved. The vaginal stump is carefully and carefully sutured to ensure the tightness of the abdominal cavity.

Layer-by-layer suturing

Abdominal surgery ends with layer-by-layer suturing of all intersected tissues of the anterior abdominal wall.

After operation

The early postoperative period after hysterectomy lasts about 1 week, during which medical supervision is required. After 6-7 days, the doctor will remove the stitches and discharge you from the hospital. Further observation by a doctor at your place of residence. The following recommendations must be followed:

• refusal of intimate life for at least 1.5-2 months with complete removal of the uterus;
• with subtotal hysterectomy, it is necessary to undergo an annual examination by a gynecologist with a smear taken from the cervix for oncocytology;
• with conservative myomectomy, it is necessary to protect against pregnancy for at least six months;
• if necessary, drug therapy, rehabilitation with physiotherapy and sanatorium treatment will be required.

Complications

Abdominal surgery can cause the following complications during and immediately after surgery:

• bleeding from the uterine vessels;
• damage to internal organs (bladder, intestines);
• infection in the blood (sepsis);
• infection of the abdominal cavity (peritonitis);
• suppuration of a postoperative wound.

If you carefully follow all the rules for preparing for surgery, the risk of complications is minimal. The experience of the doctor and the anatomical features of the woman’s internal organs are of great importance. Reviews from doctors are unanimous - if indications for surgery are found, there is no need to postpone or refuse surgical intervention: the only method to completely get rid of the disease is to remove the uterus.

Indications for abdominal surgery for leiomyoma occur in 15-20% of cases. The choice of surgical intervention method depends on the woman’s age, the size of the uterus, concomitant pathology and the need to preserve fertility. After a conservative myomectomy, the chances of pregnancy and the birth of a child are quite high, and after a hysterectomy, after 6 months a woman will forget about the operation, even if the postoperative period was fraught with complications.

Reading time: 19 minutes. Published 12/19/2019

Indications for surgery

• Pain in the lower abdomen and lower back. In nature, depending on the location and size of the formation, it can be pulling, sharp, or cramping.
• Mucous discharge mixed with blood - ichor.
• Spotting or heavy bleeding.
• Disruptions in the menstrual cycle: heavy and prolonged periods, delay or high frequency.
• Manifestation of symptoms of anemia: nausea, weakness, dizziness, pale complexion.
• Problems with stool, frequent constipation, frequent painful urination due to compression of neighboring organs.
• Fibroids aged 11–12 weeks, the size of which is more than 6 cm.
• Tumor growth by more than 3 cm per year.
• Signs of transformation of a benign tumor into a malignant cancer.
• Myomatous nodes on a stalk, having a connection with the wall of the uterus through the cervix.
• The development of necrosis associated with poor circulation in the area of ​​myomatous nodes.
• Concomitant diseases, such as: ovarian tumor and uterine endometriosis.
• It is difficult for a woman to become pregnant or maintain a pregnancy.

Fibroids sizes

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

Surgical removal of nodes is indicated when the threshold of 12 weeks is exceeded, that is, large and giant. In some cases, surgery is performed for smaller tumors.

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

The presence of any of the listed factors requires cancellation or rescheduling of the operation until the patient’s condition improves. The specialist will prescribe surgical intervention only if health indicators are satisfactory. Neglect of them can cause serious complications.

Uterine fibroids are a benign type of formation that occurs in the muscular layer of the organ. Women over 45 years of age are most susceptible to it. However, intervention will never be prescribed without serious reasons.

If the formation has not reached a large size, then conservative treatment without surgical intervention is possible.

When such indications for removal of the uterus in young women are discovered, doctors try to use conservative methods and preserve the organ. Removal is resorted to when:

• Myoma can develop into a malignant tumor;
• Myoma has questionable biopsy results, the likelihood of atopy;
• Myoma has exceeded the size of a 12-week pregnancy;
• Fibroids are located on the cervix;
• With pedunculated fibroids with a risk of twisting, which will lead to necrosis;
• Myoma nodes put pressure on nearby organs, causing pain to the patient;
• Myoma manifests itself very clearly and the time of occurrence of the pathology coincided with menopause;

For ovarian or cervical cancer, not only removal is required, but also additional radiotherapy or chemotherapy.

With this pathology, it is necessary to remove not only the uterus, but also the ovaries, cervix, upper part of the vagina and fallopian tubes with lymph nodes.

In the early stages, it is possible to carry out a gentle intervention and not remove the ovaries and uterus. In this case, only 2/3 of the organ is removed.

Endometriosis is a chronic growth of glandular tissue outside the reproductive organ. Most often, the laparoscopic method is used to eliminate the problem.

It removes the overgrown epithelium without touching the ovaries, uterus and cervix.

In extremely rare cases, when there is a risk of degeneration of the pathology or with an aggressive course and no results from drug treatment, the organ has to be removed.

Treatment of deprivation in humans at home

Uterine prolapse occurs when the pelvic floor or abdominal muscles weaken. This can occur for many reasons, for example: multiple births, heavy physical work, chronic inflammation, disruption of endocrine processes.

If the disease is diagnosed at the very beginning, treatment with therapeutic methods strengthens the peritoneal muscles. And you don't have to go through surgery.

One of the most difficult gynecological diseases to treat is necrosis of fibromatous nodes. The extent of surgical intervention is determined individually for each patient and depends on many factors. Including age, condition of the patient, presence of infections.

Preparation for surgery to remove the uterus includes nutritional adjustments, namely diet No. 1 the day before the procedure. Further actions are prescribed individually, depending on the stage of the disease and the characteristics of the woman’s body. Preparation for surgery to remove uterine fibroids involves a preliminary course of taking hormonal medications. If the reason is different, it is recommended to take a course of antibiotics to eliminate the risk of possible infections.

It is absolutely normal for a woman to feel nervous on the day of surgery; this is a common occurrence. Therefore, before the procedure begins, the patient is given a sedative injection. A few hours before surgery, a woman should, just in case, carefully consult with an anesthesiologist again to clarify the list of prohibited drugs.

Carrying out the operation

Another important question that often worries patients: how long does the operation to remove the uterus last? There is no clear answer. It all depends on the type of manipulation being performed. Hysterectomy, or removal of the uterus, is divided into types based on the number of organs removed. Namely:

• Total surgery involves removing the uterus along with the cervix;
• With subtotal manipulation, only the uterus is removed;
• Hysterosalpingovariectomy surgery involves removal of the uterus and ovaries;
• During radial surgery, the ovaries, cervix, parts of the vagina, uterus, surrounding and lymphatic tissue are removed;

The reason for the formation of polyps in the uterus

Cavitary removal - the surgeon makes an incision in the peritoneal area. After completing all stages of the operation, the incision is sutured and a bandage is applied to the seam. The duration of the procedure is from 40 minutes to 2 hours. Although this procedure is common, its use has several disadvantages. For example, a lot of trauma. The scar formed after the suture heals can last for many years.