Surgical intervention is often used in gynecology, when it is necessary to remove cysts, tumors, adhesions, endometriosis, etc. At the same time, the most common operation is ovarian resection - this is partial excision of damaged ovarian tissue while maintaining a certain healthy area. After resection, the function of the ovary in the overwhelming majority of cases also persists.
Indications for the procedure
Partial ovarian resection can be prescribed in such situations:
with a single ovarian cyst that does not respond to ongoing medical treatment, and when its size exceeds 20 mm in diameter (including dermoid cysts);
with hemorrhage in the ovary;
with purulent inflammation of the ovary;
with diagnosed benign formation in the ovary (for example, with cystadenoma);
with mechanical damage to the ovary (including during other surgical interventions);
with ectopic ovarian embryo attachment;
when torsion or rupture of cystic lesions, accompanied by bleeding and pain;
with polycystic ovaries.
Resection of ovaries with polycystic ovary
Polycystic is a rather complex hormonal disease that occurs when a hypothalamic adjustment of the ovarian function fails. When polycystic disease is often diagnosed as "infertility", therefore, resection of the ovaries is one way to help a woman still become pregnant.
Depending on the complexity and the course of the polycystic process, such surgical interventions can be carried out:
Surgery for decortication of the ovaries involves the removal of the densified outer layer of the ovaries, that is, its cutting with the help of a needle electrode. After eliminating the seal, the wall becomes more pliable, normal follicular maturation will occur with normal egg release.
The operation for cauterizing the ovaries consists of circular incision of the ovarian surface: an average of 7 incisions are made at a depth of 10 mm. After this procedure, in the area of incisions, healthy tissue structures are formed that are capable of developing quality follicles.
Wedge-shaped resection of the ovaries is an operation to remove a certain "wedge" of a triangular tissue from the ovary. This allows the formed eggs to exit the ovary to meet the sperm. The effectiveness of this procedure is estimated at about 85-88%.
The procedure of ovarian endothermocoagulation involves the introduction into the ovary of a special electrode, which burns into the tissue several small holes (usually about fifteen).
The operation of ovarian electrilling is the procedure for removing cysts from the affected ovary with the help of an electric current.
Advantages and disadvantages of laparoscopy for ovarian resection
Resection of the ovaries, which is performed by the method of laparoscopy, has a number of advantages over laparotomy:
Laparoscopy is considered a less traumatic intervention;
spikes after laparoscopy are rare, and the risk of damage to nearby organs is minimized;
recovery of the body after laparoscopic surgery occurs at times more quickly and more comfortably;
the possibility of violation of the suture line after the operation is excluded;
minimizes the risk of developing bleeding and infection of the wound;
there are practically no postoperative scars.
The disadvantages of laparoscopy can be attributed, perhaps, to the relatively high cost of a surgical procedure.
Before the intervention about ovarian resection, it is necessary to undergo diagnostics:
donate blood for general and biochemical analysis, as well as for the identification of HIV and hepatitis;
check heart function by cardiography;
to make a fluorogram of the lungs.
Both laparotomic and laparoscopic resection are operations performed under general anesthesia. Therefore, preparing for the operation, it is necessary to take into account the stage of preparation for general anesthesia. The day before the intervention, it is necessary to limit oneself in the diet, consuming mostly liquid and easily assimilated food. The last meal should be no later than 18 hours, and the use of liquid - no later than 21-00. On the same day, you should put an enema and clean the intestines (the next morning you can re-run the procedure).
On the day of surgery, food and drink are not allowed. Also, you should not take any medications unless they are prescribed by a doctor.
The operation for ovarian resection is performed under general anesthesia: the drug is administered intravenously and the patient "falls asleep" on the operating table. Further, depending on the type of surgery performed, the surgeon does certain actions:
Laparoscopic ovarian resection involves three punctures, one in the navel and the other two in the ovarian projection zone;
Laparotomic resection of the ovary is carried out by one relatively large incision of the tissues to gain access to the organs.
Further, the medical instruments are inserted into the abdominal cavity, with which the surgeon conducts appropriate manipulations:
relieves the operated organ for resection (separates from adhesions and located near other organs);
puts a clamp on the ovarian ligament suspension;
conducts the necessary variant of ovarian resection;
cauterizes and sutures damaged vessels;
sutures damaged tissue with catgut;
conducts a diagnostic examination of the reproductive organs and assesses their condition;
if necessary, performs the elimination of other pelvic problems;
establishes drains for outflow of fluid from the operating wound;
removes tools and sutures outer fabrics.
In some cases, a planned laparoscopic operation can be transformed into a laparotomic procedure: everything depends on what changes in the organs the surgeon sees when they are directly accessed.
Resection of both ovaries
If the removal of both ovaries is performed, then this operation is called oophorectomy. Usually it is carried out:
with malignant organ damage (in this case, resection of the uterus and ovaries is possible, when the ovaries, tubes and partially the uterus are removed);
with significant cystic formations (in women who do not plan to have more children - usually after 40-45 years);
with glandular abscesses;
with total endometriosis.
Resection of both ovaries can be carried out and unscheduled - for example, if before laparoscopy another, less severe diagnosis was put. Ovaries are often removed from patients after 40 years of age to prevent their malignant degeneration.
The most common resection of both ovaries with bilateral endometrioid or pseudomucinous cysts. With papillary cystoma, resection of the uterus and ovaries can be applied, since such a tumor has a high probability of malignancy.
Resection of the ovaries is divided into total (full) and subtotal (partial). Partial ovarian resection is less traumatic for the organ and allows you to maintain a normal ovarian reserve and ability to ovulate.
Partial resection is used in most cases with single cysts, inflammatory changes and thickening of the ovary tissues, with ruptures and torsions of the cysts.
This option of surgery allows the organs to recover quickly and resume their function.
One of the variants of partial resection is wedge resection of the ovary.
Re-resection of the ovaries
Repeated operation on the ovaries can be prescribed in case of polycystosis (not earlier than 6-12 months after the first resection), or if a cyst is relapsed.
Some patients have a tendency to form cysts - this predisposition can be hereditary. In such cases, cysts often occur repeatedly, and you again have to resort to surgery. It is especially important to re-resect if a dermoid cyst is found that is larger than 20 mm, or a woman can not become pregnant for a long time.
If the operation is carried out under polycystosis, then repeated resection gives the woman an additional chance to conceive a child - and this is recommended for six months after the surgery.
Contraindications to the procedure
Doctors share possible contraindications to ovarian resection to absolute and relative.
Absolute contraindication to surgery is the presence of malignant neoplasms.
Among the relative contraindications can be identified infection of the urinary system and the genital area at the stage of exacerbation, fever, blood clotting disorders, intolerance of medications for anesthesia.
Complications after the procedure
The period after the operation for partial resection of the ovary usually lasts about 2 weeks. After complete removal of the ovary, this period is extended to 2 months.
Complications after such an operation can happen, as well as after any other surgical intervention:
allergy after anesthesia;
mechanical damage to the abdominal cavity;
appearance of adhesions;
infection in the wound.
With any variant of ovarian resection, a part of the glandular tissue that contains a stock of oocytes is removed. Their number in the body of a woman is strictly defined: usually it is about five hundred of these cells. Monthly, during ovulation, 3-5 eggs are ripening. Removing a part of the tissue reduces the amount of this stock, which depends on the volume of resection. This leads to a decrease in the reproductive period of a woman - the time during which she is able to conceive a child.
At the first time after ovarian resection, there is a temporary decrease in the amount of hormones in the blood - this is a kind of response of the body to organ damage. Restoration of the ovary occurs during 8-12 weeks: for this period the doctor can prescribe hormonal maintenance drugs - substitution therapy.
Monthly after resection of the ovaries (in the form of spotting bloody discharge) can be resumed already on 2-3 days after the intervention - this is a kind of stressful reaction of the reproductive system, which in this situation is considered the norm. The first postoperative cycle can be, as anovulatory, and usual, with ovulation. A complete recovery of the cyclicity of menstruation is observed after a few weeks.
Pregnancy after ovarian resection can begin to be planned only 2 months after surgery: the monthly cycle is restored, and the woman retains the ability to conceive. If the resection was done about the cyst, the best time for trying to get pregnant is the first 6 months after the operation.
Sometimes there are tingling after ovarian resection - most often they appear as a result of circulatory disorders in the organ after the operation. Such feelings should disappear for several days. If this does not happen - you need to visit a doctor and get a diagnosis (for example, ultrasound).
If the resection was performed by laparoscopy, during the first 3-4 days a woman can feel pain in the chest, which is due to the peculiarities of this method. This condition is considered absolutely normal: the pain usually goes on its own, without the use of medication.
Ovary can be ill after resection for another 1-2 weeks. After that, the pain must pass. If the ovary hurts after resection, and after the operation has passed a month or more, you should see a doctor. The pain can be caused by the following reasons:
inflammation in the ovary;
adhesions after resection;
Sometimes the pain in the ovary can appear during ovulation: if such feelings are intolerable, then it is necessary to show the doctor.
Care after the procedure
After completing the intervention for ovarian resection, the patient is transferred to the postoperative ward, where she is 24-48 hours, depending on the condition. Rising and walking is allowed in the evening, or the next morning.
On the second day the doctor can remove the installed drainage tubes, after which he will appoint a small course of antibiotics - to prevent the development of infectious complications.
After a week, the surgeon removes the stitches. The total duration of the rehabilitation period after ovarian resection is usually 14 days.
For a month after the operation, it is advisable to use pulling linen, or wear a bandage belt. All this time it is necessary to adhere to sexual rest and minimize physical activity.
Rehabilitation period after ovarian resection
The most frequently performed laparoscopic resection of the ovaries, therefore, consider the course and the rules of the rehabilitation period for this variant of surgical intervention.
After laparoscopic resection, it is necessary to listen to such advice of doctors:
you should not resume sexual intercourse earlier than 1 month after resection (the same applies to physical activities that increase gradually, gradually bringing to normal levels);
For 12 weeks after resection, do not lift more than 3 kg;
for 15-20 days after surgery, small adjustments to the diet should be made, eliminating spices, spices, salt and spirits from the menu.
The monthly cycle after resection is often restored independently and without any problems. If the cycle is knocked down, then it may take two or three months, no more, to restore it.
To prevent the recurrent development of cysts, a doctor may prescribe a prophylactic drug, according to individual therapeutic regimens.
The patient's organism, which underwent ovarian resection, was completely restored after the operation for 1-2 months.
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