Surgery for endometriosis

Surgery for endometriosis is the leading method of combating this chronic disease. Depending on the pathology of the species methods for the removal of endometriosis may be different. Thus, when carried adenomyosis access to the uterus through the hysteroscope and removing lesions by scraping, laser degradation shock. Endometriosis of the ovaries, tubes and pelvis is the reason for the laparoscopy or laparotomy.

Common approaches to the removal of endometriosis

Endometriosis of the uterus is a hormone-dependent diseases, which has no clear origin. endometrial cells begin to grow outside the uterus. The reasons for these pathological changes were not yet fully explored by scientists. The most likely factor in the development of endometriosis - is the presence of hormonal disorders of immune homeostasis.

Laparoscopy is a leading method of surgery in gynecology. The operations performed by laparoscopy, characterized by minimal risk of complications both during the intervention, and after it. In addition, the rehabilitation period after laparoscopy is characterized by a slight current, which is especially important for patients.

Quite often laparoscopy as a method of treatment used for endometriosis. Endometriosis occurs when endometrial cells found in the lining of the inner membrane of the uterus, are thrown and grow into unusual for these fabrics. It is a pathological condition characterized by for women in fertility phase.

For relief of symptoms of the disease should be conservative and surgical therapy. The choice of tactics of treatment depends on the clinical case.

Distinguish endometriotic lesion growths inner surface of the uterus and cervix - adenomyosis and endometriosis, when foci observed in the tubes, ovaries, in the pelvic cavity. Endometriosis of pelvic peritoneum, Endometrioid ovarian cysts, tubal damage and adhesions due to endometriosis considered a cause for interference through the abdominal cavity by laparoscopy or traditional section.

Adenomyosis or endometriosis inner can be removed by scraping. If during gisterskopii detected lesions, their removal is carried out, small areas sear.

As a rule, the operation is recommended when ineffective drug tactics.

After removal operation endometriotic lesions appointed by the necessarily hormonal drugs to prevent disease recurrence.

Conservative strategy involves the use of drugs of the following groups:

• hormonal;
• anti-inflammatory;
• antibacterial;
• immunostimulatory;
• protivospaechnye.

Operation with endometriosis usually involves the implementation of laparoscopic cauterization and subsequent lesions. Drug therapy is definitely assigned before the surgery as well as after it.

Indications to Step
Indications for surgery for endometriosis - this common localization of endometrioid heterotopias. generalized external endometriosis It causes excruciating pain and can not be a conservative method of treatment. It is advisable to carry out the operation with limited lesions of endometriosis is pelvic organs.

Before you decide to step in endometriosis, the gynecologist considers it expediency volume lesions, age of the patient and the danger of damaging the adjacent reproductive authorities. Sometimes during surgery can injure the rectum and sigmoid colon, ureter and bladder.

The main reason of the operation of endometriosis - it is the inefficiency of conservative and medical treatment.

Are the following indications for surgery:

• persistent or recurrent intense pain in the lower abdomen;
• adhesions;
• pain with defecation;
• infertility;
• uterine bleeding.

Before you decide whether surgery for endometriosis, doctors consider the following important factors:

• age of the patient;
• the total amount of land that struck endometriotic lesions;
• the likelihood of damage rectum and sigmoid, ureter and bladder.

Terms of the transaction

Surgery for endometriosis is held for three days before the onset of menstruation.

A common form of endometriosis, whereby impressed ovaries, pelvic peritoneum, diagnosed conglomerate formation of tumors and cysts chocolate requires immediate removal. In this case, doctors can completely remove the uterus and ovaries. Conservative surgery, during which saved unlesioned ovary, is indicated for women who want to have a baby. It is shown the complete removal of all endometrial neoplasms.

During the comprehensive diagnosis and examination, the doctor checks the uterus and peritoneum for the presence of lesions. If patients have found widespread pathological formations, the endometriosis surgery has its difficulties. With such the disease affected tissue that is very close to the bladder, ureter and rectum. Due to the high probability of injury doctors not limited to removal of endometriotic heterotopias that are inside the abdominal cavity. Even if such operation stops the development of pathological processes in the future. Surgical treatment in women of menopausal age is carried out radical removal of the uterus and appendages.

Removal adenomyosis foci in postmenopausal women is conducted with performing the ablation - excising the basal layer to prevent further germination endometrium. Young women are less invasive surgery. Carried curettage, cauterization foci and hormonal therapy, administration of medicament in menopause for 6-9 months.

Laparoscopic surgery

The essence of laparoscopic surgery for endometriosis is a few moments.

1. Preliminary examination. The gynecologist evaluates the degree of localization and size of pathological growths.
2. Deleting. Surgeons removed pathological lesions using one of the techniques: coagulation or cauterization.
3. Taking samples of excised tissue for histological examination.

There are several successive stages during laparoscopy.

1. A doctor in the abdominal wall makes several small openings required for the introduction of manipulators.
2. FIELD peritoneum is inflated with an inert gas to improve visibility of internal organs and separating the walls from adjacent tissues.
3. A surgeon inspects and then determines the affected areas, after which they are excised or cauterized.

9 hours before surgery forbidden to consume food or drink fluids. These precautions will help prevent vomiting or nausea after surgery, throw food into the airway during anesthesia.

Laparoscopy is done exclusively under general anesthesia.

Operation starts in endometriosis peritoneal cavity with filling special gas. This intervention helps to improve visibility during surgery. The abdominal wall is lifted slightly, and doctors may well consider all sides and to monitor their actions.

On the abdomen of the patient make small holes, the amount of which no more than two centimeters. They entered the laparoscope and other tools for manipulation. A tube with a video camera displays the image on the monitor screen. Subject to removal only tissue that struck endometriosis. They cauterize electric current, liquid nitrogen or laser beams. The latter are currently the most effective and safe.

During the operation carefully cauterize the blood vessels, thus completely eliminated the risk of bleeding.

Duration of the operation an average of about 30 minutes (up to one hour), but in severe forms of endometriosis longer it is held.

At the last stage, the doctor removes all the instruments and sutures. After laparoscopic surgery patients are left with scarring.

Complications after surgery have a probability of only 1%. Possible complications include:

• penetration of infection into the abdominal cavity;
• severe bleeding;
• the presence of adhesive processes;
• damage to the urethra, bladder or bowel.

One of the indications for laparoscopy is endometrioid ovarian cyst. This pathology occurs in the propagation area of ​​endometriosis on the ovary.

Endometrioid ovarian cyst can reach a considerable size and thus flow asymptomatic. Typically, ovary formation is detected during a gynecological examination and then confirmed on US.

Endometrioid ovarian cyst may cause organ dysfunction and contribute to infertility. In addition, it is believed that this form of endometriosis is the risk of degeneration into a malignant tumor.

Many doctors strongly recommend removing endometrioid ovarian cysts using laparoscopy. In the absence of infertility considerable size and signs of cancer alertness recommended observation tactics and conservative treatment in women of reproductive age. This is due to the fact that healthy ovarian tissue unaffected and often reduced ovarian reserve after laparoscopy.

recovery period

In the rehabilitation period after performing laparoscopy women showing reception antibacterial, immunostimulating, anti-inflammatory drugs. It is mandatory appointment of hormone replacement therapy for a long time, thus avoiding the recurrence of endometriosis. Among the most popular of hormones secrete Janine, Visan, Buserelin. Visan endometriosisAs well as other hormones used from 6 to 9 months.

During the first two months after surgery, it is necessary to abandon the exercise and sexual intercourse. It is important to observe the following professional guidelines:

• balanced diet;
• in the diet should be present fiber;
• rejection of bad habits, alcohol and drugs;
• sports;
• walks in the open air;
• observance of personal hygiene;
• renounce the use of intrauterine devices.

If after surgery in women during the first five years there was no relapse and no pain, then the remission is considered resistant.

Scraping

During scraping the uterine cavity doctors remove only an upper layer of the endometrium. After surgery, it is rapidly reduced by the base layer. There are two ways curettage with endometriosis.

1. Separated. During gynecologist procedure cleans the cervix and then the cavity. The resulting material was sent for histological examination.
2. Traditional. Removes all abnormal formation of the body of the uterus blindly. This method often leads to serious complications or injury.

Due hysteroscopy scraping can completely control and evaluate the result obtained after the operation.

The procedure is done a few days before the onset of menstruation. This contributes to the rapid recovery of the endometrial tissue.

Are the following indications for curettage, concomitant adenomyosis:

• presence of endometrial abnormalities in the structure, which are well visible during ultrasound;
• significant endometrial thickening, greater than the normal value;
• polyps in the uterine cavity;
• menstrual disorders;
• suspicion of a malignant nature of the tumor;
• after spontaneous abortion;
• adhesions in the uterus after labor.

Scraping practically has no contraindications and serious complications.

Upon reaching the woman menopause may conduct ablation during surgery when removed not only the functional layer of the endometrium, but several millimeters layer situated more deeply. After this operation the woman becomes completely barren, but the endometrium is not able to grow.

Laparoscopy for uterine endometriosis, scraping is used for the ineffectiveness of conservative method infertility. After the transaction the chances of getting a healthy pregnancy are increased. However, it should be noted that endometriosis is a chronic disease. Completely get rid of this disease is only possible by removing the uterus.

Thanks to the timely birth (before 30 years), a woman with this disease may be carried out by treatment of the mother, whereas after 30 s aggressive hormonal treatment of endometriosis and surgery significantly reduces the chance of pregnancy even with ECO.