wedge resection. What is ovarian resection, methods of implementation and rehabilitation. Does the ovary recover after resection?

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Ovarian resection is one of the most common gynecological operations, which involves the removal of a fragment of an organ. Resection is used for a variety of pathological conditions - benign tumors, cysts, apoplexy, polycystic ovaries.

Removal of part of the ovary is usually indicated for young women of reproductive age. Without presenting great technical difficulties, the operation, however, cannot be considered harmless, even if performed in a minimally invasive way by laparoscopy.

The possibility of a violation of the hormonal status, difficulties with conception are the most common problems that women who have undergone resection have to face. These consequences are always remembered by gynecologists, who are very balanced in determining the indications for surgery. Only after making sure that resection is the only possible treatment, the doctor will prescribe an intervention.

As a rule, resection of the ovary is carried out as planned after appropriate preparation, but emergency treatment is also possible in case of rupture of the cyst, when the patient is a young woman who does not exclude the prospect of having children in the future and who wants to preserve at least part of the ovary and fertility. Anesthesia is always general, and accesses may differ. The traditional laparotomy is increasingly being abandoned in favor of the laparoscopic technique, which has a number of undeniable advantages.

Indications and contraindications for ovarian resection

An operation to remove a fragment of the ovary is prescribed when conservative methods do not bring the desired result or hormonal treatment is contraindicated. In such cases, the only way out is to have surgery. Indications for resection are:

• Benign ovarian tumors of any nature;
• Endometriosis of the ovary, not amenable to conservative treatment;
• Polycystic and, accordingly, infertility;
• Cysts (both pathological and functional);
• Rupture of a corpus luteum cyst or hemorrhage into the ovarian parenchyma - apoplexy (emergency intervention);
• Ovarian injury.

It is worth noting that some specialists do not pay enough attention to drug treatment or do not even try to carry it out, while a woman wants to keep her ovaries safe and sound with all her might. For example, this happens with endometriosis. In these cases, vigilance and the desire of the patient herself to do without surgery are important, therefore, if you do not trust one gynecologist, you can safely turn to another, more experienced and qualified one.

Contraindications for ovarian resection are also available, because general anesthesia and penetration into the body cavity are to be carried out. These include:

1. Severe bleeding disorders with a risk of massive bleeding during the intervention or, conversely, thrombophilia, when tissue incision can provoke inadequate thrombosis;
2. Severe concomitant pathology of the cardiovascular, respiratory system, kidneys or liver (rare due to the relatively young age group of the operated patients);
3. Malignant tumors (the entire appendage with surrounding tissues is subject to removal);
4. Acute infectious pathology (flu, intestinal infections, etc.) - the operation is postponed until the moment of complete recovery, except for emergency, life-threatening cases;
5. An acute inflammatory process in the small pelvis is subject to conservative treatment, and the operation is performed only after the elimination of the focus of inflammation.

Preparing for the operation

Preparation for surgery is not much different from that for other types of interventions. When the issue of the expediency of resection is resolved, the patient will have to undergo the necessary preoperative studies:

• Pass a general blood and urine test, a biochemical blood test, possibly - blood for sex hormones and the CA-125 tumor marker;
• Pass a blood coagulation test (coagulogram);
• Examined for infections (HIV, hepatitis, syphilis, sexually transmitted diseases);
• Visit a gynecologist to take a smear from the vagina and cervical canal;
• Make an ultrasound of the pelvic organs;
• Pass a fluorography, according to indications - an ECG.

Emergency operations imply a minimum of studies that begin in the emergency room from the moment the patient arrives and include general clinical blood and urine tests, a coagulogram, ultrasound of the pelvic organs, and a surgeon's examination to exclude acute surgical pathology of the abdominal cavity.

When all the necessary diagnostic procedures have been completed before the planned resection, the woman goes to the therapist, and he, based on the presence or absence of concomitant diseases, gives his permission for the operation. All concomitant pathology should be cured as much as possible or brought to such a state that the intervention becomes safe.

If you need to constantly take any medications, be sure to warn your doctor about it. Before the operation, anticoagulants and other drugs that cause blood thinning are canceled. In diabetes, a switch to insulin may be required, even if the patient is well helped by glucose-lowering pills. When all risks are excluded, the gynecologist sets the date of arrival at the hospital with the results of all examinations passed.

On the eve of the operation, the woman is advised to refrain from a heavy meal, exclude all those foods that will provoke gas formation or retention of feces (chocolate, legumes, cabbage, pastries, etc.). 12 hours before the intervention, food and water are taken for the last time, if you need to drink any medicines, then the woman discusses this moment with her doctor.

In the evening before the resection, you need to take a shower and change clothes, the pubic area and lower abdomen are shaved during the planned laparotomy. If there are problems with the stool, then a cleansing enema will be offered. This is not only a measure that facilitates the course of the operation, but also the prevention of postoperative complications, in particular constipation. With strong excitement, sedatives or light sleeping pills are prescribed at night.

Ovarian resection methods

As a rule, resection of the left or right ovary is performed under general anesthesia, which largely determines the importance of preoperative preparation and attention to the general condition of the woman. In some cases, local anesthesia can be used (if there are contraindications to anesthesia, allergies to certain drugs, etc.).

ovarian resection

The operation can be one-sided or resection of both ovaries is performed. The need for bilateral intervention is dictated by diagnosed polycystosis or neoplasms or cysts on both sides at once.

Removal of the ovarian fragment can be performed laparoscopically and by standard laparotomy. Laparotomy has recently been the main method of access to the pelvic organs, but today it is confidently replacing laparoscopy, which has a number of significant advantages:

1. Minor tissue trauma;
2. Faster recovery and easier postoperative period, which shortens the period of disability to a minimum;
3. Excellent cosmetic result;
4. Lower complication rate after intervention.

Laparotomy access is mainly used for emergency interventions, when there is no time for adequate preparation and pelvic examination. In addition, in such situations, the nearest hospital may not have the necessary equipment or a trained specialist. With a strong adhesive process in the small pelvis, laparoscopy is completely contraindicated, so the gynecologist has no choice - the operation takes place through an open access through a wide skin incision.

After processing the surgical field, the surgeon proceeds to perform stages of the operation:

• An incision in the suprapubic zone in the transverse direction or along the midline of the abdomen, going from top to bottom;
• Penetration into the small pelvis, examination of the appendages, isolation of the ovary, dissection of adhesions, if any;
• Applying a clamp to the ovarian pedicle, which carries the supplying arteries;
• Economical excision of damaged parenchyma with maximum preservation of healthy tissue;
• Suturing the wound of the ovary with absorbable threads, stopping bleeding and ligation of blood vessels;
• Examination of the abdominal cavity for bleeding non-ligated vessels;
• Sewing up the skin wound in reverse order.

Suprapubic laparotomy more cosmetic and indicated for small ovarian formations, with median laparotomy used for large cysts or tumors. If a purulent focus is found in the ovary, then washing with a solution of chlorhexidine is carried out and drainage tubes are installed to drain the discharge. Drainage is also indicated for inflammation in the pelvis or abdominal cavity.

Wedge resection of the ovary includes excision of its part in the form of a wedge, facing the base to the periphery (capsule) of the organ. In this case, the surgeon dissects the parenchyma deeply in the direction of the ovarian gate, but not reaching them, so as not to cause circulatory disorders in the remaining part of the organ. The resulting defect is sutured with thin needles so as not to injure a very fragile tissue. Threads should not be tightened too much, as this can cause them to eruption with the risk of complications. Bleeding vessels are tied up.

wedge resection of the ovary

Resection of an ovarian cyst can be carried out through a similar access. The cyst, after removing it into the wound, is delimited with a napkin. An ovarian incision is made at the border between the cystic cavity and healthy parenchyma, carefully so as not to damage the tissue. The cyst is separated from the ovary without much effort, and the thin bridge that connects it with the organ is crossed.

When resecting a cyst, it is important to act extremely carefully, since a large cavity can push the ovarian tissue to the periphery and make it look like a thin plate, and then there is a risk of removing such an altered, but still functioning, organ simultaneously with a pathological formation.

After excision of the cyst, the integrity of the remaining fragment of the ovary is restored, sutures are placed on the vessels, the pelvic cavity is examined, and the abdominal wall is sutured in the same way as with wedge resection.

Resection of the ovary for polycystic- one of the main methods of treating pathology, since conservative therapy does not always bring at least some effect. The operation is performed on two ovaries at once, removing at least two-thirds of each organ. Its technique does not differ from that of wedge resection.

The meaning of the surgical treatment of polycystic disease is to remove sclerotic tissues and follicles “immured” in them and, thereby, provoke the normal maturation of eggs. This method allows you to achieve ovulation and conception in case of infertility against the background of polycystic disease, as well as normalize the hormonal background of a woman.

Laparoscopic resection of the left ovary or a fragment of the right takes about the same time as an open operation, and also requires general anesthesia. The main difference between laparoscopy and laparotomy is the absence of a large incision and scar in the future, that is, a very good cosmetic result, which is achieved through the use of special instruments.

Preparation for laparoscopy is the same as for open surgery, but the patient pays special attention to the condition of the intestine and its thorough emptying. Content-filled bowel loops during laparoscopy can complicate the process of injecting gas into the abdominal cavity and impair the view for the surgeon.

After immersing the patient in anesthesia, the surgeon makes three small incisions (about 2 cm) in the anterior abdominal wall, through which he introduces instruments, a video camera, and a light source into the abdomen. To improve visibility and lift the abdominal wall, carbon dioxide is injected into its cavity.

laparoscopic ovarian resection

Dissection of the parenchyma of the ovary and removal of the fragment is performed using an electrocoagulator, through which a high-frequency electric current flows. The coagulator does not damage the surrounding tissues, but "cuts" the area where the surgeon directs its action. In addition, the high temperature created in the zone of action of the coagulator contributes to sealing the gaps of small vessels, minimizing the risk of bleeding.

After the desired section of the ovary is cut off, the surgeon takes it out, examines the pelvic area with a video camera for bleeding or other pathological changes. If everything is in order, then the instruments are removed, and small skin incisions are sutured.

Postoperative period and possible complications

The postoperative period during resection of the ovary usually proceeds quite favorably. After laparoscopy, it is noticeably lighter and shorter than after open laparotomy. In the first days after the intervention, the patient may be prescribed painkillers, anti-inflammatory drugs, antibiotics with a high risk of infectious complications.

By the end of the first day after the operation, the woman may well get up and it will be even better if she tries to do this as soon as possible. Timely activation, walking even within the ward or corridor can help prevent complications - thrombosis, embolism, intestinal disorders, and also contributes to the normalization of blood circulation and the fastest tissue regeneration.

Every day, the postoperative wound is treated with an antiseptic solution, if there are drainages, the surgeon controls the discharge through them and, when possible, removes them. In the uncomplicated course of the postoperative period, the sutures are removed on the 7th day, and the patient is discharged home. After laparoscopic surgery, the time spent in the hospital can be reduced to 3-4 days.

Leaving home, the woman receives recommendations from the attending physician that will help her in further recovery:

1. During the first month after the operation, it is recommended to use a special bandage and compression underwear to accelerate the healing of the scar on the abdomen (it is not necessary after laparoscopy);
2. Sexual life should be abandoned within the first month;
3. Up to six months after ovarian resection, the doctor may recommend contraception;
4. If you feel worse, have pain in the abdomen, discharge, you should immediately seek help from a doctor.

Complications possible both in the case of open surgery and during laparoscopic resection of the ovary. The most common are bleeding and hematoma formation, infection of the postoperative wound and pelvic organs. In rare cases, damage to adjacent structures occurs with instruments during surgical procedures.

Adhesive disease and infertility occupy a special place among the long-term consequences. Adhesive disease is directly related to surgical trauma and manipulations on the ovary, more often it occurs after laparotomy interventions. Infertility can be provoked both by the removal of part of the follicles along with the resected fragment of the ovary, and by the formation of adhesions that compress the appendages.

Another consequence of ovarian resection, especially if it was performed on both sides, is a decrease in the production of sex hormones, which is manifested by menstrual irregularities, signs of premature menopause (dry skin and mucous membranes of the genital tract, hot flashes, depression, etc.).

Even those women who undergo resection in order to establish ovulation experience infertility, for example, with polycystic ovary syndrome. If it is not possible to restore the ability to conceive after the operation, then the gynecologist offers auxiliary procedures, in particular, in vitro fertilization.

As part of rehabilitation after ovarian resection, many gynecologists recommend taking combined hormonal preparations containing estrogens and a progestogen component for a period of six months to 9 months. This allows you to normalize the hormonal background, save the remaining follicles and achieve pregnancy in a short time after hormone therapy is discontinued.

Video: ovarian resection technique

Content

An effective method of combating polycystic disease is ovarian resection. But the operation, during which the ovarian tissue is partially removed, is also performed for other pathologies. With its help, you can remove cystic formations, adhesions, tumors, foci of endometriosis.

What is an ovarian resection in women

Resection of the ovary is called a surgical intervention, during which the tissues of the gonad are partially removed. To do this, several punctures are made in the abdominal wall. Although earlier the operation was performed through an incision in the abdomen.

During surgical procedures, the doctor must excise the affected part of the ovarian tissue. But the sex glands are not completely removed. With polycystic disease, surgery is needed to facilitate the release of the egg from the follicles. After all, with a disease, the capsule of the sex glands thickens, and the oocyte cannot break through this membrane. In place of follicles that did not burst, multiple cysts appear. Over time, if left untreated, the situation only gets worse.

When performing a wedge-shaped resection, a part of the ovary is cut out in the form of an acute triangle. Thanks to this type of operation, it is possible to eliminate the concomitant factors of infertility. The probability of pregnancy after surgical procedures increases by 70-80%.

Indications and contraindications for the procedure

Most often, resection is prescribed for patients diagnosed with polycystic disease. But surgical intervention is indicated in cases where conservative therapy is ineffective.

Also, resection can be performed if:

• ovarian apoplexy;
• cystic formations;
• benign tumors;
• foci of endometriosis;
• purulent inflammation of the appendages;
• rupture of the cyst or torsion of its legs;
• ectopic pregnancy attached in the area of ​​​​the appendages.

All cystic formations, tumors, ectopic pregnancies are removed so as to preserve the ovarian tissue as much as possible. With polycystic disease, the surgeon cuts out overgrown tissue. In some cases, it can remove 2/3 of the volume of the gonad.

• exacerbation of infectious and inflammatory diseases of the genitourinary system;
• fever;
• disruption of the blood coagulation system.

After normalization of the condition, you can set the date of resection. It is impossible to excise ovarian tissues if there is a suspicion that the tumors on them are malignant.

Methods of ovarian resection

Before performing surgery, the surgeon must tell the patient which method of surgical intervention will be used. Depending on the situation, a unilateral resection is performed or the tissues of two ovaries are excised.

Reference! With polycystic disease, doctors operate on both sex glands at the same time.

The doctor can perform a resection using a laparoscopic or laparotomy approach. The choice of method depends on the equipment located in the clinic and on the state of health of the woman.

Laparotomy resection of the ovary

Laparotomy is done to patients if urgent surgical intervention is required. It is carried out with:

• ovarian apoplexy;
• rupture of the cyst or torsion of its legs;
• an emergency condition that arose against the background of a diagnosed ovarian pregnancy.

Planned laparotomy in modern clinics is done only for those patients who have a pronounced adhesive process in the pelvic region. Laparoscopy in this situation is contraindicated.

During a laparotomy, the surgeon makes an incision from top to bottom along the midline of the abdomen or in the suprapubic region in the transverse direction. Through the incision, he gains access to the appendages, can examine them, remove the identified adhesions, isolate the gonad and operate on it.

Laparoscopic ovarian resection

Most elective pelvic surgeries are performed laparoscopically. This type of access has many advantages:

• minor tissue trauma;
• reduction of the recovery period;
• reduction of the period of incapacity for work.

Attention! Thanks to the organization of laparoscopic access, it is possible to reduce the likelihood of postoperative complications. Adhesions in the pelvic area after laparoscopy occur much less frequently than after laparotomy.

During laparoscopy, 3-4 punctures are made in the patient's abdominal wall, through one of them the cavity is pumped with gas to move the organs away from the walls of the abdomen and from each other. This allows you to conduct a full examination and determine the required amount of surgical intervention.

A laparoscope is inserted through the puncture into the abdominal cavity. This is a special endoscopic instrument equipped with a video camera and a light source. Surgical instruments are inserted through other openings. Dissect the parenchyma of the gonad with an electrocoagulator using a high-frequency electric current. In the zone of its action, a high temperature is created, due to which small vessels are sealed, the risk of postoperative bleeding is minimized.

Technique of wedge resection of the ovary

If it is necessary to carry out a resection, the gynecologist surgeon, having gained access to the ovary, compresses the leg of the gonad, in which the arteries pass. After that, the ovarian tissues are excised in the form of a wedge, the tip of which is directed inward.

It is important to cut out part of the ovary in such a way as not to disturb the blood circulation in this organ. The doctor must remove the minimum amount of ovarian tissue, cut out the sclerotic formations and the immature follicles remaining in them.

After removal of the desired fragment, the ovary is sutured with self-absorbable threads using thin needles. It is necessary to do all the manipulations so that thin tissues are not injured. All bleeding vessels are tied up.

Types of surgery

Depending on the established diagnosis, the condition of the gonads and the goals set, the doctor selects the type of operation. With polycystic resection of both ovaries is performed. If cystic formations are detected on the one hand, a resection of the right or left ovary may be prescribed. In some cases, it is enough to make a partial resection. But there are situations when you need to completely remove the gonad or all appendages.

Partial resection

In reproductive age, women, if possible, do only a partial resection. Such an operation is less traumatic, during its implementation it is possible to preserve the reproductive function.

This method is mainly used to detect single cysts, polycystosis, inflammatory changes in tissues, ruptures, and torsion of cysts. After the operation, after some time, the operated organ is completely restored and begins to perform its functions again.

Resection of the left ovary

Removal of the tissues of the left gonad is necessary if there are formations on it that should be removed. The left ovaries in most women are smaller than the right ones, there are fewer follicles in them. Therefore, the probability of impaired reproductive function during operations on them is lower than during resection of the right gonad.

Resection of the right ovary

According to statistics, resection of the right gonads is performed more often. This is due to the fact that many patients have better blood circulation on the right, so problems on this side occur more often.

If a large cyst, tumor, ectopic pregnancy is found on the right ovary, then the doctor can cut out part of its tissues. The probability of maintaining reproductive health after such work of surgeons reaches 70%.

Resection of both ovaries

Most often, surgery on both gonads is performed on patients with diagnosed polycystic disease, which is not amenable to drug therapy. After all, it is necessary to remove sclerotic tissues from both sides. This will increase the chances of ovulation and pregnancy.

Bilateral resection is performed both in case of polycystic disease and in the detection of bilateral pseudomucinous or endometrioid cysts.

Rehabilitation

The recovery period after laparoscopy is much less. Patients recover in 2 weeks, after laparotomy the rehabilitation period is extended for 2 months.

During laparoscopy, in the evening on the operating day, the patient is recommended to start walking and perform simple movements. This is necessary to prevent the occurrence of complications in the form of adhesions, thrombosis, and intestinal disorders.

It is possible to prevent the occurrence of negative consequences after ovarian resection if, after discharge, you continue to follow the doctor's recommendations:

• refrain from sexual intercourse for 2-4 weeks;
• do not lift more than 3 kg;
• exclude from the menu spices, spices, smoked food, alcohol.

Medicines are often prescribed to prevent the return of the pathology. For many, the menstrual cycle after surgery is restored on its own.

Why is a part of the ovary left during surgery?

In the absence of indications for oophorectomy (complete removal of the ovaries), their tissues are excised only partially. This is necessary so that the sex hormone glands can continue to work. Otherwise, irreversible changes begin in the female body.

The ovaries are the source of estrogen, a woman needs these hormones to maintain a normal physical and emotional state. When the sex glands are removed, changes begin in the body that are similar to menopause. The difference lies in the fact that the process of the extinction of their function in women after 45 years is gradual. And after the operation, hormones cease to be produced abruptly, as a result, the body experiences tremendous stress.

Important! Partial preservation of the ovarian tissue, in which the follicles are located, contributes to the fact that the body will continue to function in the usual way.

Does the ovary recover after resection?

When excising the tissues of the ovary, its volume decreases. During the operation, the surgeon cuts out part of the follicles. Their number is laid in girls still in utero, so you should not hope for a complete recovery of the ovary after resection. In some, the process of stromal proliferation is observed, but this does not affect reproductive function.

Of decisive importance is not the size of the remaining part of the gonad, but the follicular reserve located in it. An approximate assessment of the state of the gonad after surgery can be done by measuring its volume.

How many years do the ovaries work after resection

It is impossible to predict how long the functioning of the reproductive glands will be after the resection. There are situations when a woman calmly gives birth to several children and waits for menopause after 40 years, even if she had a resection at the age of 17. In some patients, the gonads after surgery may immediately refuse to work. As a result, a woman has an unplanned early menopause.

The duration of their work will depend on which part of the gland was cut out, how many follicles were removed. With the remaining small follicular reserve, doctors often prescribe hormonal drugs to patients, they are needed to delay menopause.

What are the possible complications

After any surgical intervention, patients may experience the following problems:

• damage to the abdominal organs;
• the occurrence of adhesions;
• development of bleeding;
• wound infection;
• allergy to drugs used in anesthesia.

Among the long-term complications of resection is the appearance of infertility. Therefore, a woman is recommended to start planning a pregnancy already 1-2 months after the operation, or hormonal agents are prescribed, with which you can save the remaining follicles. Infertility can be caused by the development of adhesions in the pelvis, a decrease in the supply of eggs, and a deterioration in the production of sex hormones.

Resection of the ovaries: consequences, reviews of doctors

Often, resection is recommended for women with polycystic to normalize ovulation. In the vast majority of patients, the operation is effective. But about 20% of women face negative consequences of the operation, one of which is infertility.

In some cases, resection is the only way to achieve ovulation or remove neoplasms on the appendages. Doctors do not prescribe surgery unless necessary.

Raisa Vladimirovna Pelek, Magnitogorsk, gynecologist

If over a long period it is not possible to normalize the condition with polycystic disease by conservative methods, then I recommend surgery. It is important to immediately warn a woman about the benefits and possible consequences of resection of the right ovary. Almost all of my patients were able to get pregnant and give birth after the operation.

Igor Pavlovich Oladenko, Kirov, gynecologist

For patients who are afraid of surgery, I recommend finding and watching how an ovarian resection is done on video. Seeing clearly that the doctor is trying to leave the ovary, not to cut too much, many calm down. After all, most patients are afraid that they will immediately remove all female organs.

Ovarian resection is a necessary procedure for patients with cystic masses, benign tumors or polycystic changes that are not amenable to conservative treatment. In almost 80% of women, after partial removal of ovarian tissues, the state of reproductive health is normalized.

You can watch how laparoscopic resection is performed on the video:

The ovaries constantly produce female sex hormones and an egg. Due to the functional features of these organs, a woman is able to conceive and bear a healthy child. There are situations when the work of paired glands is disrupted for some reason, cysts, tumors, and other neoplasms appear. In such cases, ovarian resection is required.

The word "resection" itself means excision, that is, the removal of part of the ovary, its damaged tissues. Partial resection of the ovary allows you to save the woman's reproductive abilities.

Indications for the operation are various diseases and pathologies of the ovarian tissue. Here are the most common ones:

1. Various (dermoid, follicular, endometrioid, etc.), which reach a significant size and are resistant to conservative drug therapy, usually hormonal.
2. , which is also not amenable to other methods of treatment.
3. ovaries.
4. Various injuries that require surgery.
5. In case of hemorrhage or (rupture) of the ovary, the operation is performed without fail.
6. benign tumors.
7. Severe suppuration caused by a cyst or inflammatory process.
8. An ectopic pregnancy in which the fetus develops on the ovary.
9. Torsion of the cyst leg or its, accompanied by bleeding in the abdominal cavity, etc.

Before resection of the ovary, you should undergo a comprehensive diagnosis and make sure that there are no contraindications. These include:

1. Any acute infectious and inflammatory diseases, accompanied by general intoxication of the body and fever. Treatment should be carried out before surgery.
2. Inflammatory process in the pelvis in the acute stage. In this case, the operation is also postponed until the moment of relief of the acute attack, except in cases where the delay may threaten the life of the patient.
3. Blood clotting disorders, and this means both hemophilia and a tendency to increased thrombosis.
4. Violations of the functions of the liver and kidneys, cardiovascular and respiratory systems. This contraindication is taken into account, but it is quite rare, since most often the operation is performed on patients of a relatively young age, in which functional disorders of these organs and systems are rare.
5. , in which it is dangerous to remove only part of the ovary. In this case, the organ is removed completely, as well as the tissues surrounding it.

Before the appointment of the operation, you should also consider the fact that this is a last resort. It must be ensured that all possible non-operative treatments have been performed and that they have all failed. The operation is also necessary if the resulting ovarian disease can threaten the life of a woman, and not only fraught with infertility.

Wedge-shaped method of ovarian resection. It is carried out with polycystic disease, the absence of ovulation or menstruation, the ineffectiveness of hormone treatment

Operation methods

Resection of the ovaries is carried out by two methods: using or.

Laparoscopic method

Laparoscopic resection of the ovaries is the most sparing and safe method of surgical intervention, in which the removal of pathological tissue is carried out using a special apparatus. It is inserted into the abdominal cavity through small incisions (punctures) in the abdomen. Usually 3-4 punctures are enough.

Laparoscopy is performed as follows:

• a steel tube is inserted through the first puncture through which gas is supplied. This gas delimits the desired area for subsequent resection;
• a special sensor with a camera is inserted through the second puncture, with the help of which the image is transmitted to the monitor;
• equipment is inserted through the third puncture, which performs the removal of part of the ovary.

Laparoscopy has several advantages over other surgical methods. This is a very short rehabilitation period due to low tissue trauma, a minimum of possible complications, and the absence of a rough seam on the abdomen.

Laparotomic resection method

Laparotomy is a complete abdominal operation. It is performed under general anesthesia. The surgeon makes an incision of at least 5 cm, releases the area to be removed, makes the necessary incision. Then it cauterizes the bleeding area and sutures with a self-absorbable thread. Next, external sutures and a sterile bandage are applied.

With single cysts, a resection of the left ovary or the right one is performed, i.e. unilateral.

Resection of both ovaries is most often indicated for polycystic. It is performed in the complete absence of ovulation for the purpose of it and is called wedge-shaped.

Wedge-shaped resection of the ovaries involves the removal of the triangular part of the organ and the subsequent stitching of the resulting edges. The triangular part in the form of a wedge is also resected for diagnostic purposes (biopsy) in order to study the cellular composition of the tissue. Only in the case of a biopsy, subsequent suturing is not required, the incision site is cauterized using coagulation.

Resection of the ovaries in polycystic disease is indicated only in the case of a large number of follicles, a persistent absence of ovulation and menstruation, as well as in case of ineffective hormone therapy.

Preparing for the operation

Before the operation, it is necessary to pass some tests to determine the presence / absence of possible contraindications, namely:

• general and biochemical blood test;
• analysis for hepatitis B and C;
• analysis for HIV and AIDS;
• cardiogram;
• fluorography.

Also, during a general examination, the attending physician should find out if there are other diseases in which the operation cannot be performed.

After a complete diagnosis and with favorable test results, immediately before the operation, it is necessary to completely empty the intestines. To do this, you should refuse food 20 hours before the operation and make an enema.

If the patient experiences severe stress on the eve of the operation, then she is given an injection with a sedative drug, since strong emotional stress can cause a negative reaction to anesthesia.

Rehabilitation and consequences of ovarian resection

The rehabilitation period includes 2 stages: early and late.

The early stage lasts no more than a week. At this time, the woman is in a hospital under the supervision of doctors. It is necessary to ensure that infection, internal hematomas, bleeding and other complications do not occur. If a few hours after tissue removal, the ovary hurts, this is a normal reaction. Only painkillers and anti-inflammatory drugs are needed. Antibacterial injections are also given.

Usually the sutures are removed on the 7-8th day, and the patient can continue the recovery at home. The late recovery period lasts from 4 to 8 weeks, depending on the type of operation, its course, as well as the individual characteristics of the body.

During this time, aching pains of moderate intensity, scanty blood discharge from the vagina can be observed. Ovulation can occur as early as the second week after surgery.

Menstruation after resection most often comes with a delay, there may be a failure. The nature of menstrual flow sometimes changes - this is a normal reaction of the body. If the doctor prescribed hormonal drugs, then for some time menstruation may not be at all.

Remember! In order to avoid complications, it is necessary to regularly observe the attending physician during the entire rehabilitation period.

Resection and pregnancy

The resected ovary is capable of producing eggs, provided that too much tissue is not removed. Therefore, pregnancy after such an operation is not only possible, but also necessary. It is only necessary to refrain from sexual intercourse during the first month, until the ovary is fully restored after resection.

If pregnancy has not occurred within a year after the operation, you should be re-examined: it may have developed, a hormonal imbalance has occurred, etc.

Resection of the ovary is not a preventive measure of treatment. This is a rather serious operation, which has serious consequences. Laparoscopy is considered the safest, in which no more than a third of the organ was resected. Therefore, such an intervention should be carried out only as a last resort and after a comprehensive and comprehensive diagnosis.

Ovarian laparoscopy is a minimally invasive operation using an endoscope. The device is inserted into the abdominal cavity through small incisions that heal quickly. In their place are small, barely noticeable scars. The device itself is equipped with a miniature camera and other tools that allow cutting tissue. Such interventions are used not only for pathologies of the female reproductive system, but also for treatment.

During laparoscopic surgery, surgeons have the opportunity to carefully examine the structure of the ovary, see the problem as much as possible and carefully eliminate it. It is used for exfoliation, removal of part or all of an organ, elimination of foci of endometriosis.

The dimensions of the incision through which the instrument is inserted do not exceed 0.5-1 cm. In total, three holes are made. An endoscope is inserted through one, and surgical instruments through the rest. This operation is minimally traumatic, so the recovery period is relatively short.

As for the advantages of laparoscopic intervention in the region of the appendages, they are as follows:

• since the dimensions of the holes are very small, the tissues are not injured much;
• minimization, because the internal organs are not affected to the same extent as with;
• recovery in the postoperative period is faster and better;
• reducing the risk of infection or blood poisoning;
• no danger of divergence of seams and the appearance of bleeding, since the tissues are amenable to slight coagulation;
• maintaining the ability of a woman to have children, because complete removal of the ovary or uterus is not always required;
• the ability to perform even the most complex operations in a relatively short time.

All necessary manipulations are carried out under the supervision of a video camera and monitor. Specialists have the opportunity to see the smallest details of the operation without cutting the abdomen.

Indications and contraindications for

Laparoscopy of the ovaries is considered one of the most common operations, which is more often prescribed for women of reproductive age. Indications for the use of the procedure include:

1. A tumor that is at risk of rebirth or is growing in size.
2. Cyst.
3. accompanied by the formation of pus.
4. Torsion of the uterine appendages.
5. Growth of the endometrium.
6. Fibromyoma affecting the uterus.
7. Adhesive process that develops both on the ovary itself and on other organs of the small pelvis.
8. Violation of the patency of the fallopian tubes.
9. Ovarian biopsy, as well as control of the ovulation process in women who have problems conceiving.
10. that cannot be treated with conservative therapy.
11. Polycystic Syndrome.
12. Ovarian apoplexy (bleeding into the follicle).
13. Infertility of unknown origin.

However, laparoscopy of the ovaries is not allowed for everyone. There are such contraindications:

• pathologies of the cardiac or respiratory system in the stage of decompensation;
• problems with blood clotting - hemophilia;
• hepatic or renal failure in acute form;
• diathesis;
• stroke or heart attack;
• diffuse peritonitis;
• too large tumor size (more than 10 cm);
• infectious diseases transferred 1.5 months before surgery;
• subacute or acute chronic inflammation of the fallopian tubes or ovaries (you must first get rid of it);
• 3-4 degrees of purity of the vagina;
• the presence of purulent discharge from the vagina;
• adhesive process in the abdominal cavity;
• a high degree of obesity;
• bloating.

Laparoscopic intervention is used to remove the right or left ovary affected by the oncological process. Moreover, the organ may not be cut out completely, which allows you to save the reproductive function.

Features of preparation for surgery

Preparation for laparoscopy of the ovaries involves the delivery of laboratory blood and urine tests, chest x-ray, biochemical blood test, electrocardiogram and ultrasound of the internal organs. If necessary, or in particularly complicated cases, a CT scan is required. The examination is carried out only if the removal of the uterus and ovaries by laparoscopy is planned in advance. If urgent intervention is needed, it is not required.

In addition, as a preparation before the operation, it is necessary to follow the following recommendations of doctors:

1. A few days before the proposed intervention, it is necessary to exclude psycho-emotional and physical stress. They can interfere with blood pressure as well as the functionality of the heart system during and after the procedure.
2. Before the operation, it is better not to eat food that promotes increased gas formation. Food should be easily digestible so that no additional burden is created on the body.
3. The day before the intervention, the patient must go to the hospital. In the evening, the patient is allowed to drink a glass of kefir, sweet tea, yogurt.
4. With laparoscopy in the morning, you can’t eat anything at all. Breakfast is allowed if the operation is rescheduled for the evening.
5. It is important to clean the intestines before surgery. Now laxatives are used for this, as well as microclysters.
6. When removing, cysts, foci of endometriosis laparoscopically, it is necessary to prevent any complications in those people who are prone to them. Purulent processes are prevented by antibiotic therapy, and the formation of blood clots should also be avoided. Before the removal operation, specialists bandage the lower limbs with an elastic bandage.

If you need to operate on the ovaries, then you can do this on any day of the cycle, except for the time of direct menstrual bleeding. Allocations may be too plentiful. There is also a risk of bleeding that will be difficult to stop.

What is laparoscopy is already clear, but not everyone knows that its duration ranges from 20-90 minutes. It all depends on how complex the pathology is.

Rules for the procedure and possible complications

Notches on the ovaries are done only with general anesthesia. And not a mask is used, but an endotracheal tube. Such anesthesia allows you to increase the time of the operation, as well as completely relax the patient. Sometimes intravenous anesthesia is used. Further, the instruction provides for the following actions:

1. First, the patient is properly placed on the operating table. It should be slightly tilted on one side. The head lies below the body. This position will slightly shift the intestine and improve the view of the affected ovary.
2. Next, incisions are made in the abdomen. Through them, a special device is introduced to supply carbon dioxide, which pushes away other internal organs. It is given throughout the intervention.
3. Now the endoscope is inserted, equipped with a flashlight and a camera. Surgical instruments are inserted through the other two holes. All incisions must be treated with a disinfectant solution.
4. Further, all the necessary manipulations are carried out: resection, coagulation, removal. For a subsequent biopsy, notches are made on the ovaries, material is taken.
5. After the operation is completed, the blood vessels are coagulated to prevent bleeding. The instruments are pulled out, and the incisions are additionally processed, a dressing is made.

In the presence of any discharge, we can talk about infection in the wound. Other complications are also possible:

• emphysema (accumulation of air under the skin) or adhesions;
• hernia;
• damage to the vessels of the abdominal wall;
• intestinal obstruction;
• chronic pain syndrome in the abdomen;
• damage to large vessels.

With proper operation, the likelihood of complications is negligible.

Postoperative and rehabilitation period

After laparoscopy of the ovaries, a woman will need. This period passes quickly enough. Already during the first day, the patient is allowed to slowly get out of bed. A week later (or even earlier), the woman can go home. The patient's performance resumes after a maximum of 3 weeks. If a woman is not bothered by any discharge, she can continue to be observed by a gynecologist as usual.

The early postoperative period requires proper nutrition. It will allow you to recover faster. To reduce the load on the stomach and intestines, food should be mashed, liquid, as light as possible.

In the early days, recovery may be accompanied by mild pain in the lower abdomen. But after a few days it goes away on its own. Antibiotics are prescribed to a woman only if the intervention was long and extensive. To improve the condition, multivitamin preparations are prescribed that strengthen the immune system: Vitrum, Centrum.

In the rehabilitation period, a woman is forbidden to have sex for a month. In the future, all restrictions are removed. The patient may continue sexual relations and even become pregnant. recovers very quickly.

Laparoscopy is an effective and minimally invasive operation that allows you to quickly get rid of serious problems of the reproductive system. However, it should be done only by highly qualified specialists.

Pathologies in the organs of the female reproductive system cause hormonal imbalance, which affects the general state of health. The nature of the consequences largely depends on how timely and adequate the treatment was. In the most serious cases, when drug therapy does not save the situation, surgical operations are performed. Resection is a sparing method that allows you to save the organ. In particular, after such an operation on the ovary, a woman is often able to conceive and give birth to a healthy child.

Content:

What is an operation

Resection of the ovary is the removal of a certain part of it, affected by any pathology. A woman's ability to bear children depends entirely on the state of the organs of the reproductive system. The ovaries store a supply of eggs and their regular maturation occurs. It also produces female sex hormones that control the work of the whole organism. Therefore, it is very important to monitor the condition of these organs, and to carry out any interventions with the most gentle methods, especially if the woman is young and is going to have children.

Indications for resection

The volume of surgical intervention and the method of ovarian resection depend on the nature and severity of the pathology. Partial removal is shown in the following cases:

1. If the examination determined that the pathology is benign.
2. There are isolated neoplasms. Such an operation is indicated in the presence of non-functional cysts (dermoid, endometrioid) or benign tumors (cystadenomas, carcinomas).
3. Treatment for infertility, the cause of which is polycystic.
4. There is a rupture of the shell of the organ (apoplexy), it is injured.
5. An ectopic pregnancy occurs, in which the fetus begins to develop in the ovary.

Contraindications for surgery

Operations are not performed in cases where the patient has a bleeding disorder (thrombophilia or hemophilia). If it is confirmed that there are cancer cells in the tumor, then it is not a resection of the ovary, but its complete removal.

In the presence of infectious or acute diseases of the genital organs, the operation is performed only after the complete elimination of such processes. Contraindications to the operation are a violation of the kidneys, severe diseases of the heart, respiratory organs and liver.

Operation types

Depending on the type of pathology to be eliminated, one of the following types of surgical intervention is used: partial resection, wedge resection or oophorectomy (removal of the entire organ).

Partial resection

Part of the ovary is cut off when an inflammatory process occurs in it (possible spread of pus) or a large single cyst forms in its body, as well as a benign tumor.

This type of resection is used in the presence of hemorrhage in the ovarian tissue, if the ovary is damaged during operations on other organs of the small pelvis. A similar resection of the ovarian epididymis is performed if it is necessary to remove a large ovarian cyst when it ruptures and bleeding occurs in the abdominal cavity or when the ovarian cyst stem is twisted.

Dissection and partial removal of the ovarian tissue is possible if it is necessary to extract the fetal egg if an ectopic pregnancy occurs.

Wedge resection

This type of surgical intervention is usually used when it is necessary to take a tissue sample from a neoplasm for a histological analysis (biopsy). In addition, wedge resection is used as a way to stimulate ovulation in the treatment of infertility caused by polycystic ovaries. In this disease, a violation of the tissue structure as a result of the formation of many small cysts makes it difficult for a mature egg to leave the organ. In this case, fertilization becomes impossible.

During the operation, the “wedge” of ovarian tissue above the capsule with follicles is removed. As a result, the egg can move into the fallopian tube and meet with the sperm. After such an operation, a woman has a chance to conceive a child within 0.5-1 year. The effectiveness of infertility treatment is approximately 85%.

Addition: Another method of "release" of eggs is also used. Instead of resection of the ovary, several notches (up to 25 pieces) are made on its shell using a laser beam or an electric knife. In this case, the eggs have the opportunity to go outside through the incisions. In 72% of cases, such an operation helps to save a woman from infertility.

Oophorectomy

This is the name of the complete removal of the ovaries (sometimes along with the uterus). The method is used for ovarian cancer, the presence of an extensive purulent process, as well as in the presence of large neoplasms of a dubious nature in women over 45 years old.

Resection methods, possible complications

Resection of the ovary can be done through an incision in the lower abdomen (laparotomy) or through incisions in the abdominal wall (laparoscopy).

Laparotomy

To extract the affected ovarian tissue, an incision about 5 cm long is made in the abdominal wall. It is visually determined where the neoplasm is located, and then it is excised with a scalpel. A clamp is used to stop bleeding, and tweezers are used to remove tissue.

The disadvantages of this operation are:

• increased risk of adhesions between the ovaries and peritoneum;
• the presence of a postoperative suture;
• organ damage can lead to infertility;
• long period of postoperative recovery.

A woman needs to stay in the hospital for about 2 weeks. Complete healing occurs after 3 months.

Laparoscopy

During resection of the ovary by laparoscopy, 3 punctures with a diameter of 1.5 cm are made in the lower abdomen. Through one of the openings, carbon dioxide is injected into the abdominal cavity to separate the organs. A video camera is brought through the second, which allows you to display the image on the screen and monitor the progress of the operation. The third puncture is made for the introduction of instruments.

After the end of the operation, the gas is removed, and the holes are sutured. They heal much faster than a regular incision. Only dot marks remain at the puncture site. The risk of adhesion formation is much lower than with laparotomy. The likelihood of infection during the manipulation is extremely small.

Video: How laparoscopic removal of an ovarian cyst is performed

Before the operation, blood and urine tests are taken to make sure there are no inflammatory processes. Blood is tested for HIV and the presence of antibodies to various types of infection. A fluorographic study is carried out, and a cardiogram is also removed.

On the evening before the operation, the patient should stop taking fluids and food. Do a cleansing enema in the morning.

When carrying out resection of the ovaries, as a rule, general anesthesia is used. In some cases, if the volume of the operation is small, local anesthesia may be used.

Possible consequences of the operation

The consequence of surgery, as a rule, is the occurrence of hormonal disorders. If a significant part of the organ is removed, then the woman may experience amenorrhea (lack of menstruation). Hormonal failure leads to the appearance of hair on the face and body, other signs of a lack of estrogen in the body. Therefore, after such operations, a course of treatment with hormonal drugs is usually carried out to restore the background.

Due to a significant reduction in the size of the ovary and, accordingly, an artificial reduction in the ovarian reserve of eggs, a woman's chance of pregnancy is reduced. The formation of postoperative adhesions also negatively affects reproductive ability. They violate the location of organs in the abdominal cavity, which can become an obstacle to conception.

Possible complications are the introduction of infection into the abdominal cavity during the operation, damage to neighboring organs, the occurrence of internal bleeding and hematomas. After the resection of the ovaries, a woman may develop a hernia of the abdomen.

Re-development of neoplasms is possible.

Postoperative Recovery

After the anesthesia wears off, the woman feels pain in the lower abdomen. Within 3-4 days, she is given injections of painkillers. The sutures are removed after 7-10 days.

In the period after ovarian resection, a woman should follow the following rules:

1. For 1 month, you can not have sexual intercourse, play sports, lift heavy objects (weighing more than 3 kg), bathe in the bathroom or go to the pool.
2. Within 3-4 weeks it is necessary to wear compression underwear and a supporting bandage.
3. It is urgent to consult a doctor if reddening of the seam is observed, body temperature rises, pain intensifies, spotting does not disappear and even intensifies.

For 3-5 days after the operation, bleeding may occur. If the ovarian lesion is insignificant, then menstruation occurs on ordinary days (sometimes there is a delay of up to 3 weeks).

Pregnancy after surgery

If a woman has had an ovarian resection, then ovulation can occur within 2 weeks. This happens when most of the organ is preserved, and the woman does not take hormonal drugs as prescribed by the doctor. However, you should not plan pregnancy in the next 2 months after the operation, you must use oral contraceptives.

To prevent infertility due to the formation of adhesions, a woman is prescribed physiotherapy, light walks are recommended. To avoid swelling of the intestines, its convergence with the ovaries and the occurrence of adhesive processes, it is necessary to consume foods high in fiber.

Pregnancy is most likely 6-12 months after surgery. If conception does not occur for more than 1 year, it is necessary to consult a doctor to find other possible causes of infertility.

Video: Features of postoperative recovery