Cervical amputation

Amputation of the cervix is a surgical intervention on the internal female genital organs, which is often used for the surgical treatment of certain diseases. This operation is considered a gentle method of surgical treatment, which is widely used in gynecology. The degree of benign and malignant tumors of the female genital organs increases exponentially every year, which requires new methods of treatment. Moreover, the methods of treatment should be as organ-preserving as possible in order to preserve not only the reproductive 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 of such operations is amputation of the cervix.

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Indications and technique for amputation of the cervix

First, it is necessary to clarify the cases in which we are talking about surgical treatment methods at all, including amputation of the cervix. Many pathologies of the female genital organs can be treated conservatively, which allows in certain cases to completely cure the disease. If drug treatment methods are ineffective, then surgical intervention can be used. There are diseases in which surgical treatment is recommended as a first line, since the consequences of conservative treatment can be unpredictable. Such pathologies include, first of all, background and precancerous diseases of the female genital organs:

• Cervical metaplasia.
• True erosion of the cervix.
• Background pathologies in the form of leukoplakia without cell atypia.
• Minor postoperative traumatic defects of the cervix.
• Small cervical cysts.
• Endometriosis foci or small endometrioid cysts in the cervix.
• Cervical polyps, multiple or single.
• Ectropion of the cervix.

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

1. simple hysterectomy is the removal of the uterus with the cervix;
2. extended hysterectomy is the removal of the uterus with the cervix and appendages;
3. total hysterectomy is the removal of the cervix, body, appendages and regional lymph nodes;
4. Cervical amputation is the removal of only the cervix.

As for cervical amputation, there are cases where this treatment method is widely used. Indications for cervical amputation include:

• Benign formations of the cervix – polyps, condylomas.
• Myomatous node of the cervix.
• Cervical cyst.
• Endometriosis of the cervix.
• Malignant neoplasms of the cervix - stage I cervical cancer.
• Elongation of the cervix, its cicatricial deformations, narrowing or obstruction of the cervix.
• Uterine prolapse is complete or incomplete.
• Dysplastic processes of the cervix

Amputation of the cervix in dysplasia is performed very often, since it is a local process that responds well to treatment using this method. Cervical metaplasia is a disease in which the normal structure of the epithelial cover is disrupted, which does not reach the basement membrane, i.e. the process is shallow. Surgical treatment of cervical epithelial dysplasia is performed with CIN-II and CIN-III. This tactic is due to the fact that conservative treatment is ineffective at this stage, and malignancy is possible during this time. In this case, a special cone amputation technique is used, in which a fragment of the altered tissue is excised deep into the body, which allows for effective treatment of the pathology.

Preparation for cervical amputation includes general clinical aspects - first of all, an accurately established diagnosis. Before deciding on such an intervention, it is necessary to undergo a comprehensive examination by a doctor using instrumental and laboratory research methods. First, it is necessary to undergo a colposcopy, which allows you to accurately visualize the changes that will need to be removed, as well as the presence of concomitant pathologies. It is necessary to conduct differential diagnostics of diseases, if necessary, a histological examination to prevent complications. It is very important, before performing amputation of the cervix in case of malignant tumors or cervical metaplasia, 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 a deterioration in the condition, so 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 the internal genital organs with the identification of possible pathogenic microorganisms that can cause postoperative infectious complications. Therefore, in some cases, it is even recommended to carry out local prophylactic treatment with a combined antibacterial drug in the form of suppositories before the procedure.

The technique for performing cervical amputation depends on the type of amputation and the specifics of using a particular technique.

Firstly, amputation of the cervix can be performed vaginally, by open laparotomy and laparoscopically. The laparoscopic method is the least invasive, but it does not allow for revision and is limited in use for malignant cervical tumors. Laparotomy allows for examination of all changes in surrounding tissues. As for the vaginal method, it is widely used to treat cervical dysplasia.

Depending on the method of using the leading method, there are many types of this intervention:

1. knife - this is the use of a simple scalpel;
2. ultrasonic – removal using ultrasound power;
3. radio wave;
4. cryodestruction – the use of low temperatures to treat cervical diseases;
5. laser amputation – using a laser scalpel to amputate small defects of the neck. The most progressive and new method of amputation.

Amputation of the cervix has different levels, which depends on the degree of changes in the cervix. Thus, there is a high amputation, low, wedge and cone.

High amputation of the cervix is an intervention that is performed when the cervix is elongated, 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 a narrowing of the cervix and cervical canal. This amputation does not allow a woman to become pregnant and bear a child with a normal birth, therefore it is performed in women of childbearing age only for absolute indications.

Knife wedge amputation of the cervix is technically simpler and is performed by excising the anterior and posterior lips of the cervix in the form of a wedge, and then placing two sutures on the resulting horizontal incisions. This surgical intervention can be performed to excise polyposis or hypertrophy of the cervix.

Cone amputation of the cervix is a very simple intervention that is widely used in cases of cervical metaplasia. The essence of the method is to excise the epithelium of the cervix 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 area is excised to the basement membrane or even deeper if necessary.

Sturmdorff's cervical amputation is a cone amputation technique described by this doctor, which consists of a circular incision above the site of the lesion with subsequent stitches from the beginning of the incision that pass through all layers of the cervix. It is very important in this intervention to ensure normal stitches without damaging the bladder.

Consequences and complications after amputation of the cervix

Cervical amputation is considered a surgical intervention, so preoperative preparation and special postoperative management are necessary to avoid possible complications.

One of the consequences of such a procedure may be stenosis of the cervical canal of the cervix, especially when performing the procedure in the area of the external os of the cervix. Such a narrowing may be clinically insignificant, but if it is of significant size, then bougienage of the cervical canal may be required in the future. Such a narrowing occurs due to a large defect in the mucous membrane, which after healing forms a scar, which contributes to the narrowing of the lumen. Also, complications after amputation of the cervix may be earlier in the form of bleeding, which occurs when blood vessels are injured. In this case, the bleeding can be quite massive, which requires significant measures. The cause of such bleeding may be the failure of the sutures, so it is necessary to check their condition. In case of any suspicion of bleeding, it is necessary to conduct a thorough examination in order to revise not only the uterine cavity, but also the extrauterine space.

The consequences of amputation may manifest themselves in the form of complications of the operation itself in case of injury to adjacent organs - the bladder or rectum. This happens rarely, since doctors have experience and the appropriate qualifications.

Discharge after amputation of the cervix can also be one of the consequences that occurs due to infection of the cervical cavity or due to increased secretion of glands during their intensive proliferation. If the discharge is mucous, light in small quantities, then you should not worry, since this is a normal phenomenon of such an intervention associated with active proliferation and secretion of cells at the site of the defect formed. In the case of green purulent discharge with an unpleasant odor, you must consult a doctor to treat the infectious process.

Menstruation after cervical amputation should be restored completely, with a regular cycle. It is important to ensure that their quantity does not change, in comparison with previous menstruations, since changes in the amount of discharge are possible. In this case, in the case of scars after surgery, a mechanical barrier to normal menstruation can be created, which will contribute to the development of hematometra - a condition of blood accumulation in the uterine cavity. Therefore, it is necessary to monitor the duration of the cycle and its main characteristics, and when everything resumes, you can calm down.

Life after cervical amputation is quite normal, you can have sex fully, since the hormonal background and the number of receptors are preserved, and the vagina is not completely changed. It is also possible to get pregnant and bear a healthy child if you follow the recommendations.

The rehabilitation period lasts a month, when all damaged tissues are restored and the wound channel and suture site are healed. During this time, complete epithelialization and regeneration occurs, which allows new cells to function normally. During the rehabilitation period, it is recommended not to have sex. After two weeks, it is necessary to undergo a follow-up examination to assess the treatment result.

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

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