Reasons for development of uterine fibroids
Despite numerous scientific studies, modern scientists cannot name the exact cause of uterine fibroids. According to one of the versions, hormonal imbalance leads to the growth of fibroids, because conservative therapy of this disease is based on the intake of hormonal drugs that suppress the growth of neoplasms. But on the other hand, there are many cases when fibroids develop in women without hormonal disorders.
Through long-term observations, scientists still managed to compile a list of risk factors that increase the likelihood of fibroids:
hormonal disorders and menstrual irregularities;
diagnostic curettage, birth trauma;
inflammatory diseases of the reproductive organs;
concomitant diseases: hypertension, diabetes mellitus, obesity.
According to many gynecologists, irregular sex life, lack of pregnancy and childbirth in women over 30, and even physical inactivity and excessive love of sun exposure can also provoke the development of fibroids. Therefore, if you do not exercise much, do not exercise and lead a sedentary lifestyle, moving only from the office to your home sofa, you are at risk of developing fibroids. If you like to sunbathe and often spend time on the beach, you should also take care of your health and do not forget to regularly visit a gynecologist for preventive examinations.
Fibroids and pregnancy
In some cases, small fibroids allow a woman to become pregnant. But the onset of pregnancy does not mean that the fetus will be able to bear. With the growth of fibroids in the uterine cavity, the neoplasm can impede the growth of the fetus and lead to miscarriage, and not at the earliest possible date. If the myomatous node is located in the cervical canal, natural childbirth becomes impossible, which means that you will have to resort to a cesarean section.
There are also known cases when during pregnancy, due to hormonal fluctuations, there was a rapid growth of fibroids, which poses a danger to the unborn child. Therefore, if you are diagnosed with fibroids and you are planning a pregnancy, be sure to visit an experienced gynecologist before this, who will help minimize the risks and offer adequate treatment.
Laparoscopic conservative myomectomy is an operation to remove fibroids while preserving the uterus through small punctures in the abdominal wall. This operation is preferable for women who are planning pregnancy and for women who want to maintain their menstrual function. The technique of laparoscopic myomectomy largely depends on the size, location, and the presence of single or multiple nodes in the uterus.
Laparoscopic surgery to remove uterine fibroids differs from traditional surgery in several key ways:
During laparoscopic surgery, surgeon does not look directly into the abdomen through a large incision across the abdomen, but performs the operation while looking at a large video monitor.
To be successful, the operation itself, and especially the suturing of the uterus, which is necessary during laparoscopic myomectomy, requires great hand-eye coordination and dexterity, as well as knowledge of the anatomy of the pelvic region.
The procedure is safe and effective when performed properly by a well trained professional. The procedure is in fact complex, therefore more demands are made on the preparation and experience of doctor performing it than with abdominal surgery.
Conservative removal of fibroids is performed in four stages:
1. Cutting off and exfoliation of myomatous nodes.
2. Restoration of myometrial defects - suturing of the uterus wound.
3. Removal of myomatous nodes.
4. Hemostasis and sanitation of the abdominal cavity.
Preparing for Surgery
Before hospitalization, patient must undergo standard examination. In the presence of concomitant diseases that can affect the operation and the postoperative period (diabetes mellitus, coronary heart disease, varicose veins of the lower extremities, etc.), additional examinations and / or consultation of other specialists are required.
Patient is hospitalized on the day of the planned surgery.
Colon preparation (cleansing enema or taking special laxatives) is only necessary before surgery for infiltrative endometriosis with suspected rectal involvement.
Symptoms of Uterine Fibroids
Pain in the lower abdomen
Abdominal feeling of heaviness
Discomfort in intimate relations
Size of uterine fibroids is 12 weeks of pregnancy and more in women of reproductive age.
Presence of at least one myomatous node with a diameter of more than 3.5 cm in women planning pregnancy.
Presence of fibroids of any size with miscarriage and infertility, if other causes of this problem are excluded.
Fibroids causing bleeding due to deformation of the cavity and impaired contractility of the uterus, which leads to anemia in women of reproductive age.
Rapid growth of fibroids - more than 4 weeks of pregnancy per year.
Pelvic pain syndrome resulting from circulatory disorders in the myomatous nodes.
Dysfunction of adjacent organs (bladder, intestines) due to their mechanical compression by the tumor.
Decompensation of diseases of the cardiovascular and respiratory systems, diabetes mellitus, liver failure, blood diseases and some other diseases. To determine contraindications, it is necessary to consult a therapist or specialist of the appropriate profile.Malignant diseases of the endometrium and cervix. If there is a suspicion of malignancy before the operation, it is necessary to assess the state of the organs using oncocytology, but a biopsy is, of course, more informative.
Obesity of II-III degree.
Conservative myomectomy for multiple uterine myoma requires a balanced approach due to the high recurrence rate (from 30% or more), while with single nodes no more than 10-20%.
Contraindications to performing myomectomy by laparoscopic access are to a certain extent relative and depend on the prevention of bleeding during the operation and surgeon's proficiency in the endoscopic suture technique. Despite the advantages of the laparoscopic approach, treatment of "difficult" myomas, which have the following characteristics: sizes more than 7-8 cm, are located interstitially with centripetal growth, perichecus, along the posterior wall of the uterus, intraligamentary and in the uterine rib area, previously had limitations. This is associated with high risk of complications, such as bleeding when the node is exposed, the formation of an unreliable scar on the uterus due to poor visualization of the wound in conditions of ongoing bleeding and active use of electrosurgery in such conditions.
After laparoscopic operations, 4 incisions 5-10 mm long remain on the skin of the abdomen. Patients from the first day begin to get out of bed and take liquid food. They are discharged from the hospital for 4-6 days. It should be noted that the scars remaining on the uterus after this type of surgery require increased attention in the management of pregnancy and childbirth in these patients.
The operation is a radical method of treatment - myomatous nodes are removed from the uterus, but at the same time:
Myomectomy is an organ-preserving operation: the uterus remains in place, which means that in the future a woman has a chance to have children.
Patient is discharged home the next day.
Short rehabilitation period.
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