Surgical treatment of endometriosis and its effectiveness. Surgical treatment of endometriosis - is it necessary to remove the uterus Indications for removal of the ovary in endometriosis

If there are indications for surgical intervention for endometrioid disease, the doctor will choose the most optimal type of operation. Laparoscopy for endometriosis is used for diagnostic and therapeutic purposes, allowing the removal of pathological foci from the abdominal cavity. Endoscopic intervention will give excellent results in endometrioid ovarian cysts and in peritoneal endometriosis. The doctors' comments indicate the high efficiency of the laparoscopic technique for nodular forms of adenomyosis, especially in combination with subserous uterine leiomyoma. After the operation, you will need to continue medical treatment to prevent the recurrence of the disease.

Indications for surgery

A guaranteed option to completely get rid of endometrioid disease is the surgical removal of heterotopias of any localization. For young women who want to have a baby, the doctor will choose methods to preserve reproductive function. Older women who have performed childbearing function can use radical surgery.

Surgical treatment is indicated in the following cases:

endometrioid ovarian cysts;
adenomyosis with severe menstrual bleeding and anemia;
lack of effect from drug therapy;
combined pathology of the uterus (adenomyosis and leiomyoma, isthmus myomatous node and retrocervical endometriosis, doubling of the uterus in any form of endometrioid disease);
infertility with endometriosis;
the presence of a malignant tumor of the reproductive organs in adenomyosis;
diseases of the internal organs, excluding the possibility of long-term hormonal therapy;
defeat by endometriosis of neighboring organs (rectum, bladder, ureters and kidneys).

Removal of the pathological focus will be the best option for getting rid of the disease, but subject to the correct choice of the method of operation. In addition, it is necessary to continue conservative treatment after surgery. Reviews of women after surgery show that refusal of therapy can cause a relapse of the disease.

Operation types

Depending on the type of endometrioid disease, the following types of surgical interventions are possible:

embolization of the uterine arteries, used for severe bleeding against the background of adenomyosis;
removal of the uterus or resection of a cystic ovarian tumor during abdominal surgery;
extirpation of the uterus by vaginal access;
laparoscopic version of the operation.

Endoscopic surgery can effectively treat endometrioid disease while maintaining a woman's reproductive capacity. Reviews of women who have undergone laparoscopy are encouraging: most of them become pregnant in the coming months after the operation.

Preparation for laparoscopy

Endometrioid ovarian cysts require mandatory surgical intervention. The laparoscopic technique is optimal because this variant of the cystic tumor is never very large in size. In addition, prior drug treatment can reduce the formation before surgery.

At the preparation stage it is necessary:

take tests;
treat anemia and remove chronic infections;
follow the doctor's prescription for preoperative hormone therapy;
get advice from specialists (therapist, cardiologist, endocrinologist).

Reviews of doctors show: the better the preparation, the less complications after the operation.

Operation progress

Any type of operation requires a full-fledged general anesthesia, both for abdominal and laparoscopic intervention. The main goal of surgical treatment is the complete removal of endometrial lesions while preserving healthy tissues as much as possible. This is especially important in women of reproductive age.

Features of laparoscopic surgery for endometriosis:

a gentle method of intervention, thanks to which women have a real opportunity to become pregnant and give birth after surgery;
laparoscopy is used for all types of endometriosis for diagnostic and therapeutic purposes;
effective removal of ovarian cysts with minimal trauma to the abdominal cavity and preservation of the endocrine function of the organ;
coagulation of heterotopias on the inner surface of the small pelvis, which allows to remove multiple small foci of endometriosis;
treatment of combined pathology - removal of subserous leiomyoma and endometrioid lesions;
preventing the formation of adhesions inside the abdomen.

At the first stage of the intervention, the doctor introduces air into the abdominal cavity through a puncture to create conditions for the operation. Through 2 holes in the abdomen, the specialist inserts an endoscopic instrument and conducts a complete examination of the internal organs and structures of the small pelvis (ovaries, uterus, tubes, peritoneum, ligaments).

When confirming the diagnosis and identifying all endometrioid lesions, the following operations are performed:

resection of the ovary with removal of the cyst;
resection of the endometrioid node in adenomyosis;
conservative myomectomy;
laser coagulation of endometriosis foci on the peritoneum.

Laparoscopic surgery is used according to indications, and in the case when it is necessary to preserve the childbearing function. Feedback from women indicates a quick recovery after the intervention and minimal complications in the future.

After laparoscopy

The postoperative period with laparoscopy takes several days. Discharge from the hospital is usually carried out for 2-3 days. Treatment in a polyclinic lasts about 2 weeks. There will be 3 single stitches on the abdomen after the operation, which must be removed on the 5-6th day. After 10 days, the result of histology is ready (the removed tissues must be sent for a special histological examination, which makes it possible to confirm the diagnosis with a guarantee).

Of great importance for the treatment is the implementation of the doctor's recommendations for hormone therapy. A long course of drugs is possible in the form of intramuscular injections, which are administered according to the scheme, or in the form of tablets. The therapy option is selected individually, depending on the desire of the woman to have a baby in the near future. The doctor will definitely take into account the histological result when choosing a therapy regimen.

The optimal prevention of recurrence of endometriosis is gestation and prolonged breastfeeding. During this period, a natural hormonal background is created that prevents the emergence of new foci of the disease. If conception does not occur, then it is necessary to start a course of treatment using special hormonal agents. Drug therapy should be long-term to prevent the risk of recurrence of endometrioid disease.

One of the effective methods of treating internal endometriosis is laparoscopic intervention, which allows you to visually assess the situation in the small pelvis and remove pathological foci in a timely manner. The specialist will use the endoscopic option strictly according to indications. The desire of a woman to have a baby will definitely be taken into account. If there are conditions, then the doctor will always leave the uterus and ovaries in order to maintain menstrual and reproductive function. After endoscopic intervention, it is necessary to continue conservative therapy using drugs prescribed by the doctor. It is possible and necessary to become pregnant and give birth after laparoscopy in order to effectively prevent a possible recurrence of endometrioid disease.

A woman often encounters diseases that affect the genitals. When an abnormal growth of the endometrium occurs in the uterus, a radical method of solving the problem may be required. Surgery for endometriosis allows you to get rid of unpleasant symptoms by removing lesions.

Indications for surgical treatment of the disease

The main task of treating the disease is to remove damaged tissues, therefore, an operation is performed. It is assigned in the following cases:

with retrocervical localization of endometriosis;
due to adenomyosis, in which there is an abnormal growth of tissues in the uterine cavity, and fibroids with uterine bleeding;
with an endometrioid ovarian cyst;
due to the lack of effectiveness of conservative therapy.

For treatment, choose the appropriate type of removal of endometriosis.

What operations are carried out

There are several types of surgical intervention. The choice of method in each case is influenced by: the age of the patient, the form of the disease, reproductive function and the location of the foci. Doctors offer to carry out organoplastic operations, minimizing surgery, in which the organ is completely removed.

During laparoscopy, small incisions are made. Of all types of operations, it is the safest with minimal risks. It is carried out a few days before the start of the menstrual cycle. Preparation begins 1-3 days before menstruation. For the procedure, high-tech equipment is used. The operation is carried out as follows:

The operation takes from 30 minutes to 1 hour. Its duration depends on the severity of the pathology. A method such as laparotomy is used when the affected area is in the pelvis and peritoneum. To ensure full access to the internal organs, an incision is made in the abdominal cavity. The procedure takes place in several stages:

The doctor carefully examines the fallopian tubes, uterus, ovaries, rectum, abdominal region and connections to determine the size and.
To ensure normal conditions for surgical intervention, adhesions are dissected, if these actions are necessary.
Removal of foci of the disease is carried out using a laser, electrocoagulation or thermal destruction.

This method of treatment has many advantages, since open access to organs is provided. Vaginal operations will relieve the unpleasant consequences of cutting the peritoneum. The procedure will require spinal or local anesthesia. The method is not used in severe forms of the disease.

It is used to remove endometriosis, the cervix, fibroids, and in some cases the entire organ.

Rarely, a hysterectomy is required, in which the uterus and ovarian appendages are removed. The method is radical and is used for problems with the genitals. The operation is performed vaginally or by cutting the peritoneum. Before surgery, it is necessary to prepare by passing tests, cleansing the intestines and getting rid of problems with the cardiovascular system, if any.

Postoperative period

Recovery after surgery will be different. If methods without cutting the peritoneum were used to remove the foci of the disease, then the suture will not remain. A woman will be prescribed so that infection of the affected tissues does not occur. The patient will be able to return home a few hours after surgery.

The rehabilitation period after laparoscopy lasts several days. At this time, unpleasant phenomena may occur due to the presence of gases in the abdominal cavity. An abdominal operation requires a long hospitalization, during which the woman is given antibiotics, the suture is treated and dressings are made.

In this case, the patient must avoid stress, get enough sleep and eat right so that constipation does not occur. and lifting heavy objects are prohibited. After the control ultrasound, the patient is discharged. The danger of the disease is that it may appear again if not treated. Endometriosis will not recur only if the uterus is completely removed.

When the organ was saved, after the removal of endometriosis, the patient is prescribed hormonal drugs. Their action is aimed at reducing estrogen levels and preventing tissue proliferation. It is recommended to undergo an examination by a gynecologist at least 4 times a year.

Preparations for hormone therapy are selected by the doctor, taking into account the age of the woman and her state of health. The disease can be considered cured if no characteristic symptoms have occurred for 5 years, and hardware diagnostics have shown the normal thickness and location of the endometrium. In some cases, during this period, the development of pathology may repeat.

The extinction of the disease is observed with a decrease in reproductive function. When menstruation stops, there is no tissue proliferation, so constant monitoring and therapeutic measures are not required. At menopause, endometriosis and its relapses are observed only because of a violation of hormonal function.

Possible consequences

Removal of endometriosis allows you to eliminate severe manifestations of symptoms. Sometimes, despite the many advantages of surgery, there are negative consequences. As a result of laparoscopy, the following complications may occur:

Laparotomy can lead to the following consequences:

inflammatory process and infection;
the formation of adhesions;
scar formation at the incision site;
profuse menstruation;
pain caused by tissue damage;
bleeding.

Emotional problems arise with a hysterectomy. A woman may have an early menopause, dark brown discharge, pain after rehabilitation, or a difficult recovery period. In some cases, the patient will no longer be able to have children, but specialists are trying to minimize the risk of such complications.

Therapy and prevention after surgery

After surgery, it is recommended to exclude sexual intercourse and physical activity during the first 2 months. In this case, it is necessary to observe preventive measures:

Prevention of the disease is an established sexual life, taking hormonal drugs as prescribed by a doctor, and the birth of a child under 30 years old.

Usually, when a woman finds out her diagnosis - endometriosis, the thought that an operation is required follows. Does the removal of the affected lesions always take place surgically, are there any possibilities to carry out therapy by other methods? It all depends on the characteristics of the course of the disease and the health of the patient.

Endometriosis often greatly complicates the quality of life. Excruciating pain in the pelvis, cycle disorders, inability to conceive a child. Endometriosis is characterized by the development of adhesions in the abdominal cavity, in the area of the sacrum. Nearby organs begin to function abnormally, and treatment is simply necessary.

Treatment: conservative or surgical?

First, the patient is diagnosed. After a series of studies, the specialist decides which treatment will be effective, taking into account the localization of pathological foci and the characteristics of the woman's health. Sometimes hormonal therapy, immunosuppressive drugs and other medications are prescribed. However, this approach does not always work. In this case, the operation is shown.

Indications for surgery

Surgery to remove endometriosis is indicated for:

retrocervical location of endometriotic lesions,
endometrioid ovarian cyst,
adenomyosis (when the uterus itself is affected by endometriosis), and there are complications - bleeding,
lack of effectiveness of drug therapy, even if endometriosis is uncomplicated.

Operation types

Each operation to remove, more specifically, excision or coagulation, endometriosis has its own characteristics.

Laparoscopy. Removal is minimally invasive, with minor incisions.
Laparotomy. An incision is made through the abdominal wall to gain access to the internal organs.
Operation through vaginal access.
Combined technique: laparoscopy and vaginal access.

Many doctors today agree that surgery for uterine endometriosis, even if the pathology is in a complicated form, should be as gentle as possible. If possible - organoplastic. Radical removal is a measure only for the most extreme situations, when all methods of treatment, both medicinal and minimally invasive surgical, have exhausted themselves. In addition, this applies to those patients who plan to have children.

Removal by laparoscopy

Laparoscopy is the treatment of choice if the pelvic peritoneum, ovary (or both ovaries), retrocervical endometriosis, adhesions, and cysts are affected.

The reproductive function of the woman is preserved, and the removal of pathological foci allows you to stop the development of the disease.

Laparoscopic removal, provided that it is carried out by a good specialist, helps to avoid postoperative complications and overcome the symptoms that accompany endometriosis and so torment a woman:

pain,
dyspareunia,
functional infertility, etc.

Laparoscopic surgery to remove uterine endometriosis does not guarantee a 100% cure. It may be necessary to repeat the intervention, since endometriosis is a chronic, recurrent pathology.

Removal of pathological foci on the peritoneum

If endometriosis is localized in the peritoneum, then the operation goes like this.

The specialist carefully examines the area of the peritoneum, depressions (rectal-uterine, vesico-uterine), fallopian tubes, each ovary, sacro-uterine ligaments. The uterus and some parts of the rectum also receive close attention.
Based on the results of the examination, the doctor determines the size, as well as the degree of spread of the identified foci.
After the surgeon dissects the adhesions and performs other manipulations that are necessary to eliminate endometriotic lesions.
At this stage, coagulation or excision of pathological foci is carried out. Use a laser, methods of electrocoagulation, thermal destruction or others.

Surgery for ovarian endometriosis

If the ovary is covered with endometrioid cysts for a long time, then adhesions occur. In this case, adhesions occur: the uterus with the sacro-uterine ligaments and nearby organs.

For the effectiveness of treatment in this case, it is not enough just to clean the cyst that has arisen. The capsule should be removed.

How is ovarian endometriosis surgery performed?

An ovary with a pathological process is isolated from adhesions, adhesions are cut off.
The organ is resected, leaving tissues unaffected by the pathological process.
If the cyst is no more than three cm in size, then it is easier to eliminate it. It is husked, the capsule is removed or excised in fragments if it is too large.
The cyst bed is treated with a laser or an electrode. This ensures hemostasis.
The removed cyst capsule is transferred to the laboratory for histology.

Who can be referred for spaying or adnexectomy? Adult women at the age of the upper limit of reproductive age or in the postmenopausal period, those with chronic endometriosis, the ovaries are affected by large cysts, in whom the disease often recurs.

Retrocervical endometriosis: scope of intervention

The volume of the necessary operation depends on the degree of pathology, as well as whether other organs are involved in the process. Therefore, ultrasound and colonoscopy are performed first.

Counts,

that an operation with such a pathology is the most difficult task, since it is necessary not only to eliminate the foci of pathology, but also to restore the correct anatomical structure, to establish the functioning of the pelvic organs.

Recently, the laparovaginal method is often used. To begin with, the doctor excised the endometrioid focus through the vaginal access. And at the same time, he performs a laparotomy to clarify the degree of pathology, to control how the process of eliminating the affected foci takes place. Then the affected area is treated with electrodes or a laser.

Curettage of the uterus

This procedure has indications:

the uterus is affected by polyps,
on ultrasound, deviations in the structure of the endometrium are noticeable,
the endometrium is very thickened, which exceeds the permissible values,
problems with the menstrual cycle,
suspicion of oncology,
after a miscarriage,
with adhesions in the postpartum period.

Scraping can take place in 2 ways. With a separate specialist cleans first the neck, then the cavity of the organ. The material is sent for histology. And with the usual, all pathological formations in the body of the uterus are removed blindly. This method can cause complications and damage.

Careful preoperative research leads to a better result. Minimally invasive techniques are effective in more than 50% of patients aged 20-36 years.

2011-03-31 16:56:30

Elena asks:

Hello. I am 35 years old. I had 3 pregnancies, 1 birth, 2 abortions. Three years ago, an intramural myomatous node was discovered. At first it was 20 mm, now it is 41 mm (8 weeks). There is also a 17 mm node. Endometriosis. Numerous small cysts.
Now I am worried about heavy periods with blood clots.
I was offered a choice of surgical treatment:
1.EMA
2. removal of the 41 mm node and after that put the Mirena Navy
3. removal of the node along with the uterus. At the same time, the ovaries and fallopian tubes remain.

What should I do, I am worried that after the operation I would not have problems with the growth of new nodes. What would you advise me. Is it possible to avoid surgery in my case? Thank you in advance.

Responsible Silina Natalya Konstantinovna:

Elena, I am categorically against the setting of mirena for you. It is necessary to begin with hysteroscopy - examination of the uterine cavity. After receiving the results, the most optimal would be to take Lindinet 20 according to the 24 + 4 scheme. But it is better to make an appointment to discuss further tactics in detail.

2010-11-17 08:15:42

Irina asks:

Hello! IM 33 years old. Ultrasound showed signs of an endometrial polyp and endometriosis. This month I am going to go to the hospital to remove the polyp. Please tell me, is it possible to carry out curettage of the uterine cavity in case of endometriosis and whether endometriosis will spread even more?

Responsible Petrik Natalia Dmitrievna:

It is better to carry out curettage under the control of hysteroscopy for a more gentle effect. In the postoperative period, hormone therapy is required to suppress the spread of endometriosis under medical supervision.

2008-10-20 14:26:27

Natalia asks:

Hello! I am 31 years old. I have endometriosis after a surgical scar on the anterior abdominal wall. At 21, I had a ruptured right ovarian cyst, histology confirmed endometriosis. At the age of 22, a cyst of the left ovary endometriosis during laparoscopy. At the age of 23, peritonitis was removed from the right and left ovaries along with the tubes. The pain continued to take hormonal drugs. At the age of 29, the removal of the uterus from the uterus, with histology, endometriosis of the uterus and cervix. completed a course of hormonal therapy. After 3 months, seals went along the scar. For 2 years, I had 18 operations to remove the endometriosis scar. Blood hormones show elevated estradiol and lutropin. I completed the full course and am currently taking danazol 400 mg and a supporting vitamin complex. I visited all the specialists, but they only spread their hands, they say that another operation must be done in the abdominal cavity to check whether a piece of the ovary remains there, the ultrasound does not show anything. What should I do if you can answer. with my hemoglobin of 138, I now have 75-95 blood transfusions, but it will not rise. Constant increase in blood temperature up to 37.7, but if compaction begins up to 40. Blood and urine are sterile. AIDS, Australian, RV, tank. cultures are negative. Help.

Responsible Kaliman Victor Pavlovich:

Good day, Natalia! I do not think that subsequent operations will bring you an improvement in your condition. Therefore, it is better, in my opinion, to refrain from surgery for endometriosis. Try triptorelin 3.75 mg. If this does not improve, contact a highly professional doctor for examination and the appointment of the maximum possible etiopathogenetic treatment.

2013-05-05 01:57:04

Oksana asks:

Hello, please tell me which drugs are better to use for the treatment of endometriosis, found after abdominal surgery during the removal of fibroids, the uterus with appendages was left.

Responsible Petropavlovskaya Victoria Olegovna:

Oksana, good afternoon. Endometriosis is a hormone-dependent disease in which a benign tissue growth occurs outside the uterine cavity, structurally and functionally similar to the endometrium (the location of the intrauterine layer in an unnecessary place). To date, there are no methods that would make it possible to claim its complete cure. Modern methods include the following approaches: observation; conservative treatment - hormone therapy, mainly; surgical - removal of foci of endometriosis with the preservation of organs. Many prefer the management of women with this problem by combining endosurgical intervention with pre- and postoperative hormonal therapy (mandatory) - the basic drugs are gonadotropin-releasing hormone agonists.

2013-02-08 12:34:23

Svetlana asks:

January 22, 2013 A laparotomy was performed to remove bilateral ovarian cysts (endometrioid) and multiple leukomyoma. An Intersid napkin was applied to the uterus. Foci of endometriosis were found in the peritoneum and intestines. The adhesive process is pronounced. (There was a laparoscopy operation in 2007 for the removal of bilateral cystic ovaries (endometrioid)). Pipes are good. Tell me, is pregnancy possible in such a situation? And what can be done against adhesive processes of the pelvic organs?

Responsible Shapoval Olga Sergeevna:

Hello Svetlana. Whether pregnancy will occur in this case, no one, unfortunately, will answer you 100%. Try it, especially since the condition of the pipes allows. Have you been recommended gonadotropin-releasing hormone agonists for the treatment of endometriosis? against the adhesive process, you can put distreptase suppositories, drink enzymes (serata, biozym, wobenzym). Anti-adhesion therapy should be carried out for at least 1.5 - 2 months.

2013-02-03 06:46:34

Tatyana asks:

Hello, Doctor!
After removal of the endometrioid ovarian cyst, she took femoston for 5 years, since menopause began. At the same time, internal endometriosis was observed. And over the past 8 months, ultrasound showed polyps of 8 and 9 mm in the uterus. (True is questionable!) The doctor canceled femoston and prescribed a second ultrasound in 3-4 months.
The question is, am I doing the right thing, waiting so much time and can these neoplasms go away when Femoston is canceled. Thank you!

Responsible Gritsko Marta Igorevna:

I advise you to undergo a follow-up ultrasound now to confirm the presence of polyps. If they really are and their growth will be observed in a few months, then a cleaning will be necessary.

2012-03-24 13:02:40

Iraida asks:

Hello, I am 47 years old, 14 years ago, my ovaries were excised - an endometriosis cyst. I have chronic pyelonephritis, pancreatitis and cholecystitis, calcium deficiency, ultrasound of the uterus - involution of the uterus. HRT was not prescribed at all. and phytolysin paste and sent for a consultation to a gynecologist, who decided that it was not enough hormones (dryness of the vagina and pain during sexual activity, pain during urination) and prescribed HRT and femaston 1/5. After 4 tablets, the lower abdomen fell ill, but not like on monthly-muscle pain and lower back, no monthly. Do I need HRT, what to do, nothing hurt before. Are there any cases of HRT being prescribed now if the operation to remove the ovaries was 14 years ago.

Responsible Wild Nadezhda Ivanovna:

Go back to the doctor for an examination, do a gynecological ultrasound. In parallel - repeat an.mochi. Possible exacerbation of cystitis, pyelonephritis. Do not rush to cancel HRT, only after examination by a doctor, if indicated.

2011-08-20 19:20:30

Elena asks:

Hello! On July 13, I underwent a laparoscopic operation to remove endometrioid cysts from both ovaries, the dimensions before the operation were: ovary - 5.7 * 4.1 * 3.3; left - 5.3 * 4.5 * 4.8. Jeanine was prescribed 3 months after the operation, plus postoperative ultrasound and blood and urine tests. I passed the tests 14 days after the operation, the urine was normal, the soybeans were elevated in the blood (21), a week later the second blood test was normal. Immediately after the operation, on the 2nd day, spotting began, I was warned that it might be so, they lasted 6-7 days, not very plentiful, like discharge, and not menstruation. My gynecologist said that this is ovulatory discharge, and I should wait for my period according to the schedule. My period was supposed to start around July 26-30, since my cycle can be 28-32 days. I was waiting for my period, but only on August 5 did at least some sign of spotting appear, that is, the cycle lasted 38 days. Why such a delay, postoperative stress for the body? Before the operation, my menstruation was also very poor, on August 5, it was a little smeared and calm, that is, it didn’t bleed like during normal menstruation, it just smeared a little and that’s it, but I had to start taking janine from the first day, I hesitated whether it was menstruation or not, and nevertheless, she began to take it on August 5, in the following days it was also just smeared, and not bloody. What is the reason for this, because the ovaries were now without cysts? Approximately 2 weeks after the operation, she began to notice the temperature only in the evenings up to 37.3, in the morning the usual 37.4-37.8, now (on August 20) the temperature rises to 37.1 in the morning. What is the reason for such a temperature for 3 weeks already, she told her gynecologist, she says that it could be postoperative. reaction. I had an ultrasound scan on August 17, a month after the operation, the ovaries are normal. sizes: right - 1.8 * 2.7, left - 2.4 * 2.8; conclusion diffuse enlargement of the uterus, condition after surgery, the body of the uterus is tilted backwards, dimensions 6.2 * 5.0 * 6.2, internal the structure is heterogeneous due to the uneven distribution of signals, the uterine cavity is not expanded. Why is the uterus so enlarged, maybe my post is connected with this. temperature? Magnetic resonance. tomography before the operation showed that the uterus is of normal size, the usual location (anteversio), 9.1 * 4.5 * 5.6, together with the cervix, the zonal structure of the uterine walls is preserved, the endometrium is well differentiated, corresponds to the menstrual phase. cycle (it was the 34th day of the cycle), the transition layer of the myometrium is unevenly thickened, max. transverse size 0.3 cm, its contours on the border with the myometrium are fuzzy, ext. the contour (on the border with the endometrium) is clear, even. The postoperative discharge also says that the uterus is normal. size and shape, normal color, mobile, there is no endometriosis in the uterus, the tubes are in order, as the endoscopist who operated me told me. Please tell me what the diffuse enlargement of the uterus can be associated with (maybe with the intake of janine, I have no special contraindications) and what to do about it? I don’t live a sexual life now, after the operation, too, I didn’t particularly strain after the operation, I didn’t lift anything heavy. Thank you very much, Elena

Responsible Klochko Elvira Dmitrievna:

Good afternoon. This condition is possible after surgery. Recovery takes about 3 months. Jeanine drink according to the scheme. It suits you - only a daub is possible on 1 package - keep drinking and do not quit. the uterus on zhanina will decrease in a couple of months.

2011-08-15 16:45:09

Asks tanya-m1964:

Hello, Doctor! Help me please! I am 47 years old, myoma of the uterus is put from the age of 30 and endometriosis. In May 2007, I put the Mirena spiral, until January 2011 everything was fine, and from January my periods became plentiful and for 10 days, on June 27 I started menstruating, there were plentiful, and then a small daub, went to the doctor, decided to remove Mirena, see how and what and put a new one. On July 20, Mirena was removed, and on July 22, as the doctor said, my period began, but it just poured from me. On July 29, they did a diagnostic curettage against the background of bleeding, dripped gentamicin, metrogilom and started drinking Norcolut from 5 tablets and stopped at 2. Somewhere since August 9, I began to bleed a little, on August 12 they made an injection of Diferelin 3.75, and Norkolut was canceled. The first day after the injection, it bled, as with menstruation, I drank vikasol, the second day a little, and today on the third day it bleeds more abundantly. Last ultrasound 08/12/11. Length 82, width 65, thickness 93. On the anterior wall, interstitial nodes 32*26mm, 13*8mm, along the posterior wall closer to the bottom at the border with the cavity, deforming the latter, interstitial node 21*19mm, in the lower segment along the posterior wall of similar growth knot 11mm. On both walls there are areas of increased echogenicity without clear contours. The thickness of the endometrial layer is 3mm. The structure of the endometrium is not changed, the uterine cavity is not expanded, the contours of the endometrium at the border with the inner muscle layer are clear. The cervix is visualized. The structure of the neck is along the cervical canal and there are several cysts up to 11 mm thick. The cervical canal is not dilated. The right ovary is visualized not enlarged, localization is typical, length 26, width 15, thickness 16. The structure is unchanged. The left ovary is the same. Pathological formations in the pelvic region were not detected. Free fluid in the retrouterine space is not detected. Conclusion - uterine fibroids with submucosal growth. echocardiography of internal endometriosis. Pathological examination after diagnostic curettage. - In the sent material, a large fragment (a whole node?) of fibroleiomyoma of a typical structure, with the phenomena of small-nested hyalinosis, is determined. The boundaries of the fragment are clear, in some places there is a narrow strip of normal myometrium outside. Separately, very small single fragments of the superficial endometrium. Scraps of cervical epithelium. Before the removal of Mirena, only one node was seen along the anterior wall and no changes were seen in the neck. I don't know what to do next. continue treatment with Diphereline, 3 months, then Mirena, or do surgery? If surgery, what kind? The doctor suggests removing the uterus along with the cervix. What are the consequences after such an operation? How will it affect your personal life? I will get rid of bleeding, but how will my ovaries work without the body of the uterus and can I leave the cervix? What should I do? Please help with advice, thanks in advance.

The term endometriosis is used in medicine to refer to a common gynecological disease caused by the growth of endometrioid tissue in the thickness of the muscular layer of the uterus or in other organs outside the uterus. At the same time, there are pathological foci which become more and more over time. In addition, endometriosis develops adhesive process in the sacrum and abdominal cavity, which interferes with the normal functioning of nearby organs.

So the pathology itself is characterized by very unpleasant symptoms, in particular severe pelvic pain, menstrual irregularities, etc., and is also the cause of severe complications, one of which often becomes infertility, the issue should be acute.

After a series of diagnostic studies, the doctor determines the most effective therapy, starting primarily from the localization of the pathology, as well as the physiological characteristics of the patient. In some cases, the problem can be dealt with by conservative treatment methods, including hormone therapy, immuno-strengthening drugs, and other means. But there are situations when drug treatment does not give the expected effect or is completely contraindicated, then endometriosis can be cured only with the help of surgical intervention.

Indications for surgical treatment

The main goal of any endometriosis should be complete removal of pathological foci. Only surgery can fully cope with this task, and the subsequent one can be aimed at preventing relapses of the disease. However, there are situations when it is impossible to do without surgical intervention. So indications for surgery serve:

endometriosis;
Availability ;
(adenomyosis) occurring together with fibroids, complicated by uterine bleeding;
inefficiency even in uncomplicated forms of endometriosis.

Operation types

Any surgical intervention for endometriosis is carried out in order to excise or coagulate the lesions. For this, they can be used the following methods:

(minimally invasive surgical technique with minimal incisions);
laparotomy(global incision of the abdominal wall in order to gain access to the internal organs);
with help vaginal access;
with help laparoscopy and vaginal access.

Most physicians agree that it is even necessary to exercise organoplastic operations, resorting to radical methods only in the most extreme cases, when all other surgical and medical treatment options have failed. This is especially important for patients of childbearing age who wish to maintain their reproductive function in order to have children in the future.

Today, an effective method of treating endometriosis, which allows preserving the generative function of a woman, is laparoscopy, which is used to remove pathological foci from the pelvic peritoneum, ovaries, as well as endometrioid cysts and adhesions.

Thanks to the laparoscopic method, the doctor can radically remove the lesions, while minimally injuring the patient. In addition, such a minimally invasive operation allows you to avoid many postoperative complications, as well as eliminate unpleasant ones, consisting in pain, menstrual irregularities, dyspareunia, functional infertility, etc.

can be performed repeatedly, given the chronic and recurrent nature of endometriosis. Sometimes repeated operations are carried out only to control the effectiveness of treatment. The nature of the pathology and the degree of its spread determines the scope of laparoscopy.

Surgery to eliminate foci of endometriosis on the pelvic peritoneum

When the pathological process is localized in the pelvic peritoneum, surgical treatment involves the following steps:

a thorough examination of the peritoneal area, as well as recto-uterine and vesico-uterine recesses, fallopian tubes and ovaries, sacro-uterine ligaments, uterus, as well as certain parts of the rectum;
determination of the size and extent of the detected endometrioid lesions;
creation of optimal conditions for the removal of lesions, which may include dissection of existing adhesions and other manipulations;
excision or coagulation of endometriosis foci using a laser, thermal destruction, electrocoagulation or other methods.

Surgical treatment of ovarian endometriosis

With long-term existence on the surface of the ovaries, a characteristic adhesive process develops, in which adhesions occur between the sacro-uterine ligaments, the posterior surface of the uterus and other organs. In order for the treatment to be effective, it is not enough just to empty the cyst, it is necessary to completely remove its capsule.

When removing the endometrioid cyst of the ovary, the operation is in the following way:

the affected ovary is released from adhesive adhesions. Adhesions are cut, as a rule, with the help of surgical scissors;
then the organ is resected within the limits of normal, healthy tissues, the cyst is husked, its capsule is excised;
after that, the cyst bed is necessarily processed with an electrode or laser to ensure reliable hemostasis;
all the internal organs of the abdominal cavity are washed, and the removed cyst capsule is sent to the laboratory for further histological examination.

It should be noted that it is much easier to remove the capsule if the size of the cyst does not exceed three centimeters. If it is not possible to completely remove the capsule, it is excised in parts.

In women who are at an older reproductive or postmenopausal age, suffering from ovarian cysts with large cysts and frequent relapses of the disease, adnesectomy(removal of the ovaries). The expediency of this operation can also be explained by oncological alertness. Removal of the ovaries can also be carried out by laparotomy.

Surgical treatment of retrocervical endometriosis

The volume of the required operation at is determined, first of all, by the degree of spread of the pathology and the involvement of other organs in the process. Before the operation, be sure to use an intravaginal and rectal sensor, as well as colonoscopy.

It is believed that the surgical removal of retrocervical endometriosis is the most difficult task to complete, since here it is necessary not only to remove pathological foci, but also to restore the normal anatomical structure and functioning of the pelvic organs.

In recent years, in medical practice, if surgical treatment of this type of endometriosis is necessary, it is most often used laparovaginal method, in which the lesion is first excised by the vaginal route, but at the same time, a laparotomy is also performed to clarify the extent of the pathology and control the removal of the lesion. After all the manipulations, the affected area is treated with a laser or electrodes.

It is very important to note that the effectiveness of surgical treatment is most ensured by a thorough preoperative examination of the patient, which makes it possible to detect and determine the degree of spread of the pathology. In addition, even at the diagnostic stage, it is important to analyze the stages of surgical intervention and prevent the possibility of complications.

How is the effectiveness of treatment assessed?

A woman can consider that she is completely cured of endometriosis if she has not experienced any symptoms for five years. recurrence of the disease, she felt well and did not show any clinical manifestations of pathology.

If endometriosis is diagnosed in a young woman, doctors always try to do everything in order to preserve her ability to bear children. In this case, the main criterion for the health of the patient can be considered the onset of her pregnancy and successful delivery. It should be noted that in today's gynecological practice, the use of effective minimally invasive surgical methods makes it possible to achieve this result in more than half of patients aged 20-36 years old.