Cervical amputation

Cervical amputation is an operative intervention on the female's internal genitalia, which is often used to promptly treat certain diseases. This operation is considered a sparing method of surgical treatment, which is widely used in gynecology. The degree of benign and malignant formations of female genital organs increases yearly in geometric progression, which requires new methods of treatment. Moreover, the methods of treatment should be as much as possible organ-preserving to preserve not only the genital function of the female body, but also to maintain the normal hormonal background of the woman necessary for the normal functioning of many organs and systems. One such operation is amputation of the cervix.

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Indication and technique of cervical amputation

First, it is necessary to clarify the cases in which in general it is a question of surgical methods of treatment, and about amputation of the cervix including. Many pathologies of female genitalia can be treated conservatively, which allows in certain cases completely cure the disease. If the medicinal methods of treatment are not effective, then surgical intervention can be used. There are diseases in which surgical treatment is recommended as the first line, because the consequences of conservative treatment may be unpredictable. To such pathologies is primarily the background and precancerous diseases of female genital organs:

• Metaplasia of the cervix.
• A real erosion of the cervix.
• Background pathologies in the form of leukoplakia without atypia of cells.
• Small postoperative traumatic defects of the cervix.
• Cysts of the cervix are small in size.
• Foci of endometriosis or endometrioid cysts of small size in the cervix.
• Cervical polyps are multiple or single.
• Ectropion of the cervix.

These pathologies require surgical treatment, and the volume of operative intervention is decided in each case individually. There are several types of surgical interventions:

1. simple extirpation of the uterus - is the removal of the uterus with the neck;
2. Extended uterine extirpation is the removal of the uterus with the neck and appendages;
3. total extirpation of the uterus - is the removal of the cervix, body, appendages and regional lymph nodes;
4. Amputation of the cervix is the excision of the cervix.

As for amputation of the cervix, there are cases when this method of treatment is widely used. Indications for cervical amputation include:

• Benign cervical structures - polyps, condylomas.
• Myomatous node of the cervix.
• Cyst of the cervix.
• Endometriosis of the cervix.
• Malignant formation of the cervix - cervical cancer of the first stage.
• Elongation of the cervix, its scar deformities, narrowing or obstruction of the cervix.
• Absolution of the uterus is complete or incomplete.
• Dysplastic processes of the cervix uteri

Amputation of the cervix with dysplasia is very often, because it is a local process that can be treated with the help of this method. Metaphlasia of the cervix is a disease in which the normal structure of the epithelial cover that does not reach the basal membrane occurs, that is, the process is shallow. Operative treatment of dysplasia of the epithelium of the cervix is carried out at CIN-ІІ and CIN-ІІІ. This tactic is due to the fact that conservative treatment with such a degree is ineffective, and during this time, malignancy is possible. In this case, a special technique of cone amputation is used, in which a fragment of the altered tissue is excised far into the interior, which effectively cures pathology.

Preparation for amputation of the cervix includes general clinical moments - this is, first of all, an exactly established diagnosis. Before deciding on such an intervention, it is necessary to undergo a comprehensive examination of the doctor using instrumental and laboratory methods of investigation. First, you need to undergo colposcopy, which allows you to accurately visualize the changes that will need to be removed, and the presence of concomitant pathologies. It is necessary to carry out differential diagnosis of diseases, if necessary, a histological study to prevent complications. It is very important, before performing amputation of the cervix in malignant formations or with metaplasia of the cervix, it is necessary to accurately determine the degree of tissue damage. After all, amputation of the cervix is an organ-preserving operation, and an insufficient volume of surgery can contribute to worsening of the condition, therefore it is necessary to conduct a histological examination without fail. Also, when preparing for amputation of the cervix, it is necessary to conduct a study of the microflora of internal genital organs with identification of possible pathogenic microorganisms that can cause a postoperative infectious complication. Therefore, in some cases, even recommend before the procedure to conduct local preventive treatment with a combination antibacterial drug in the form of candles.

The technique of amputation of the cervix depends on the type of amputation and the particular use of a particular technique.

First, amputation of the cervix can be performed by the vaginal method, by open laparotomy and laparoscopically. The laparoscopic method is the most minimally invasive, but it does not allow for an audit, and is limited in use in malignant cervical structures. Laparotomy allows you to inspect all changes in surrounding tissues. As for the vaginal method, it is widely used to treat cervical dysplasia.

The method of using the leading method distinguishes many types of this intervention:

1. Knife - this is the use of a simple scalpel;
2. ultrasonic - removal by means of ultrasound force;
3. radio wave;
4. cryodestruction - use of low temperature for the treatment of cervical diseases;
5. Laser amputation - using a laser scalpel to amputate small neck defects. The most progressive and new method of amputation.

Amputation of the cervix has a different level, which depends on the degree of changes in the cervix. Thus, high amputation, low, wedge-shaped and conical are distinguished.

High amputation of the cervix is an intervention that is performed with the lengthening of the cervix, as well as with hypertrophic changes in its structure. In this case, the operation is performed with the maximum removal of the cervix. This amputation is also possible with narrowing of the cervix and cervical canal. Such amputation does not allow a woman to conceive and bear a child with normal childbirth, so it is performed in women of childbearing age only by absolute indications.

Knife cuneate amputation of the cervix is technically more simple and is performed by excising the anterior and posterior lip of the cervix in the form of a wedge, and then applying two seams to the formed horizontal incisions. Such surgical intervention can be carried out for excising polyposis or cervical hypertrophy.

Cone amputation of the cervix is a very simple intervention, which is widely used for metaplasia of the cervix. At the same time, the essence of the method consists in the cutting of the cervical epithelium in the form of a cone, depending on the depth of the lesion. This method has its advantages, since the risk that any cells will remain deeper is minimal, since the site is cut to the basement membrane or even deeper if necessary.

Cervical amputation by Sturmdorf is a method of cone amputation described by this doctor, which consists in a circular incision above the lesion site with further overlapping of the sutures from the beginning of the incision that pass through all layers of the cervix. It is very important with such an intervention to ensure normal sutures without damage to the bladder.

Consequences and complications after cervical amputation

Amputation of the cervix is considered a surgical intervention, therefore preoperative preparation and special management of the postoperative period are necessary in order to avoid possible complications.

One of the consequences of this procedure can be stenosis of the cervical canal of the cervix, especially when performing a procedure in the area of the external throat of the cervix. Such a narrowing can be clinically insignificant, but if it is of considerable size, then later the cervical canalization may be necessary. This narrowing occurs due to a large defect in the mucosa, which forms a scar after healing, which helps to narrow the lumen. Also complications after amputation of the cervix can be earlier in the form of bleeding that occurs when the vessels are injured. In this bleeding can be very massive, which requires significant measures. The cause of this bleeding may be the inability of stitches, so you need to check their condition. In case of any suspicion of bleeding, a thorough examination is necessary to check not only the uterine cavity, but also the extrauterine space.

The consequences of amputation can appear in the form of complications of the operation in case of injury of neighboring organs - the bladder or rectum. This is rare, because doctors have experience and appropriate qualifications.

Discharge after cervical amputation can also be one of the consequences that arises from infection of the cervical cavity or due to increased secretion of glands during their intensive proliferation. If the discharge is mucous, light in a small amount, then there is no need to worry, since this is a normal phenomenon of such interference, associated with active proliferation and secretion of cells at the site of the defect. In the case of green purulent discharge with an unpleasant odor, it is necessary to consult a doctor for the treatment of the infectious process.

Monthly after amputation of the cervix should be restored completely, with a regular cycle. It is important to make sure that their number does not change, in comparison with the previous menstrual periods, since changes in the number of secretions are possible. In the case of scars after surgery, a mechanical obstruction can be created on the way to normal menstruation, which will promote the development of hematomas - the state of blood accumulation in the uterine cavity. Therefore, it is necessary to monitor the cycle duration and its main characteristics, and when everything is renewed, you can calm down.

Life after amputation of the cervix is very ordinary, you can have full sex, because both the hormonal background and the number of receptors and the vagina are not completely changed. Also, there is the opportunity to become pregnant and take out a healthy child with appropriate follow-up recommendations.

The rehabilitation period lasts a month, when all the damaged tissues are renewed and the wound channel and the place of the sutures are healed. During this time, complete epithelization and regeneration takes place, which allows new cells to function normally. In the rehabilitation period it is recommended not to live a sexual life. In two weeks it is necessary to undergo a second examination to evaluate the result of treatment.

Cervical amputation is an operation that is widely used in gynecology and is a very effective method, since it allows one to radically remove all histological changes in the cervix. At the same time, there are different methods of performing this operation, the choice of which depends on the type of pathology. It is necessary to conduct a full preoperative examination, as well as to conduct a postoperative period correctly. The result of the treatment is positive and the prognosis for complete recovery is positive if all recommendations are followed.

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