Now, for the treatment of fibroids, doctors often prescribe a conservative myomectomy. What it is? This method is one of the most common and effective. Its main advantage is that women retain the uterus and reproductive function. It is desirable to have an idea of myomectomy for all representatives of the weaker sex, since no one is immune from diseases of the genital organs. In our article, we will talk about the indications for such a surgical intervention, as well as about the recovery period following it.
Treatment methods
Many women are very worried when they are prescribed a conservative myomectomy. What is it, they are not very well aware. As mentioned above, the uterus is not removed during this operation, only myomatous nodes are husked. Depending on their size, location in the body, shape and other indications, the doctor decides which way they will be removed. Conservative myomectomy is of the following types:
- Abdominal.
- Laparoscopic
- Cavity.
- Endoscopic.
- Hysteroscopic.
Each type of operation has its own indications and contraindications. Each is characterized by a different degree of difficulty. An alternative to myomectomy is EMA (uterine artery embolization). In this case, the embolizing drug is injected into the vessels of the uterus, after which the blood supply to the myomatous nodes can be interrupted. They are significantly reduced in size, some may disappear altogether. Symptoms of the disease in this case go away, the restoration of the organ begins, the possibility of becoming pregnant again appears.
For a woman, this is the easiest and least traumatic type of treatment. EMA is performed without anesthesia in an outpatient setting. Even if the therapy is carried out in a hospital, the patient is discharged home the very next day. The advantages of EMA also lie in the fact that the effect is carried out only on the problem area, absolutely not affecting healthy tissue.
However, this remarkable method may not be used for all patients. EMA is contraindicated in intramural serous fibroids (more than 8 cm), giant tumors, single subserous formations on a thin stalk. With such indications, only myomectomy is performed. We will consider all methods in more detail below.
Causes of the tumor
For many years, it was believed that uterine fibroids are a benign tumor, which eventually turns into a malignant neoplasm. That is why gynecologists recommended completely removing the organ in order to save the patient's life. A woman after such an operation actually became disabled. The quality of her life was significantly reduced, she lost the opportunity to have a baby. Moreover, in the process of recovery, mental health disorders often began, hormonal levels were disturbed.
Modern studies have shown that the myomatous node is not a tumor, although it has some signs of a benign formation. The risk of its transformation into cancer is extremely low and is comparable with the likelihood of developing this dangerous disease from healthy uterine tissue. That is why when a fibroid occurs, the uterus is no longer removed.
The causes of fibroids are not fully understood. There are several factors that contribute to its growth. This is a change in the hormonal background, in which the amount of estrogen, stress, abortion, diagnostic curettage, trauma of the uterus during obstetric procedures, the late onset of menstruation, menses, inflammatory diseases of the female genital organs increase.
In most cases, fibroids develop in patients with thyroid disease, diabetes, hypertension, as well as in overweight patients. Among all diseases of the genitourinary system in women, according to official data, 25% fall on myoma. However, doctors believe that the figure is underestimated by about half.
Symptoms
To begin timely treatment of the disease, you should understand its symptoms. However, in the early stages, this ailment may not manifest itself at all. Signs appear only with the progression of formations. These include heavy and prolonged menstruation, cycle disruption, spotting between menstruation, infertility, pain in the lumbar region or lower abdomen.
The fibroids that appear on the cervix press on the rectum and bladder. As a result, a woman has constipation or there are disorders during urination. If they are too large, this can lead to an increase in abdomen in size. With a violation of the blood circulation of the myomatous node in the neoplasm, fatal necrotic changes begin to occur. When a symptom of the so-called acute abdomen appears, surgeons perform an emergency operation.
The result of heavy and constant bleeding is chronic anemia. At the same time, patients complain of dizziness, general weakness, fatigue for no apparent reason. The following manifestations of uterine fibroids become a rapid pulse, low blood pressure, a disturbance in the rhythm of cardiac activity. With chronic anemia, the nails become brittle, and the hair begins to fall out.
Because of fibroids, problems with conception and pregnancy appear. The uterine cavity may be deformed. In this case, the embryo is not implanted into the organ wall. The uterus with such disorders is often in good shape, which leads to the threat of premature birth or miscarriage. Also, with myoma, the development of the fetus itself is disrupted. The main consequences of this disease are miscarriages, impaired fertility, difficult births.
Conservative surgery, pros and cons
Conservative myomectomy helps to cope with the disease. What is it, consider further. Gynecologists recommend this operation to women who plan to have a baby in the future. The advantages of this treatment method:
- The uterus is not removed. The quality of life of the patient is not impaired.
- It is possible to remove the formation completely in one operation.
- Low trauma, especially when performing myomectomy in a closed way.
The method also has disadvantages:
- Relapses are often observed (again, fibroids grow in approximately 70% of patients).
- During surgery, an open scar remains on the abdomen and on the uterine wall.
- Sometimes after surgery complications begin.
Contraindications
Dealing with what it is - a conservative myomectomy, one can not help but mention contraindications to its implementation. The operation is not performed in such cases:
- Relapse of a neoplasm after a similar operation performed earlier.
- Severe anemia.
- Chronic inflammatory process that develops in the pelvic organs.
- The submucosal (submucous) node measuring 10 cm or more on the leg, fully protruding into the body of the uterus.
- Submucous tumor protruding into the uterus in whole or in part.
- The size of the uterus is up to 14 weeks.
- Subserous nodes.
- Interstitial fibroids (develops from the myometrium).
Such an operation is also not prescribed for women who do not want to give birth anymore, who are in the period of menopause, as well as for those patients who have suspicions of uterine sarcoma. Doctors do not perform myomectomy in cases where the myomatous node is located in a hard-to-reach place, so its removal is associated with great risks for the patient.
Complications
Patients should be prepared for the possibility of relapse after conservative myomectomy surgery. Myoma can grow back. If a woman does not plan to have a baby, she can even nowadays be recommended to remove the uterus in order to solve the problem with myoma once and for all.
However, many doctors believe that such a procedure is unacceptable. An alternative is embolization of the uterine arteries, after which the patient's quality of life improves, her reproductive function is restored. If the patient is in reproductive age, this may be an important indication for conservative myomectomy.
A serious complication that occurs during the operation is bleeding. However, this can mainly happen with abdominal or abdominal myomectomy. To reduce risks, the patient undergoes hormonal treatment before surgery. Another way is to perform an EMA, and after it removal of the tumor nodes. In addition, during the operation do temporary occlusion of the iliac arteries.
After surgery, such undesirable processes are possible:
- Divergence of seams.
- Infection
- The formation of adhesions on the walls of the uterus, which can become an obstacle to pregnancy.
If there are too many formations, the course of the operation with conservative myomectomy can be performed by an open method. Usually, before the operation for one to three cycles, the patient is recommended to take contraceptives, which in this case can ease the course of the operation, reduce bleeding.
Laparoscopic
Now consider what it is - a laparoscopic conservative myomectomy, because this is one of the most common methods of this operation.
This is a minimally invasive intervention, in which all actions are performed using several punctures in the abdominal wall and uterus. The thinnest tools are introduced into them. The surgeon observes all his actions on the monitor screen.
The advantages of laparotomy with conservative myomectomy are minimal damage to surrounding tissues, preservation of the uterus, which allows you to become pregnant and carry the baby on your own in the future. Rehabilitation of the patient in this case is very fast. You can become pregnant as early as six months after surgery.
Laparoscopy is a conservative myomectomy, an indication for it is the presence of nodes of not very large size, as well as single and multiple neoplasms with a specific structure. They can lead to impaired reproductive function and activity of neighboring organs, problems with bearing a pregnancy.
There are a number of contraindications in which it is not recommended to conduct a laparoscopic conservative myomectomy. These include:
- Complicated hemorrhagic diathesis.
- Disorders of the organs of the cardiovascular system and respiratory functions.
- Suspicions of malignant neoplasms.
- Chronic or acute renal failure.
- Identification of a large number of myomatous nodes.
- The location of the tumor in such places of the uterus where it is difficult or impossible to work with a laparoscope.
- The size of fibroids is more than 9 weeks.
The duration of rehabilitation after such an operation, as a rule, is two to three months.
Abdominal
During the operation, with conservative myomectomy (abdominal), two incisions are made. One is on the patient’s stomach, through which it is possible to reach the uterine cavity, and the second - on the uterus itself, in order to remove the node. The operation is performed under anesthesia, after which a suture is left, leaving a very noticeable scar. A woman has to stay in the hospital for several weeks as part of the recovery period.
The attitude to this operation is very ambiguous, since it has many shortcomings. These include the need for general anesthesia, a long recovery period, a high probability of relapse, scars and scars on the body.
An indication for surgery is a myoma in an inaccessible place, its large size, the formation of a tumor in the muscle layer.
The advantages are:
- The ability to preserve the childbearing function of the patient.
- Performing surgery in clinics not equipped with laparoscopes.
- The ability to create a special suture after removal of a large fibroid, which reliably fixes tissue, which allows a woman to become pregnant and give birth in the future.
Hysteroscopic
This operation is the removal of a benign tumor through the vagina using a special device called a hysteroscope. It is recommended that it be carried out if the patient has one of the following indications:
- Myoma on the leg, which causes severe pain.
- Small myomatous nodes directed into the uterus.
The main advantages of this surgical method are the short duration of the operation itself, the absence of complications during subsequent births, the preservation of reproductive function, the cosmetic effect (there are no scars and sutures), and minimal blood loss. Perform it on an outpatient basis without anesthesia.
Abdominal
The most traumatic type of operation. It is used for very large fibroids, as well as for large accumulations of tumor nodes. Also, this myomectomy can be performed with torsion of the fibroid legs and with necrosis of the tumor itself and adjacent tissues.
During the operation, a sufficiently large incision is made, allowing you to visually assess the complexity of the case and gain access to any part of the uterus. The recovery period after such an intervention is more than two months.
Endoscopic
This is one of the least traumatic methods. The operation can be performed using a laparoscope or hysteroscope. In any case, it is performed under general anesthesia. After the intervention, there are no scars on the uterus, and on the abdomen you can see only small traces of punctures for the introduction of a laparoscope (if it was used for treatment).
Recovery period
The postoperative period with conservative myomectomy lasts several weeks. If the procedure is carried out by the laparoscopic method, the patient is already allowed to get out of bed on the second day.
After conservative myomectomy in the postoperative period, a woman has to wear a special bandage for several months, prevent constipation, and avoid heavy physical exertion. All this can lead to divergence of seams. Disorders in the intestines can also cause inflammatory diseases of the appendages and uterus.
After conservative myomectomy, it is recommended to monitor your diet. It should include foods with a lot of fiber, which help cleanse the intestines. If as a result of the operation the uterus was saved, you should wait for the restoration of its inner layer.
Many women are wondering if pregnancy can be planned after conservative myomectomy. After how many months is the full restoration of the uterus? This process can take from 6 to 12 months. Each woman's recovery process takes place individually. Therefore, before conception, you need to undergo a full examination.