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Hieterectomy, i.e. removal of the uterus, is a very serious operation, leaving its mark on a woman's psyche. Check what are the causes of a hysterectomy, how it is performed and what recovery after surgery looks like.

Removal of the uterus , orhysterectomy , is a message that falls on a woman like a bolt from the blue. It is hardly surprising, because such a radical operation is usually associated with the worst. Meanwhile, in most cases, a hysterectomy is performed for a completely different reason than cancer. If two or three gynecologists decide that removal of the uterus is the only effective treatment for your illness, try to find out as much as possible about what awaits you. Then you will approach the procedure more calmly. Ask your attending physician what exactly is your disease, what method you will be operated on, how radical the surgery must be, i.e. whether it is also necessary to remove the ovaries and fallopian tubes, how long will you recover and what the consequences of the procedure will be, e.g. will you be had to use hormone replacement therapy (HRT).

Contents:

  1. Hysterectomy - indications for uterine removal
  2. Hysterectomy - when is it possible to leave the cervix?
  3. Hysterectomy - traditional method
  4. Hysterectomy - laparoscopic method
  5. Hysterectomy - convalescence

Hysterectomy - indications for uterine removal

Hysterectomy is most often performed when a woman has numerous, enlarging fibroids that cause severe pain and prolonged up to 10 days, heavy periods that are almost hemorrhagic.

In elderly women, the reason for the procedure is the decrease (sometimes even prolapse) of the reproductive organ. This ailment is caused by the relaxation of the muscles and ligaments that hold the uterus, vagina and bladder in the correct position. It is favored by numerous or difficult births and hard physical work.

The uterus is also removed for endometrial cancer (the lining of the womb) and endometrial cancer (the widest part of the uterine cavity, limited by the bottom on one side and the cervix on the other).

These cancers usually affect women in their 50s. It also happens that it is under examinationcytological doctor detects numerous cancer cells in the cervix (IV group). If there is a suspicion that the cancer affects not only the cervix, it is also necessaryhysterectomy .

Hysterectomy - when is it possible to leave the cervix?

Doctors sometimes perform a hysterectomy, leaving the woman's cervix behind. Some experts say it is a "delay bomb" because cancer may develop here someday. That's true. But if a woman has regular cytology after surgery, the doctor will detect disturbing changes before the disease develops. Then he will be able to apply the appropriate therapy.

Leaving the cervix is ​​possible provided that the woman did not have erosions and she always had cytological group I or II.

The patient's mental well-being is the main argument for leaving the cervix. Since women consider a total hysterectomy as castration, they prefer to have "more than just a vagina" left.

From a he alth point of view, leaving it is also justified. The point is to prevent a rare and long-term complication of vaginal prolapse after hysterectomy. If the cervix is ​​also left with the vagina, it will be better supported by ligaments and muscles.

Doctors use one of two surgical techniques depending on the diagnosis and test results.

Hysterectomy - traditional method

It is performed under general or lumbar anesthesia (then the patient does not feel pain, but is conscious). It consists in opening the abdominal cavity and removing the uterus (if necessary - with appendages). The cut is made over the pubic symphysis or from the navel to the pubic symphysis.

The latter type is performed when, for example, the uterus is very large or when more access to the abdominal cavity is needed. After such an operation, the patient usually remains in the hospital for 6 to 10 days.

Important

The doctor may not always decide before the operation whether it is enough to excise the uterus itself or whether it is also necessary to remove the appendages, i.e. ovaries and fallopian tubes. This is why the patient is usually prepared for a more extensive operation. If during the procedure it turns out that its scope can be narrowed down - all the better.

Hysterectomy is preceded by an ultrasound of the ovaries. If it detects, for example, cysts, sometimes a blood test is ordered for the presence of the so-called CA 125 antigen - its high level may be seen, inter alia, in about ovarian cancer. During the procedure, a histopathological examination of the ovarian cyst is also performed to find out what its nature is.

In the case of younger women, one ovary is removed when a cyst is detected,leaving "better" as a source of hormones. In women over 48, the uterus and appendages are usually excised. Removal of the ovaries eliminates the risk of developing cancer of this organ.

Hysterectomy - laparoscopic method

The operation is performed under general anesthesia. Right next to the navel, an approx. 2 cm incision is made, through which the doctor inserts a laparoscope - a speculum, thanks to which he will be able to observe the inside of the abdominal cavity and the surgical field on the monitor.

Through a second, equally small incision in the lower abdomen, he introduces the micro-tools and severs the uterus from the ligaments that support it and the vagina (or the cervix, if it remains).

The uterus is cut into small pieces and drained out through an incision in the abdominal wall or, if the uterus was small, through the vagina. The end of the vagina or cervix is ​​sewn sutured and the fallopian tubes are ligated.

The laparoscopic technique is used in lighter cases, e.g. with not very large myomas. The patient remains in the hospital for about 5 days. Laparoscopic surgery puts less strain on the body, but it cannot always be performed.

Hysterectomy - convalescence

Recovery after hysterectomytakes about 8 weeks. However, for at least six months, a woman should not physically work hard or even carry a weight greater than 5 kg.

If the patient had menstruated before the hysterectomy, she will not have menstruation after the hysterectomy, but the ovaries will still release estrogen, so she will not start a premature menopause.

The consequences of removing the uterus and appendages may be more serious for the body. A menstruating woman begins to experience unpleasant symptoms characteristic of the menstruation after the procedure.

To prevent this, doctors suggest starting hormone replacement therapy right after the surgery. A contraindication to its use is hysterectomy due to endometrial cancer. If the uterus and appendages have been removed in a woman who went through the menopause a few years ago, HRT is not recommended as the ovaries have stopped producing hormones on their own.

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Female diseases