Pelvic Adhesions (scar tissue) – UNC Department of Obstetrics & Gynecology

Adhesions are bands of scar tissue that can cause internal organs to be stuck together when they are not supposed to be.  Most often, adhesions are the result of previous surgery, but some can occur following pelvic infection, and many times they accompany more severe stages of endometriosis.  When adhesions are dense, or restrict the normal movements of internal organs like the bowels, pain can result.  Uncommonly, adhesions can cause blockage of the bowels (intestinal obstruction).

Adhesions, when they are involved in causing pain, are usually present along with some other disease process that can cause pain, such as irritable bowel syndrome (IBS) or endometriosis.  They may signal their presence by aggravating the symptoms of IBS or by causing pain during sexual intercourse. Unfortunately, diagnosing the presence of pelvic adhesions is difficult. Except in extreme cases, an examining physician cannot feel them during a pelvic examination, and tests like ultrasound, MRI scans, and CT scans do not detect them very often. This means that a thorough history and a pelvic examination by a physician experienced in evaluating pain problems are the best tools for detecting their presence.

When it seems likely that adhesions may be important, then a laparoscopy can be done to see them, and the adhesions can often be removed during the same laparoscopic procedure. There are several cautions here.

First, laparoscopic treatment of adhesions is most safely and effectively done by laparoscopic surgeons specially trained and experienced in performing this type of surgery.  Except in rare cases, it is not thought to be useful to perform a laparotomy (large open incision) in order to treat adhesions, because they much more often re-grow after open surgery.

Second, just because adhesions are present doesn’t mean they are the cause of pain!  It often takes the clinical experience of physicians trained in the evaluation of pain to know when surgical treatment of adhesions is likely to be helpful, and when it is not.   When surgery for adhesions is done, it works best when combined with an overall approach to all the components of an individual pain.

In the Pelvic Pain Clinic at UNC, the staff have over 20 years of experience as a referral center in evaluating chronic pelvic pain, and in performing high level laparoscopic surgery for adhesive disease. Our safety record in these cases is unmatched in the state.  We combine surgical treatment with multiple other avenues of pain management and treatment, such as physical therapy, diet and exercise, stress reduction techniques, counseling, and medication management.

Surgical Adhesions from Gynecologic Surgery

This article has been archived. We will no longer be updating it. For our most up-to-date information, please visit our pelvic health information here.

When you’re headed for hysterectomy or other gynecologic surgery, you are probably worried about many things. Will you have any bad reactions to the anesthesia? Will the surgeon find any major problems? Will you be in much pain? Will recovery be fast? One thing you probably don’t think about, however, is whether the surgery will cause pelvic or abdominal adhesions—a complication that could cause health problems for you in the future.

Yet adhesions, which occur when bands of scar tissue in the abdominal cavity get “stuck” to pelvic or abdominal organs, are one of the most common complications of pelvic and abdominal surgeries. The type of surgery doesn’t matter; although adhesions are slightly less likely to occur with laparoscopic surgery (in which a surgeon makes very small incisions in the abdomen instead of one large incision) they still occur at a fairly high rate.

Adhesions form as a result of injury or trauma to the peritoneum, the clear membrane that covers the inside of the abdomen and all abdominal and pelvic organs, except the ovaries. When healthy, this membrane is slippery. Once injured, however, the immune system kicks in to repair things, leading to inflammation and the production of sticky scar tissue called a fibrin matrix.

Normally these bands of scar tissue dissolve through a biochemical process called fibrinolysis, just like a cut on your finger and any resulting scab eventually heal. But surgery reduces levels of blood chemicals needed for fibrinolysis, meaning these fibrous brands may not dissolve; instead, they develop into adhesions. They may form within a couple of weeks after surgery or not for months or even a year or more.

Although all gynecologic and abdominal surgeries can cause adhesions, cesarean sections, particularly repeat cesarean sections, carry a very high risk. One study found that women having their third or more cesarean section were almost twice as likely to experience dense adhesions as those undergoing their second (46.1 percent vs. 25.6 percent). Both groups, however, experienced a significant rate of adhesions.

Although many women develop adhesions after surgery and never know it, in some women adhesions can cause serious complications, including:

• Pelvic pain: One study found that 82 percent of 224 patients suffering from chronic abdominal pain had adhesions and no other disease. Other studies find that adhesions are the most common reason for chronic pelvic pain in women. This pain occurs because adhesions bind together normally separate organs and tissues. As you move throughout the day, these tissues stretch, affecting nearby nerves and causing pain.
• Pain during intercourse: Adhesions can also cause pain during intercourse (a condition called dyspareunia).
• Infertility: Adhesions that form as a result of certain types of gynecologic surgery, especially tubal surgeries and surgeries to remove fibroids (myomectomies), are a common cause of infertility. Adhesions between the ovaries, fallopian tubes or pelvic walls can prevent an egg from the ovaries from getting into and through the fallopian tubes. Adhesions around the fallopian tubes may make it difficult or impossible for sperm to reach the egg. One study found adhesions in 37 percent of 733 infertile women; in 41 of these women, adhesions were the only reason for their infertility. Overall, some experts suspect that pelvic adhesions may be responsible for up to 40 percent of infertility.
• Bowel obstruction: Adhesions are one of the leading causes of intestinal blockages, responsible for 30 to 60 percent of all cases. Such obstruction limits or stops passage of feces through the intestines, leading to pain, nausea and vomiting, possibly resulting in infection and additional surgery.

Adhesions can also make other abdominal surgeries longer and more challenging. For instance, they may make it impossible to perform a laparoscopic procedure, meaning you must undergo an open abdominal incision, which typically has a greater risk of complications and pain and requires a longer recovery time.

All surgeons know about the risks of adhesions, so they try their best to reduce this risk. The most important thing they can do is limit any injury of the peritoneum, the membrane that covers the inside of the abdomen. Surgeons can also reduce the risk of adhesions by:

• Using certain sutures found to be less likely to cause adhesions.
• Administering medications to reduce inflammation.
• Creating barriers between damaged tissues so they don’t stick. Today there are several approved devices, liquids, gels, films and other substances surgeons can use as “adhesion barriers.” Some have been found to result in adhesions rates at 40 percent or more lower compared to surgeries not using any barrier.
• Closing the peritoneum after a cesarean section. Several studies find this significantly reduces the risk of adhesions during subsequent cesareans.

Minimizing risks for adhesions is the best course since the only way to treat adhesions is to surgically remove them during a procedure called adhesiolysis. Ironically, since the procedure itself damages the peritoneum, it can cause even more adhesions. Plus, adhesions often reform after adhesiolysis.

Pelvic Adhesions – Its Causes, Symptoms & Treatment

Diagnosed with Pelvic Adhesions: What Does that Mean?

Pelvic adhesions are common in women who have extensive endometriosis that has been left untreated. Adhesions can also form after cesarean sections or other types of open surgery and can be the result of infections. Scar tissue can grow between two organs in the pelvic area and cause significant pelvic pain. Pelvic adhesions can occur around the bladder, bowel, ureter, uterus and ovaries.

Surgical procedures, such as myomectomy and endometriosis surgery, can also lead to adhesions. Adhesions are more common after open surgery, (meaning the surgeon used an 8-inch incision to gain access to the pelvic cavity), than laparoscopic surgery. The risk of adhesions increases with the number of major abdominal and pelvic surgeries and post-surgery infection or bleeding can lead to adhesion formation due to increased inflammation during the healing process.

Pelvic adhesions can have an impact on a woman’s ability to conceive and carry a baby to term — particularly pelvic adhesions or scar tissue related to endometriosis.

This scar tissue can be completely asymptomatic in many cases. However, when it causes infertility, pain or gastrointestinal problems such as bloating and constipation, a woman might consider a procedure called resection of pelvic adhesions.

Talk to a patient advocate about seeing a specialist for pelvic adhesion resection.

Treatment for Pelvic Adhesions

If pelvic adhesions are causing bothersome symptoms, they should be treated with resection surgery, which removes the scar tissue. This is best performed as a minimally invasive procedure by laparoscopic specialists, who can ensure that additional adhesions do not form after the resection. The surgeons at The Center for Innovative GYN Care are fellowship-trained in minimally invasive laparoscopic surgery.

• Laparoscopic removal of scar tissue (lysis of adhesions) is most effective in patients with extensive adhesions and adhesions involving the bowel.
• In cases of mild adhesions, cutting down of adhesions may not treat all of the pain. In these cases, other causes of pain such as fibroids or adenomyosis need to be considered.
• If scar tissue is caused by multiple cesarean deliveries, the removal of the uterus may be necessary to avoid adhesion reformation and repeat surgery.

Genetic factors make some patients more prone to form adhesions than others. Two patients may have the same surgery and complications, but one may form severe adhesions and the other no adhesions at all.

Read: Diagnosed With Endometriosis, Pelvic Adhesions After Menopause

Get the treatment and recovery you deserve. Talk to a patient advocate to get started today.

Understanding the Procedure & What to Ask Your Surgeon About Pelvic Adhesions

The surgeon’s skill level plays a role in the likelihood of adhesion formation after surgery. Gentle handling of the tissue, minimal blood loss and minimally invasive surgery decrease the risk of adhesions. Adhesion barriers are dissolvable materials that have been shown to decrease the risk. After a myomectomy, the material is placed on the uterus to prevent the bowel from adhering to it.

Choosing a specialist to perform laparoscopic resection of pelvic adhesions is an important step in finding relief. Many surgeons who perform laparoscopy do not have the advanced skills required to effectively and safely remove the pelvic adhesions. In the hands of a less experienced laparoscopic surgeon, resection of adhesions will result in higher risk of conversion to open surgery and injury to organs such as the bowel and bladder. It can also result in further adhesions forming after the procedure, which would continue to cause pain.

Although the American Medical Association and other leading medical societies have issued statements discouraging robotic GYN surgery techniques due to dramatically higher costs to patients without any medical advantages, robotic methods continue to be used in GYN surgeries. This is because robotic procedures “enable” an OBGYN not well trained in laparoscopic GYN surgical techniques to complete a GYN surgery through a “minimally invasive” approach. This is why women need to ask if robotics will be used during a GYN surgery and to seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques.

Dr. Paul MacKoul and Dr. Natalya Danilyants developed DualPortGYN, a minimally invasive technique used for minimally invasive resection of pelvic adhesions. At CIGC, this procedure uses only two incisions, one at the belly button and another at the bikini line. This minimally invasive procedure allows patients to have a better overall recovery. All procedures are performed in an outpatient setting so patients can return home the same day.

BOOK A CONSULTATION

GYN surgical specialists can often see women sooner than a standard OBGYN because they are focused entirely on surgery. Each patient gets detailed, in-depth attention from Dr. Natalya Danilyants and Dr. Paul J. MacKoul. This personalized care helps patients understand their condition and the recommended treatment so they can have confidence from the very start. Our surgeons have performed over 25,000 GYN procedures and are constantly finding ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul, MD, or Natalya Danilyants, MD.

Offices are conveniently located throughout the Washington D.C. area in Rockville, MD and Reston, VA as well as in New York City and Montclair, NJ. Women looking for a GYN specialist for a laparoscopic hysterectomy, endometriosis excision or fibroid removal have traveled to CIGC from over 30 countries around the world.

REVIEWS

Dr. Natalya Danilyants
Vitals
RateMDs
Google
Wellness

Dr. Paul MacKoul
Vitals
RateMDs
Google
Wellness

CIGC TRAVEL PROGRAM

Learn more about our travel program.

Post Hysterectomy Pain Relief

Hysterectomy Pain Overview

The most common surgical technique for hysterectomy is abdominal surgery. To access the uterus, the surgeon must first cut through several structures, including the skin and the peritoneum (tissue enclosing the abdominal and pelvic organs). After surgery, all of the cut tissues must heal.

Doctors generally expect complete recovery within four to eight weeks. For vaginal surgery, recovery usually occurs within one to two weeks. Either approach presents the possibility for adhesions to form deep within the abdomen, pelvis, or both. 

Hysterectomy has become a fairly common surgery. In fact, so many women struggle with issues related to the pelvis that one in three women in the U.S. over age 60 has had a hysterectomy. (Office of Women’s Health, 2009b)

Of the 600,000 women who undergo hysterectomies in U.S. every year, most recover within the given time frame and return to pain-free lives. (Office of Women’s Health, 2009b) However, a study in 2007 found that 32% of women who underwent hysterectomies experienced chronic pelvic pain one year after their hysterectomy. The study also found that a vaginal surgery (rather than an abdominal surgery) did not significantly lower the risk of chronic pain. (Brandsborg et al. , 2007)

Adhesions are thick strands of collagen that form to help the body heal and repair after infection, trauma, surgery or various other injuries. Although the body needs these strands to help tissue repair, adhesions can spread, with the unwanted side-effect of binding and restricting structures that were previously mobile.

The tissues of the pelvis are extremely delicate and are meant to glide easily over each other. During a hysterectomy, the surgeon cuts or burns through pelvic tissues to remove the uterus and sometimes other structures. Tiny but powerful collagen fibers rush in to repair the tissues at the surgical sites. Attached to each other with molecular-chemical bonds called cross-links, the fibers create adhesions (internal scars) as the first step in the process of healing. Thus, adhesions form naturally after surgery. Pain and problems come when these adhesions spread. They can act like a powerful glue, binding neighboring structures – such as the intestines, bowels, vagina or bladder.

Inventing a new goo to prevent scarring

In 2016, Tim Keane’s aunt, Jackie, was ready to have more children. She already had one child, but part of her identity was deeply rooted in the idea of raising a big family.

“A big family was important to my sisters and my aunts and my uncles,” Keane said. “I’m one of seven kids. My dad is one of 11. We’re used to having big families. … Being from an Irish Catholic family, that was definitely part of my family’s identity.”

But over the course of three years, each of her pregnancies resulted in miscarriages—leaving her to deal with the guilt and grief of each loss. Her doctors were finally able to solve the mystery of her infertility: Adhesions from a previous cesarean section.

::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Looking for the latest on the CORONAVIRUS? Read our daily updates HERE.
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

An adhesion is a band of scar tissue that forms like fibrous webbing between tissues and organs when the body’s repair mechanisms kick in, usually after surgery, infection, trauma or radiation. The body deploys its army of repair cells—including macrophages, fibroblasts and blood vessel cells—to repair the damaged tissue. Because repair cells can’t differentiate between organs, adhesions can form when the surfaces of two organs come in contact with each other, creating a tangled mess of scar tissue that obstructs normal anatomy and organ function.

Scars can form anywhere on the body after an injury, but adhesions are commonly found in the abdomen, pelvis and heart, and oftentimes interfere with the internal anatomy. Abdominal adhesions form in more than 9 out of 10 people who have open-abdomen surgery, according to the National Institutes of Health. Pelvic adhesions occur in 55 to 100 percent of patients who undergo gynecologic surgery, such as a C-section.

“A lot of women, after they have a C-section once, the next time they get pregnant, they’re going to have a C-section again because of adhesions,” Keane explained. “The same adhesions could actually cause miscarriages and cause infertility in those women. That’s what happened with her.”

According to Keane’s studies, more than 500,000 cases of infertility in women and 7 million cases of chronic pelvic pain are associated with pelvic adhesions each year in the United States. A nearly unavoidable certainty, adhesions also can lead to post-surgical morbidity, bowel obstruction and chronic pelvic pain or chronic abdominal pain.

“It’s just, to me, mind-boggling that a surgery that is done to either fix a problem or to do a routine procedure, is something that can cause lifelong complications for a person,” Keane said.

Coming to Houston
When Keane, a bioengineer with a Ph. D. from the University of Pittsburgh, joined the TMC Innovation Institute’s Biodesign program in August 2019, he teamed up with Stephen Ramon, a medical student at the University of Virginia School of Medicine, and Alex Smith, Ph.D., a former research engineer at the Texas Heart Institute, to form TYBR Health.

“We all knew we wanted to build the next something,” said Smith, the company’s vice president of product, “but I don’t think any of us knew what that something would be.”

As they shadowed gynecological, pediatric, orthopedic and trauma surgeons around all the major hospitals in the Texas Medical Center, they realized that adhesions were the biggest problem they observed across all surgical specialties.

The team began developing an idea with Keane’s aunt in mind: “What if we could prevent scars from ever forming?”

“I knew roughly what adhesions were before, but it wasn’t something that I started to think about how I could apply things that I know to this type of problem until it was a personal case,” Keane said. “When you hear about a personal story of the complications and how it can change the course of someone’s life and how they identify themselves, I think that’s when it really hit home for me.”

With Keane’s expertise in extracellular matrices (a 3D structural network of macromolecules that serves as a physical scaffold for surrounding cells), Smith’s background in mechanical engineering and Ramon’s knowledge of medicine and surgery, the trio of scientists developed a pioneering solution for preventing adhesions: the first extracellular matrix hydrogel spray.

How it works
It’s an elegantly simple recipe they cook up in their designated JLABS @ TMC space. First, they chop up bovine tibia into 2-inch chunks and pound out the cancellous bone (the spongy tissue in the center of the bone containing marrow and collagen) using a hammer they purchased at Walmart. Once they decellularize and remove the calcium from the cancellous bone, they pulverize it into a fine powder using a home coffee grinder, which they also purchased at Walmart. They mix the powder into a solution with pepsin enzymes—the same digestive enzyme found in our stomachs that breaks down proteins into smaller amino acids—to create a viscous, gooey concoction that is then sprayed onto the surgical site through a laparoscopic nozzle.

Stephen Ramon, center, demonstrates how they cut bovine tibia into 2-inch chunks and pound out the cancellous bone (the spongy tissue in the center of the bone containing marrow and collagen) to produce their extracellular matrix hydrogel spray.

“These particles stick to the tissue you’re spraying it onto,” Keane explained. “Once the gel reaches body temperature, then it forms a gel that covers the injured tissue. This thin film prevents the contact of adjacent organs with the injured tissue. It’s that contact, actually, that causes adhesions.”

Not only does the spray prevent adhesions, but it helps accelerate tissue regeneration. The spray interacts with the immune cells and the repair cells to stimulate the healing process.

“Instead of getting a scar in response, you actually get a response that is functionally repaired and closer to the normal anatomy that it was before,” Keane said.

Based on an early study the team conducted in November 2019, the spray significantly reduced scar formation by 75 percent.

Currently, the standard approach to preventing adhesions is to use an implant called adhesion barriers, a thin translucent film made of biomaterial that physically separates tissue surfaces to keep them from touching. Repair cells are unable to penetrate the barrier and, therefore, allow the tissue surfaces to heal properly. Once the tissue heals, the barriers dissolve.

However, as robotic technology and minimally invasive techniques become more common in the operating room, TYBR’s spray is poised to have an advantage over the traditional barriers, which are more fragile to use and expensive.

“It’s like trying to place saran wrap with tweezers,” Smith said. “It’s like laying hundreds of dollar bills in the abdomen.”

Approximately 70 percent of abdominal and pelvic surgeries are done laparoscopically, but adhesion barriers currently on the market can only be implanted in open procedures, leaving a large population of patients with no other option than to develop scars that can lead to lifelong complications.

Future expansion
Adhesiolysis, a surgical procedure in which surgeons snip away at the messy web of adhesions to restore normal anatomy and organ function, is one of the top seven emergency general surgeries performed in the U.S.—along with laparotomy, large bowel resection, small bowel resection, operative intervention for ulcer disease, cholecystectomy and appendectomy procedures. According to a study published in BMC Surgery, more than 400,000 adhesiolysis procedures are performed annually nationwide, resulting in an estimated cost of $2.3 billion to the health care system.

“Sixty percent of all operations that occur are actually re-operations,” Keane said, adding that a majority of the repeats are due to an aging population. “The older people are, they probably had, at some point in their life, a surgery. That surgery caused scars or adhesions forming, keeping doctors in the OR for an extra 15 to 45 minutes, where they’re just spending time cutting away adhesions, which can cause complications, before they can even get to the reason that they’re there to do the surgery in the first place.”

By preventing adhesions from forming, TYBR Health’s hydrogel spray could alleviate the burden of hospital readmissions.

Although the team is currently targeting abdominal and pelvic adhesions, the hydrogel spray is a platform technology that could be expanded to include dermatology, plastic and reconstructive surgery (specifically breast reconstruction) and orthopedic surgery.

“In almost every tissue in the body, and every disease you can think of, there’s some aspect of scarring that affects the lives of millions and millions of people,” Keane said. “If you could affect a small percent of these diseases and these complications that lead to scarring, then you could have a massive effect on the way medicine is practiced in the world.”

Laparoscopic Hysterectomy

A hysterectomy is the surgical removal of the uterus. Hysterectomies are performed for a wide variety of reasons. A hysterectomy is major surgery, but with new technological advances, the discomfort, risk of infection and recovery time has all been decreased.

There are currently three surgical approaches to hysterectomies. These include:

1. Open, traditional hysterectomy. This involves a six to twelve inch incision made in the abdominal wall.
2. Vaginal Hysterectomy. This involves removing the uterus through the vagina. This approach is better than the open, traditional hysterectomy, but still does not allow the surgeon a full view of the surrounding organs, including the bladder.
3. Robotic-Assisted Radical Total Laparoscopic Hysterectomy. Using a state-of-the art robotic platform allows the surgeon a full view of the surrounding organs and more precise control over incisions. 

• Laparoscopic Assisted Vaginal Hysterectomy. This is when a portion of the operation (intra-abdominal) is completed with the laparoscope and the remainder of the operation (vaginal incision, excision of cervical tissues) is completed transvaginally.

• Total Laparoscopic Hysterectomy. When the entire operation is performed using the laparoscope and the surgical specimen is removed via the vagina.

Benefits of a Robotic-Assisted Radical Total Laparoscopic Hysterectomy

da Vinci Hysterectomy offers numerous potential benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, particularly when performing more challenging procedures like radical hysterectomy for gynecologic cancer.

Potential benefits include:

• Significantly less pain
• Less blood loss
• Fewer complications
• Less scarring
• A shorter hospital stay
• A faster return to normal daily activities
• Decreased risk of infection 

Fewer complications, Preserved Functionality for Organs

Robotic-Assisted Hysterectomy also allows your surgeon better visualization of your anatomy, which is especially critical when working around delicate and confined structures like the bladder. This means that surgeons have a distinct advantage when performing a complex, radical hysterectomy involving adhesions from prior pelvic surgery or non-localized cancer, or an abdominal hysterectomy.

Treatment of Uterine Cancer (Endometrial Cancer)

Robotic-Assisted surgery provides the surgeon with a superior surgical tool for dissection and removal of lymph nodes during cancer operations, as compared to traditional open or minimally invasive approaches. At the Johns Hopkins Hospital, our surgeons also perform a pelvic lymphadenectomy with staging during a hysterectomy for suspected or confirmed gynecological cancers. By performing this at the same time as the hysterectomy, our physicians receive real time critical information that may affect the surgery and treatment.

What you should expect from this surgery

Robotic-Assisted Radical Total Laparoscopic Hysterectomy usually takes 1-3 hours under general anesthesia. You will be hospitalized for at least one night so your physicians can monitor your healing progress. Most patients return to normal daily activities within one week. Your physician will give you detailed instructions so your recovery is unremarkable.

Choosing Robotic-Assisted Radical Total Laparoscopic Hysterectomy

Our surgeons are committed to providing the best treatment option for every individual patient. While radical hysterectomy or abdominal hysterectomy performed using robotic-assisted surgery is considered safe and effective, these procedures may not be appropriate for every patient. Always ask your doctor about all treatment options, as well as their risks and benefits.

Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis

Hysterectomy is the commonest major gynaecological procedure [5]. Most hysterectomies can be performed laparoscopically including those with large myomas and severe endometriosis [6–8]. Various techniques have been described previously to tackle difficult hysterectomies, but the level of expertise needed limits the general use of these techniques [9, 10]. Even experienced gynaecologic laparoscopic surgeons find it very difficult to operate in such condition, and the surgery may be abandoned in some cases. In our series, three patients had failed surgeries with attempted hysterectomy and were abandoned due to the operative difficulties. At our centre, total laparoscopic hysterectomy with retrograde adhesiolysis is chosen in all cases of frozen pelvis.

Laparoscopic hysterectomy in frozen pelvis facilitates adnexa removal compared to vaginal hysterectomy as the adnexa may be adherent to surrounding structures that may be extremely difficult to reach transvaginally [9]. The laparotomy conversion rate for laparoscopic hysterectomy in severe endometriosis and large fibroids as described in literature is 4.3 and 7.9 % [8, 11]. In our series, one patient had conversion to laparotomy. This was done to facilitate repair of incidental bladder perforation in a densely adherent bladder and to achieve bowel resection for severe bowel endometriosis with bowel stenosis of greater than 60 % [12]. A study involving 115 patients with severe endometriosis undergoing laparoscopic hysterectomy reported bladder injury in 1 (0.9 %) of 115 cases without any bowel or ureteral injury [8]. In our series, 23 patients had frozen pelvis due to severe endometriosis. Our surgical approach in these patients is focused primarily on symptom-guided approach rather than mandatory oncologic resection [13]. All visible endometriotic lesions were excised and the cul de sac cleared of endometriotic lesions. Considering the rare progressive nature of deep endometriosis, segmental bowel resection was not performed for superficial bowel lesions [14, 15]. We routinely identify the ureter during and after dissection and do cystoscopy at the end of the procedure to confirm the integrity of the bladder and patency of the ureters. Even the most experienced surgeon may encounter bowel injury. The golden rule is early recognition of injury as time of diagnosis is the most important independent factor determining the outcome. A difficult surgical condition can be well anticipated, and the surgeon can arrange for preoperative and, if required, intraoperative surgical or urological assistance. Surgery should be performed in a setting where such facilities are readily available. Paralytic ileus may occur probably due to extensive bowel adhesiolysis and handling; out of 25 patients, two patients developed paralytic ileus in the post-operative period whereas James et al. reported seven cases with paralytic ileus following major gynaecological procedure in 707 patients [16]. The risk of complications depends upon the extent of bowel involvement, adhesions and extent of endometriosis infiltration, surgeon experience and bowel resection [16, 17]. The operating time was 210 min in our study compared to 185 ± 48.7 min mentioned by Chalermchockchareonkit et al., while it was 131 and 147 min in two case reports by Walid et al. [6] in laparoscopic hysterectomy for severe endometriosis [8]. This can be explained by the severity of the disease process and grossly distorted anatomical planes, necessitating meticulous dissection and slow progression. Mean (SD; 95 % CI) weight of the uterus was 390.2 (441.59; 207.91–572.49) g. The mean estimated blood loss in our series was 384 ml whereas Chalermchockchareonkit reported a mean blood loss of 302.6 ml [8], while that reported by Walid et al. was 150 ml in laparoscopic hysterectomy for severe endometriosis [6]. The length of hospital stay was 1.3 ± 1.07 days in our series which is shorter when compared to 3.5 ± 1.1 days reported in the literature [8]. One patient (4 %) required blood transfusion in our series, whereas nine (7.8 %) required blood transfusion out of 115 patients undergoing hysterectomy for severe endometriosis [8].

All procedures have their own limitations, and retrograde adhesiolysis during hysterectomy in frozen pelvis requires adequate surgical experience and expertise to change the course of surgery and manage the complications associated with difficult pelvic surgery. Specialized assistance may be needed to manage the complications. The surgeon should be prepared to modify the surgical technique according to the case. The overall key to success in such cases depends on thorough knowledge of pelvic anatomy and operative experience involving varying degrees of pelvic distortion with or without enlarged uteri. This technique of retrograde adhesiolysis can decrease the complications in difficult hysterectomies with gross pelvic distortion due to adhesions even in the presence of enlarged uteri. This is a retrospective study, and further evidence is required, preferably by adequately powered well-designed multicentre randomized controlled trials (RCTs) before definitive conclusions can be given.

Laparoscopic hysterectomy – operation in Kazan

Get advice

Leave a request and our specialist will call you back within 15 minutes

Laparoscopic hysterectomy – an operation to remove all or part of the uterus using modern optical equipment (laparoscope). Depending on the causes of the disease, a total hysterectomy (extirpation of the uterus) is used – removal of the body and cervix of the uterus and subtotal (amputation of the uterus) – removal of only the body of the uterus while preserving the cervix.

In our Clinic, the operation is carried out on the latest German equipment “Karl Srorz”, which allows very careful and efficient surgical intervention.

Indications

The indications for this operation are:

• uterine myoma – a tumor that is not malignant, but threatens the health of a woman,
• adenomyosis (endometriosis of the uterine body) – tissue proliferation, leading to pain, infertility, etc. …,
• malignant neoplasms,
• recurrent hyperplasia – excessive growth of the inner layer of the uterus, endometrium, etc.

Progress of the operation

The operation is performed under general anesthesia, duration, on average, 1-2 hours. The first incision is made in the navel, through which carbon dioxide is injected into the abdominal cavity to increase its volume and improve the view of the internal organs for the surgeon.

Then a laparoscope with a video camera is inserted through the same incision.Under the control of a laparoscope, another 2-3 small incisions (0.5-1 cm) are made on the anterior abdominal wall for the introduction of the necessary instruments. The uterus in the abdominal cavity is fixed with special connective tissue ligaments to the walls of the pelvis.

During hysterectomy, coagulation and transection of the ligaments of the uterus and the vessels feeding it are performed in stages. Further, depending on the volume of the operation, the body of the uterus is separated from the cervix or from the vaginal vaults (with total hysterectomy). From the abdominal cavity, the uterus is removed through the vagina or, after dividing into smaller fragments, through incisions in the anterior abdominal wall.The vagina or cervix is ​​sutured. 1-2 sutures are applied to the incisions of the anterior abdominal wall.

Vaginal total hysterectomy (extirpation of the uterus) without appendages

Price: 22,850 R

Vaginal total hysterectomy (extirpation of the uterus) with appendages

Price: 26850 R

Preoperative examination by a doctor obstetrician4 : 600 R

Appointment (examination, consultation, smear on the degree of frequency) of an obstetrician-gynecologist (endocrinologist) primary

Price: 2 500 R

Appointment (examination, consultation, smear on the degree of frequency) of an obstetrician-gynecologist primary

Price: 2000 R

Appointment (examination, consultation) of an obstetrician-gynecologist (endocrinologist) repeated within 1 month

Price: 1000 R

Appointment (examination, consultation) of an obstetrician-gynecologist repeated during 1 month

Price: 800 R

Rehabilitation

The period of postoperative rehabilitation is on average 4-5 days.By the end of the first day after the operation, it is allowed to sit down, on the second day to get up. Removal of stitches occurs on the 5-6th day of recovery. Compliance with a special diet is recommended for the first 2-3 days, then you can return to your normal diet. The first months after surgery, it is necessary to limit physical activity, not to lift weights of more than 5 kg.

After a laparoscopic hysterectomy, the menstrual cycle stops, if the ovaries are removed, a “surgical menopause” occurs and appropriate treatment is prescribed.The specialist will select the entire therapy taking into account the indications.

No changes in sexual activity after the operation are observed, especially if the cervix is ​​preserved.

Result

The result of the performed laparoscopic hysterectomy is the elimination of the causes of diseases of the female genital area, which cause the symptoms of concern to the woman.

Laparoscopic hysterectomy is a real life-saver for women when alternative treatments fail. Timely referral to a specialist will avoid undesirable consequences and complications in the future. The professional gynecologists of the SL Youth and Beauty Clinic have extensive experience in performing surgical operations. Turning to them, you can be sure of the result and quality of the laparoscopic hysterectomy.

Get advice

Leave a request and our specialist will call you back within 15 minutes

Information indicated on the Clinic-sl website.ru is not a public offer. Images of goods, services in the photographs presented on the site may differ from the originals. Information on the price of a product or service indicated on the website may differ from the actual one, check the cost by phone (843) 522-47-47 or from the administrators at the clinic’s reception at the address: Kazan, st. Pavlyukhina, 37. You can independently familiarize yourself with the services here. 90,000 How to avoid serious consequences after surgery to remove the uterus in women

How to preserve the uterus and quality of life

d.MD, Professor Maxim Stanislavovich Afanasyev, oncologist, surgeon, gynecological oncologist, expert in the treatment of dysplasia and cervical cancer

Historically, in medicine, the opinion has been fixed that the uterus is needed only for bearing a child. Therefore, if a woman does not plan to give birth, she can safely resort to surgery.

Is this really so or not? Why, for example, in March 2015, Angelina Jolie removed both ovaries with fallopian tubes, but left the “unnecessary” uterus? Let’s find out together whether it is dangerous to remove the uterus.And if it is dangerous, then with what.

From the point of view of a surgeon, a radical operation solves the question “in the bud”: no organ – no problem. But in fact, the recommendations of surgeons can not always be perceived as objective. They often do not take patients after discharge, do not conduct examinations six months, a year, 2 years after the removal of the uterus, do not record complaints. Surgeons only operate and rarely face the consequences of the operation, therefore they often have a false idea about the safety of this operation. Meanwhile, scientists from different countries independently conducted a series of observations.They found that within five years after the removal of the uterus, most women developed:

1. (previously absent) pelvic pain of varying intensity,

2. bowel problems,

3. urinary incontinence,

4. prolapse and prolapse of the vagina,

5.depression and depression, up to serious mental disorders,

6.emotional and physiological problems in the relationship with the spouse,

7. in some women who were operated on for severe dysplasia or in situ cancer, there was a relapse of the disease – damage to the stump and vaginal vault.

8.fatigue,

9. persistent increase in blood pressure and other serious cardiovascular problems.

The problem is not invented, because according to the Scientific Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, various operations to remove the uterus make up from 32 to 38.2% of all abdominal gynecological operations. In Russia, this is about 1,000,000 queen bees removed annually! There is another side to the problem. Since all of these complications develop gradually, over a year or several years after surgery, women do not associate the deterioration in their quality of life with a previous operation. I am writing this material so that you yourself can evaluate all the pros and cons of the operation, , weigh the pros and cons, and consciously make your choice. My practice shows that there are no extra organs. Even in older women, removal of the uterus has negative health consequences, and in the second part of the article I will dwell on them in detail.

I want to reassure those patients who are faced with a difficult choice – to agree to the removal of the uterus or not. In some cases, removal of the uterus can be avoided. About half of those diagnoses that 10 years ago were considered direct indications for surgery are now treated without surgery or without removal of the organ.

Diagnoses that have ceased to be indications for removal of the uterus

Thanks to the introduction of high-tech methods, some of the indications for genital removal have ceased to be absolute indications. Here is a list of diagnoses in which the removal of the uterus in women can be replaced with other methods of treatment and the organ is preserved.

1. Symptomatic, overgrown, fast-growing uterine fibroids are now treated by embolization of the uterine arteries: the vessels feeding the fibroids are blocked. In the future, the myoma gradually dissolves.

2. Adenomyosis, or internal endometriosis, can be treated with the therapeutic method of photodynamic therapy (PDT).

With endometriosis, the cells of the inner lining of the uterus grow in atypical places. PDT destroys these cells in a targeted manner without affecting healthy tissues.

Photodynamic therapy is an organ-preserving method of treatment, which is included in the federal standard for the provision of medical care (see the order of the Ministry of Health of Russia dated 01.11.2012 N 572n (as amended on 11.06.2015) “On approval of the Procedure for providing medical care in the profile of” obstetrics and gynecology “) …

3. Precancerous endometrial condition – complex endometrial hyperplasia , adenomatous endometrial hyperplasia, atypical endometrial hyperplasia – also amenable to PDT treatment.To date, I have successfully treated 2 patients with this pathology.

In cases where hyperplasia is predominantly of a viral nature, PDT treatment can eliminate the cause of the disease. In the treatment of pathologies of the cervix uteri, complete destruction of the human papillomavirus after one PDT session is confirmed in 94% of patients, and in 100% of patients after the second PDT session.

4. Precancerous conditions and oncological formations in the cervix. Grade 3 dysplasia , cervical in situ cancer and even microinvasive cancer can be completely cured with photodynamic therapy in 1 or 2 sessions.

The PDT method eliminates not only the disease itself, but also its cause – the human papillomavirus.

Therefore, correctly and fully photodynamic therapy performed is the only method that provides a lifelong recovery and minimal risk of recurrence (reinfection is possible only in case of re-infection with HPV).

There is one more good news. Previously, a combination of age and multiple gynecological diagnoses was a compelling reason for removing an organ.For example, a combination of condylomas of the cervix and uterine fibroids, or dysplasia of the cervix with adenomyosis against the background of the performed generic function. To justify the removal of an organ, the surgeon usually does not give rational arguments, but refers to his own experience or an established opinion. But today (even if the attending physician tells you otherwise) the combination of several diagnoses is no longer a direct indication for the removal of the uterus. Modern medicine considers each diagnosis as an independent one, and the treatment tactics are determined individually for each. For example, dysplasia and adenomyosis regress after photodynamic therapy. And the presence of multiple fibroids is not a reason for oncological alertness. Numerous observations of recent years show that fibroids have nothing to do with cancer, do not degenerate into a cancerous tumor, and are not even a risk factor. In surgery, there is a concept of the risks of treatment. The job of a good doctor is to minimize risks. When a doctor determines the tactics of treatment, he is obliged to evaluate the indications, to measure the possible negative consequences of different methods of treatment, and to choose the most gentle and effective one. By law, doctors are required to inform about all possible treatments, but in practice this does not happen. Therefore, against the background of the surgeon’s urgent recommendations for organ removal, I strongly advise you to consult several specialists or write to me in order to evaluate the possibility of performing organ-preserving treatment that is right for you. Unfortunately, not all diseases of the uterus are treated with minimally invasive and therapeutic methods, and in some cases it is still better to remove the uterus.Such indications for removal are called absolute – that is, they do not require discussion.

Absolute indications for removal of the uterus

1. Myoma of the uterus with necrotic changes in the node. Preservation of an organ with such a diagnosis is life threatening.

2. Prolonged uterine bleeding that cannot be stopped by any other means. This condition is fraught with the loss of a large volume of blood and is a serious life-threatening condition.

3. Combination of large uterine fibroids and cicatricial deformity of the cervix.

4. Prolapse of the uterus.

5. Cancer from stage I.

6. Giant sizes of tumors.

Depending on the indications, operations on the uterus are performed by different methods and in different volumes. First, we will get acquainted with the types of surgical intervention. Then I will dwell in detail on the consequences that, to one degree or another, every woman will experience after the removal of this organ.

Types of operations to remove the uterus

In medical practice, abdominal and endoscopic removal of the uterus is performed.

• Cavity surgery (laparotomy) is performed through an incision in the anterior abdominal wall. The method is considered traumatic, but it provides great access and in some cases simply has no alternative. For example, if the uterus has become large due to fibroids.
• The second method is endoscopic surgery (laparoscopy). In this case, the surgeon removes the uterus through punctures in the anterior abdominal wall. Laparoscopic removal of the uterus is much less traumatic and allows for faster recovery from surgery.
• Vaginal extirpation of the uterus – removal of the uterus through the vagina.

Operations are classified by the volume of intervention

1. High amputation of the uterus – only part of the uterus, its bottom, is removed.

2. Subtotal hysterectomy (amputation of the uterus) – complete removal of the uterus while preserving the cervix.

3. Total hysterectomy (extirpation of the uterus) – surgical removal of the uterus together with the cervix.

4. Pangysterectomy – removal of the uterus with the cervix and appendages.

5. Radical removal of the vagina, cervix, lymph nodes.

Consequences and complications after removal of the uterus are often a direct consequence of the volume of intervention. Let’s talk about them.

Consequences after abdominal surgery to remove the uterus

Cavity surgery to remove the uterus through a large incision is one of the most traumatic procedures. In addition to the complications caused by the direct removal of the uterus, such an operation has other negative consequences.

1. A noticeable scar remains after the operation.

2. High probability of hernia formation in the scar zone.

3. Open surgery usually leads to the development of an extensive adhesive process in the pelvic area.

4. Rehabilitation and recovery (including work capacity) requires a lot of time, in some cases up to 45 days.

Consequences after removal of the uterus by laparoscopic method

The consequences of laparoscopy are less traumatic. Laparoscopic surgery to remove the uterus is performed through punctures, so small scars remain on the skin of the abdomen, which eventually become almost invisible.The risk of adhesions and hernias formation after laporoscopy is much lower than after abdominal surgery. In addition, the postoperative period after this operation is shorter and recovery is faster.

Removal of the uterus without the cervix. Consequences of supravaginal amputation of the uterus without appendages

Whether the cervix is ​​retained or removed when the uterus is removed depends on the condition of the cervix and the risks associated with its preservation. If the cervix is ​​left, this is the most favorable situation possible. On the one hand, due to the preserved ovaries, the hormonal system continues to function in a more or less normal mode.But why leave the cervix when the uterus is removed? Preserving the cervix allows you to maintain the length of the vagina, and after recovery, the woman will be able to lead a full sex life.

Removal of the uterus without ovaries. Consequences of extirpation of the uterus without appendages

Removal of the uterus without appendages, but with the cervix, is a more traumatic operation. Leaving the ovaries, the surgeon enables the woman to maintain normal hormonal levels. If the operation is performed at a young age, the ovaries avoid the climax and all associated health consequences.But even after removal of the uterus without appendages, the anatomical ratio of organs is disturbed. As a result, their function is disrupted. In addition, complete removal of the uterus, even with preservation of the ovaries, leads to a shortening of the vagina. In many cases, this is not critical for sexual activity. But the anatomy of the organ is different for everyone, and not all women manage to adapt.

Removal of the uterus with appendages

This is the most traumatic operation and takes a long time to recover.It needs serious hormonal correction and usually causes all the most severe consequences, especially if it is performed at the age of 40-50 years – that is, before the onset of natural menopause. I will describe in more detail the most common consequences of removing the uterus below. The most unpleasant thing is that all these consequences are irreversible and practically not amenable to correction.

Consequence 1. Serious hormonal disorders

Until now, persuading patients to agree to the operation, surgeons utter the same monologue – supposedly, the uterus is needed only for the birth of children, supposedly it does not produce hormones, and its removal has almost no effect on the quality of life.It remains a mystery to me on what basis these surgeons believe that removing the uterus will not affect the patient’s quality of life in any way. Moreover, many surgeons are really convinced that after 50 years a woman does not need organs such as the uterus and ovaries.

Meanwhile, a series of recent scientific studies in this area say the opposite. Even with preservation of the ovaries, removal of the uterus is operation with a high risk of endocrine disruption .

The reason is simple.The uterus is connected to the ovaries and tubes by a system of ligaments, nerve fibers and blood vessels. Any operation on the uterus leads to serious disruption of the ovarian blood supply, up to partial necrosis . Needless to say, hormone production is disrupted in literally choking ovaries. Hormonal disruptions are manifested by a whole string of unpleasant symptoms, the most harmless of which is a decrease in sex drive. In the overwhelming majority of cases, the ovaries are not able to completely restore or compensate for the normal blood supply.Accordingly, the hormonal balance of the female body is not restored either.

Consequence 2. Ovarian cysts after removal of the uterus

This is a fairly common complication in cases where the ovaries are preserved after removal of the uterus. This is how the negative influence of the operation itself is manifested. To understand the nature of a cyst, one must first understand how the ovaries work. In fact, a cyst is a natural process that occurs every month in the ovary under the influence of hormones and is called a follicular cyst.If the egg is not fertilized, the cyst bursts and menstruation begins. Now let’s see what happens to the ovaries after the removal of the uterus. By itself, the uterus does not produce hormones. And many surgeons assure that after its removal, the hormonal background will not change. But they forget to say how closely the uterus is connected to other organs. When the ovaries are separated from the uterus, the surgeon inevitably disrupts the blood supply and injures them. As a result, the work of the ovaries is disrupted, their hormonal activity decreases.Unlike the uterus, the ovaries produce hormones. Disturbances in the work of the ovaries leads to a violation of the hormonal background and the process of maturation of follicles. The cyst does not dissolve, but continues to grow. It takes about 6 months to restore full ovarian function and hormonal levels. But everything does not always end well, and the enlarged cyst resolves. Often, to remove an overgrown cyst, a second operation is required – with a large formation there is a risk of rupture and bleeding.If a few months after the removal of the uterus in the lower abdomen, pain appears, which grows over time, it is necessary to visit a gynecologist. The most likely reason why the ovary hurts is an overgrown cyst. The likelihood of developing this complication is only 50% dependent on the skill of the surgeon. Each woman’s anatomy is unique. It is not possible to predict the location of the ovaries and their behavior before surgery, therefore, no one can predict the development of a cyst after removal of the uterus.

Consequence 3.Adhesions after removal of the uterus

Extensive adhesions after removal of the uterus often leads to the development of chronic pelvic pain. The characteristic symptoms of these pains are that they are aggravated by bloating, indigestion, peristalsis, sudden movements, and prolonged walking. Adhesions after surgery to remove the uterus form gradually. Accordingly, pains appear only after a while. At the initial stage, postoperative adhesions in the small pelvis are treated conservatively; if ineffective, they resort to laparoscopic excision of adhesions.

Consequence 4. Weight after removal of the uterus

Body weight after surgery can behave in different ways: some women get fat, sometimes even get fat, and some manage to lose weight. The most common scenario after the removal of the reproductive organs is rapid weight gain, or a woman’s belly grows.

1. One of the reasons why women get better is associated with metabolic disorders and the resulting fluid retention in the body. Therefore, strictly monitor how much water you drink and how much you excrete.

2. After removal of the uterus with the ovaries, the hormonal background changes, which leads to a slowdown in the breakdown of fats, and the woman begins to gain excess weight.

In this case, a gentle diet will help to remove the belly. Meals should be fractional, in small portions 6-7 times a day.

Is it worth worrying if you lost weight after having your uterus removed? If the reason for the operation was a giant tumor or fibroid, don’t worry, you lost weight after removing the uterus. If there was no volumetric education, but you are losing weight, most likely the matter is in hormonal imbalance.To get your weight back to normal, hormone therapy will be required.

Consequence 5. Sex after removal of the uterus

Women who have undergone vaginal removal of the uterus should observe sexual rest for at least 2 months until the internal sutures heal. In all other cases, sex can be engaged in 1-1.5 months after the operation. Sexual life after removal of the uterus undergoes changes. In general, women are worried about vaginal dryness, burning after intercourse, discomfort, painful sensations.This is due to a drop in estrogen levels, due to which the genital mucosa becomes thinner, and begins to produce less lubricant. Hormonal imbalance reduces libido, interest in sex life decreases.

• Removal of the uterus with appendages is most reflected in the intimate side of life, since the absence of female hormones leads to frigidity.
• Removing the body of the uterus has little effect on intimate life. There may be vaginal dryness, decreased libido.
• Removing the uterus with the cervix shortens the vagina, making it difficult to have sex after surgery.

Consequence 6. Orgasm after removal of the uterus

Does the woman have an orgasm after removing the uterus? On the one hand, all sensitive points – the G-point and clitoris – are preserved, and theoretically a woman can still experience an orgasm even after the organ is removed. But in reality, not every woman gets an orgasm after surgery. So, when the ovaries are removed, the content of sex hormones in the body drops sharply, and many develop sexual coldness.A decrease in the production of sex hormones occurs even when the ovaries are preserved – for many reasons, after the operation, their activity is disrupted. The best prognosis for orgasms is for those who still have the cervix. The consequences after removal of the uterus and cervix are manifested in the shortening of the vagina by about a third. Full sexual intercourse often becomes impossible. Research carried out in this area has shown that the cervix is ​​of great importance in achieving vaginal orgasms, and when the cervix is ​​removed, it becomes extremely difficult to achieve.

Consequence 7. Pain after removal of the uterus

Pain is one of the main complaints after surgery.

1. In the postoperative period, pain in the lower abdomen may indicate a problem in the suture area or inflammation. In the first case, the stomach hurts along the seam. In the second case, high temperature is added to the main symptom.

2. If the lower abdomen hurts and there is a swelling, you can suspect a hernia – a defect through which the peritoneum and intestinal loops go under the skin.

3. Severe pain after surgery to remove the uterus, high fever, poor health indicate pelvioperitonitis, hematoma or bleeding. Reoperation may be required to resolve the situation.

4. Pain in the heart speaks of the possibility of developing cardiovascular diseases.

A large Swedish study of 180,000 women showed that hysterectomy significantly increases the risk of cardiovascular disease, coronary artery disease and stroke.Removing the ovaries further aggravates the situation.

5. If you are concerned about leg swelling, increased local skin temperature – you need to exclude thrombophlebitis of the veins of the small pelvis or lower extremities.

6. Pain in the back, lower back, right side or left can be a symptom of adhesive disease, cysts on the ovary and much more – it is better to consult a doctor.

Consequence 8. Descent after removal of the uterus

After removal of the uterus, the anatomical arrangement of organs is disrupted, muscles, nerves and blood vessels are injured, and the blood supply to the pelvic region is disrupted.The framework that supports the organs in a certain position ceases to fulfill its functions. All this leads to displacement and prolapse of internal organs – primarily, the intestines and bladder. An extensive adhesion process exacerbates the problem. This is manifested by numerous growing problems from the intestines and urinary incontinence during exercise, coughing.

Consequence 9. Prolapse after removal of the uterus

The same mechanisms cause the so-called prolapse of the genitals – the prolapse of the vaginal walls and even their prolapse.If in the postoperative period a woman begins to lift weights without waiting for full recovery, then the situation is aggravated. Intra-abdominal pressure rises, the walls of the vagina are “pushed” outward. Weight lifting for this very reason is contraindicated even for healthy women. When omitting, the woman has a sensation of a foreign object in the perineal region. Disturbed by pain. Sexual life becomes painful. To reduce the symptoms of prolapse of the vaginal walls after removal of the uterus, special gymnastics is shown.For example, Kegel exercises. Constipation also increases intra-abdominal pressure, therefore, in order to prevent the process, you will have to learn how to monitor the work of the intestines: bowel movements should be daily, and feces should be soft. Unfortunately, vaginal prolapse after removal of the uterus cannot be treated.

Consequence 10. Intestines after removal of the uterus

Bowel problems after surgery are affected not only by the altered anatomy of the pelvis, but also by the massive adhesions. The work of the intestines is disturbed, constipation, flatulence, various defecation disorders, soreness in the lower abdomen occur.To avoid intestinal problems, you must follow a diet. You will have to learn to eat often, 6 to 8 times a day, in small portions. What can you eat? Everything, with the exception of heavy food, foods that cause bloating, stool retention. Improves the condition of the pelvic organs and regular exercise.

Consequence 11. Breast after removal of the uterus

Removal of the uterus has no effect on the incidence of breast cancer. However, with one exception. If the cause of the operation was fibroids, then the mammary glands after removal of the uterus require special attention.The fact is that myoma is a hormone-dependent disease. And the trigger for the development of the tumor process of the mammary glands is often hormonal disruptions.

Consequence 12. Urinary incontinence after removal of the uterus

This syndrome develops in almost 100% of cases as a result of a violation of the integrity of the ligamentous and muscular frame during surgery. There is a prolapse of the bladder, the woman ceases to control urination. To restore bladder function, doctors recommend doing Kegel exercises, but even with exercise, the condition usually progresses.

Consequence 13. Relapse after removal of the uterus

Operation on the uterus is performed according to different indications. Unfortunately, the operation does not protect against recurrence if the removal of the uterus was performed for one of those diseases that lead to the development of the human papillomavirus, namely:

Regardless of the technique used, a surgical operation does not guarantee 100% recovery, it only removes the lesion. In the vaginal mucosa, traces of the human papillomavirus remain, which is the cause of all these diseases.When activated, the virus causes a relapse. Of course, if there is no organ, then a relapse of the disease cannot occur either in the uterus or in its cervix. The cervical stump and the mucous membrane of the vaginal vault are subject to relapses – dysplasia of the vaginal stump develops. Unfortunately, relapses are very difficult to treat with classical methods. Medicine can offer such patients only traumatic methods. Removing the vagina is an extremely difficult and traumatic operation, and the risks of radiation therapy are comparable to the risks of the disease itself.

That is why, against the background of high risks of relapse, e the only correct way to treat virus-associated diseases of the cervix is ​​to use not surgery, but high-tech therapeutic treatment using photodynamic therapy . This method eliminates not only atypical epithelial cells, but also the virus itself.

According to various sources, relapses after surgery occur in 30 – 70% of cases. That is why, for the purpose of prevention, the Herzen Institute recommends performing photodynamic therapy of the vagina and cervical stump even after surgical removal of the uterus.Only the elimination of the papilloma virus protects against the return of the disease. This is the story of my patient Natalia, who faced recurrent cancer in situ of the vaginal stump after removal of the uterus.

“Well, I’ll start in order my sad story, with a happy ending. After giving birth at 38 and fulfilling my daughter for 1.5 years, I had to go to work and I decided to go to a gynecologist. In September 2012, nothing boded about sadness, but the tests were not reassuring – first-degree cervical cancer.It was, of course, shock, panic, tears, sleepless nights. In oncology, I passed all the tests, where the human papillomavirus 16.18 genotype was found.

The only thing that our doctors suggested to me was the expiration of the cervix, uterus, but I asked to leave the ovaries.

The postoperative period was very difficult both physically and mentally. In general, there was a vaginal stump, no matter how sad it may sound. In 2014, after 2 years, the analyzes show again a not very good picture – dysplasia of the 1st degree, then six months later, the 2nd degree.What they didn’t treat her – all kinds of suppositories, antivirals, ointments.

In short, a lot of money was spent, and after a year and a half of treatment for this dysplasia, she passed into the third stage and again cancer. What did our doctors suggest to me this time: photodynamics.

After reading about her, I was delighted and surrendered into their hands. And what do you think, what was the result of their innovative technologies? And nothing has changed! Everything remained in place. But I read so much about this method, studied various articles, I was especially attracted by the method of photodynamics of Dr. M. Afanasyev.S., and comparing the methodology and technology of treatment, I was surprised that everything that this doctor writes and tells differed significantly from what was done to me in our clinic. Starting from the ratio of the drug per kilogram of my weight, the very technique, the questions they asked me. After photodynamics, they were forced to wear glasses for almost a month, to sit at home with closed curtains, not protruding out into the street. I had no doubt that they simply do not know how to do this procedure! I contacted Dr. M. Afanasyev.S., bombarded him with questions, told her story and he offered to help. I thought for a long time and doubted.

My doctor offered me radiation therapy, but knowing the consequences of it and the quality of life after this therapy, I still chose photodynamics again, but what would have been done to me by Maxim Stanislavovich.

Gathering up with renewed energy, I flew to Moscow. The first impression of the clinic was, of course, pleasant, you feel like a person that everyone cares about, attentiveness and responsiveness are the main qualities of these employees.

About PDT procedure and recovery

The procedure itself was carried out under anesthesia, went away quickly, in the evening I went to the sister where I was staying. I wore glasses for only three days. After 40 days, I went to my clinic for an initial examination, but I had an eroded spot, apparently the healing was going slowly, but with all this, the tests were good! The doctor prescribed healing suppositories. And when I came 3 weeks later, the doctor spent … … .., everything healed, and was very surprised – how so! Indeed, for the entire practice of carrying out photodynamics using their technology, there was not a single positive result! Now in April I will go for another examination.I am sure that everything will always be fine with me!

This is my story. And I am telling it to you so that you do not give up, and during the treatment you choose the most gentle method of treatment, and not immediately remove everything, apparently this is easier for our doctors. If I had known about Maxim Stanislavovich earlier, I would have avoided these tears, a terrible operation, the consequences of which will strain my whole life! So think about it! No money costs our health! And most importantly, if you have a human papillomavirus of this particular genotype, which provokes cervical cancer under certain circumstances, you need to remove this cause.This is exactly what photodynamics does, but the technology and the doctor who does it must be masters of their craft. They have extensive experience, scientific work and positive results in this area. And I think the only doctor who observes all this is Maxim Stanislavovich. Thank you very much Maxim Stanislavovich !!! ”

The consequences described above after removal of the uterus affect different women to varying degrees. Young women of childbearing age are the most difficult to remove the uterus.

Consequences of removal of the uterus after 60 years

Removal of the uterus in old age, after menopause, is relatively easy. In postmenopausal women, the main discomfort is brought by the operation itself, as well as the adhesion process and the consequences of displacement and prolapse of organs. Removal of the uterus after menopause no longer leads to a sharp hormonal disorder.

Consequences of removal of the uterus after 50 years

Operation during menopause also does not greatly affect the health and well-being of a woman.And if the operation was performed according to the indications, then you made the right choice.

Consequences of removal of the uterus after 40 years

If a woman did not have menopause before the operation, then it will be very difficult for her during the recovery period. The consequences of surgery in an active childbearing age are tolerated much more acutely than in the age of natural menopause. If the surgery was caused by huge fibroids or bleeding, removal of the uterus brings significant relief. Unfortunately, over time, almost all the long-term consequences, which we talked about above, develop.In medical language, this condition is called posthysterectomy and postovariectomy syndrome. It manifests itself as mood swings, hot flashes, arrhythmias, dizziness, weakness, headache. The woman does not tolerate stress, begins to get tired. Within literally a few months, sexual desire falls, soreness develops in the pelvic area. The skeletal system suffers – the level of minerals falls, osteoporosis develops. If the hormonal background is not corrected, aging will begin immediately after the operation: 5 years after hysterectomy, 55–69% of women operated on at the age of 39–46 have a hormonal profile corresponding to the postmenopausal one.

Surgery to remove uterine cancer is not needed in its early stages

Uterine cancer – adenocarcinoma and carcinoma – a malignant process. The choice of the method of treatment and the scope of the intervention depends on the stage of the disease. Earlier, the initial stages of cancer ( in situ cancer , microinvasive cancer) and precancerous diseases ( cervical dysplasia of the 3rd degree , atypical hyperplasia ) were indications for removal of the uterus. Unfortunately, oncological surgery does not eliminate the cause of the disease – the human papillomavirus – and therefore has a high relapse rate.With the advent of the method of photodynamic therapy for these diagnoses, it became possible to preserve the organ and eliminate the very cause of the disease. What is the essence of the technique? The patient is injected with a drug that increases tissue photosensitivity – a photosensitizer. This drug is eventually cleared from healthy cells and stored in atypical cells, including those containing the human papillomavirus, the cause of cancer and precancerous conditions. 2-3 hours after the administration of the drug, the doctor conducts irradiation with laser light to activate the photosensitizer.The photochemical reaction, which occurs in response to the interaction of light with a photosensitizer, causes the formation of toxic substances destructive for them in pathological cells. The cells die, and recovery occurs.

Photodynamic therapy is effective not only up to removal of the uterus for dysplasia, in situ cancer, 1A cancer, endometrial hyperplasia, but also after surgery. The procedure allows to exclude the development of relapse and while preserving the organ .

Call and sign up for a consultation, and together we will find a solution to save the uterus and avoid these problems. Send your test results to email [email protected] or make an appointment by phone
8 (800) 555-77-26
in Moscow.

Reception is conducted by Maxim Stanislavovich Afanasyev, oncologist, Doctor of Medical Sciences, professor and member of the Academic Council of the First Moscow State Medical University. THEM. Sechenov MH RF, surgeon-oncologist, gynecologist-oncologist, gynecologist-immunologist, expert in the treatment of dysplasia and cervical cancer.

The following sources were used in the article, which we allowed ourselves to popularly adapt for non-specialists:

1. Erik Ingelsson, Cecilia Lundholm, Anna L.V. Johansson, Daniel Altman. Hysterectomy and risk of cardiovascular disease: a population-based cohort study. // European Heart Journal, Volume 32, Issue 6, 1 March 2011, Pages 745–750

academic.oup.com

2. Skorbach EI, Shcherbina IN, Lazurenko VV, Mertsalova OV “Posthysterectomy disorders and prevention of their development.”// International Medical Journal. 2011, no. 2. S. 27-31

dspace.nbuv.gov.ua

3. D.I. Gaivoronskikh, A.A. Koval, V.G. Skvortsov. “Posthysterectomy syndrome: clinical manifestations and methods of their correction.” // Bulletin of RVMA. 2012, 4 (40). S. 120-123.

www.vmeda.org

Services by department

14451 Removal of a nascent myomatous node

operation 9045 3 000

14.26 rupture

14.34452

14.42 surgery

14.42 surgery 9045 34 900

Operative gynecology

A hysterectomy is an operation to remove the uterus. Today it ranks second in Russia in terms of frequency after operations on the uterine appendages.
In LDK “Medgard” removal of the uterus is carried out as an open access (through an incision in the lower abdomen), laparoscopically (through three small punctures) and vaginal access…. The operating gynecologists of “Medgarda” are one of the few doctors in the region who have the technique of performing such an operation through natural pathways.

Indications for hysterectomy

Removal of the uterus is a serious surgical intervention, the decision to carry out which is made on the basis of a thorough diagnosis and assessment of all accompanying factors. The indications for surgery are:

• Tumor diseases and large fibroids that affect nearby organs
• with prolapse or prolapse of the uterus
• for malignant neoplasms of the cervix
• for inflammatory diseases of the uterus and appendages that do not respond to conservative treatment

At the age of up to 40 years, preference is given to organ-preserving operations.Their goal is treatment while preserving reproductive function. The final decision on the method of surgical treatment is also influenced by the patient’s reproductive plans.

Types of hysterectomy

Depending on the involvement in the pathological process, as well as the patient’s history, there are

• Subtotal hysterectomy – removal of the uterus while preserving the cervix
• total hysterectomy – removal of the body of the uterus and its cervix
• radical hysterectomy – removal of the uterus, cervix, appendages and ovaries

Subotatal hysterectomy is performed before the age of 50 and subsequently allows sexual activity.However, with this, the risk of developing cervical cancer remains. That is why laboratory diagnostics (smear for oncohistology) comes to the fore when making a decision.

Total hysterectomy is the most common type of such surgery. It is carried out with uterine fibroids and high risks of developing cervical cancer (colposcopy data, identified by HPV).

Radical hysterectomy is performed in case of high risks of further development of ovarian cancer. But since menopause occurs as a result of the operation, the decision to carry it out is made based on many factors.The patient’s age is one of them.

Methods of carrying out hysterectomy

The laparotomic approach allows the surgeon to remove the uterus (cervix and appendages) through an incision in the abdominal wall in the lower abdomen (10-20 cm).
The disadvantage of laparotomic hysterectomy in the high trauma of the operation, pain in the recovery period, which require the use of analgesics.

Laparoscopic hysterectomy is performed through three small punctures (in the navel and lower abdomen).The surgeon manipulates the instruments under the control of the optics, which displays the image on the screen. Thus, a low invasiveness and a short recovery period, small blood loss, a good cosmetic effect, as well as better visualization when enlarging the image are achieved, which allows you to act, on the one hand, targeted, on the other hand, not to miss the details.

Vaginal hysterectomy is performed through an incision in the upper third of the vagina, so there are no sutures and scars on the anterior abdominal wall.With the advantages of this method (low trauma, low blood loss, quick recovery), it should also be taken into account that the operation is possible with a sufficient volume of the vagina and a moderate size of the uterus. The maximum weight of the uterus removed by the gynecologists of the Medgard LDK by vaginal access is 860 grams.

Recovery period

The operation takes about 3 hours. After that, for 3-5 days it is necessary to stay in a round-the-clock hospital “Medgarda” under the supervision of a doctor and medical staff.
After laparoscopic and vaginal hysterectomy, it is allowed to turn, sit down and get up on the day of the operation. The next day, walk and eat (in accordance with the postoperative diet).
For two to three weeks, it is recommended to shower only and treat existing wounds. For a period of up to a month, a ban is imposed on any physical activity over everyday life.
A month after the operation, a control appointment and examination are prescribed, followed by a histological examination and recommendations for the recovery period.

About the operation to remove the incisional hernia of the abdomen

This guide will help you prepare for your incisional abdominal hernia surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect as you recover.

Read this manual at least once before your surgery and use it as a reference as you prepare for the day of your surgery.

Take this guide with you to all visits to MSK, including the day of your surgery.You and your healthcare team will guide you through your treatment.

to come back to the beginning

Operation Information

About hernias of the abdominal wall

The abdominal wall, made up of muscles, protects the organs located in the abdominal cavity (belly).

A hernia is a protrusion of an organ or adipose tissue through a weak spot in the muscles or connective tissue of the abdominal wall (see Figure 1).

Figure 1.Abdominal hernia

One of the types of hernias is incisional hernia. Such a hernia can form around an incision (surgical cut) in scar tissue after previous surgery (see Figure 2). This can happen after any surgery performed on the abdomen, from the sternum to the groin.

Figure 2. Postoperative abdominal hernia

If you have a postoperative hernia, you may notice a swelling or protrusion under the skin at the site of the surgery.In addition, you may experience abdominal discomfort by lifting weights or bending over.

About hernia surgery

You will need to have surgery to repair the hernia. Such operations are of various types, including open surgery or laparoscopic surgery. Your surgeon will explain to you which type of hernia surgery is best for you.

Operation laparoscopy

During a laparoscopic operation, your surgeon will make several small incisions in your abdominal wall.The abdominal cavity will be inflated with air, allowing the surgeon to see your organs freely. Through one of the incisions, the surgeon will insert a thin, illuminated endoscope called a laparoscope. Through other incisions, he will insert instruments to repair the hernia.

Open transaction

For open surgery, your surgeon will make an incision that is large enough to remove the scar tissue and fat from the abdominal wall near the hernia. It can also strengthen the weakened abdominal wall with a special mesh.This mesh will be secured from the inside of the abdominal wall under an opening or weakened area. Over time, the mesh grows into the inner lining of the abdominal cavity.

The operation will take about 3 hours.

to come back to the beginning

Before operation

The information in this section will help you prepare for your surgery. Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches. It contains important information about what you need to do before your surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

Preparation for surgery

You and your healthcare team will prepare for your surgery together.

Help us make your transaction as secure as possible: Tell us if any of the statements below match your situation, even if you’re not entirely sure.

• I am taking blood thinning medication, for example:
  • aspirin;
  • Heparin
  • Warfarin (Jantoven ^® or Coumadin ^® )
  • Clopidogrel (Plavix ^® )
  • Enoxaparin (Lovenox ^® )
  • Dabigatran (Pradaxa ^® )
  • Apixaban (Eliquis ^® )
  • Rivaroxaban (Xarelto ^® )

  There are other similar medications, so be sure to tell your healthcare provider about any medications you are taking.

• I am taking prescription drugs (prescribed by my healthcare provider), including patches and ointments.
• I take over-the-counter medicines (which I buy without a prescription), including patches and ointments.
• I am taking nutritional supplements such as herbs, vitamins, minerals, and natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter defibrillator (AICD), or other cardiac pacemaker.
• I have sleep apnea attacks.
• I used to have problems with anesthesia (with the administration of a medication that makes me fall asleep during surgery).
• I am allergic to some drugs or materials such as latex.
• I do not want to receive a blood transfusion.
• I drink alcohol.
• I smoke or use electronic smoking devices (eg disposable e-cigarettes, vape, Juul ^® ).
• I take soft drugs.

Alcohol use

The amount of alcohol you drink may affect your condition during and after surgery. It is very important to tell healthcare providers how much alcohol you are drinking. This will help us plan your treatment.

• If you stop drinking abruptly, it can cause seizures, alcoholic delirium and death.
  If we know that you are at risk for these complications, we can prescribe medications for you to avoid them.
• If you drink alcohol regularly, there is a risk of other complications during and after surgery. These include bleeding, infections, heart problems, and longer hospital care.

To prevent possible problems, before the operation, you can:

• Tell healthcare providers honestly how much alcohol you drink.
• After the appointment of the operation, try to stop drinking alcohol.If, after stopping alcoholic beverages, you experience headaches, nausea (vomiting sensation), increased anxiety, or have trouble sleeping, tell your healthcare provider right away. These are early signs of alcohol withdrawal that can be treated.
• Tell your healthcare provider if you are unable to stop drinking.
• Ask your healthcare provider questions about how drinking alcohol might affect your body in connection with surgery.As always, we will ensure the confidentiality of all your medical information.

On smoking

During surgery, smokers may experience breathing problems. Quitting smoking even a few days before surgery will help prevent these problems. If you smoke, your healthcare provider will refer you to the Tobacco Treatment Program. You can also contact this program by calling 212-610-0507.

Sleep Apnea Information

Sleep apnea is a common breathing disorder that causes a person to stop breathing for a short period during sleep.The most common type is obstructive sleep apnea (OSA). In OSA, the airways are completely blocked during sleep. OSA can cause serious complications during and after surgery.

Let us know if you have sleep apnea attacks, or if you think you may have sleep apnea. If you are using a breathing apparatus (such as a CPAP machine) to prevent sleep apnea, take it with you on the day of surgery.

Within 30 days prior to surgery

Preoperative study

Before your surgery, you will be assigned a presurgical testing (PST). The date, time and location will be indicated in the appointment reminder that you receive at the surgeon’s office. You will help us if you take with you to the preoperative examination:

• A list of all the medicines you take, including prescription and over-the-counter medicines, patches, and creams;

90,019 Results of any tests you did outside of MSK, such as exercise ECG, echocardiogram, or carotid Doppler

90,019 names and phone numbers of the medical staff treating you.

On the day of your appointment, you can take your food and medicine as usual.

During the preoperative study, you will meet a highly qualified nurse. This is a medical professional who works with anesthesiologists (medical personnel who have received special training who will perform anesthesia during surgery). A senior nurse / nurse will review your medical record and your surgical history with you. You will need to undergo a number of tests, including an electrocardiogram (EKG) to check your heart rate, chest x-rays, blood tests, and other tests needed to plan your treatment.In addition, a trained nurse can refer you to other specialists.

The Nurse will also advise you on what medications you will need to take on the morning of your surgery.

Determine who will look after you

Your caregiver plays an important role in your treatment. Before your surgery, your healthcare team will tell you and your caregiver about the surgery. In addition, the person will need to take you home after your surgery and discharge from the hospital.Also, this person will help you at home.

Information for caregivers

Existing materials and support are available to help you meet the many responsibilities that come with caring for someone undergoing cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read the resource Guide for Caregivers
…

Complete the Health Care Proxy Form

If you have not yet completed the Health Care Proxy, we recommend that you do so now.If you have already completed this form or have other advance directives, please take them with you to your next appointment.

The Power of Attorney for Health Care Decisions is a legal document that specifies the person who will represent you in the event that you are unable to do so on your own. The person listed there will be your health care agent.

Talk to your healthcare provider if you are interested in completing a power of attorney to make healthcare decisions.You can also read the resources Advance Care Planning and How to Be a Care Representative for information about health care proxies, other advance directives, and acting as a care agent.

Perform breathing and coughing exercises

Take deep breaths and clear your throat before surgery. Your healthcare provider will give you a stimulation spirometer to help expand your lungs.For more information, see the resource How to use your incentive spirometer.

Stick to a healthy diet

Aim to eat a well-balanced, healthy diet prior to surgery. If you need help with diet planning, ask your healthcare provider to refer you to a dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) antiseptic cleanser (such as Hibiclens®).

4% CHG solution is a skin cleanser that kills various microorganisms and prevents their appearance within 24 hours after use. By showering with this solution before surgery, you can reduce the risk of infection after surgery. You can purchase a 4% CHG antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before surgery

Follow your healthcare provider’s instructions when taking aspirin

If you are taking aspirin and any medicines containing aspirin, you may need to change your dose or not take them within 7 days of your surgery.Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless directed to do so. Read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Vitamin E for more information.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before surgery.These medicines can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatments.

2 days before surgery

Stop taking nonsteroidal anti-inflammatory drugs [NSAIDs].

Stop taking NSAIDs such as ibuprofen (Advil ^® and Motrin ^® ) and naproxen (Aleve ^® ) 2 days before surgery. These medicines can cause bleeding.For more information, read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Vitamin E.

1 day before surgery

Follow a clear liquid diet

You will need to follow a clear liquid diet the day before your surgery. The clear liquid diet is all about clear liquids. Examples are shown in the Liquid Diet Zero table.

While you are on a clear diet:

• Do not eat any solid food.
• Aim to drink at least 1 glass (8 oz. Or 240 ml) of clear liquid every hour while awake.
• Drink a variety of clear liquids, not just water, coffee and tea.
• Do not drink sweetened fluids unless you have diabetes and are instructed to do so by a healthcare team member.

Diabetes

If you have diabetes, talk with your healthcare provider about what to do with the clear liquid diet.

• If you are taking insulin or other diabetes medications, please ask if you need to change your dosage.
• Ask if you should consume sugar-free clear liquids.

Check your blood sugar frequently while you are following a clear liquid diet. If you have any questions, ask your healthcare provider.

Initiate bowel preparation as needed

If your surgeon or nurse tells you that you need bowel preparation for your surgery, you need to start it 1 day before your surgery.During bowel preparation:

• Do not eat solid food.
• Drink plenty of liquids other than water, black coffee, and tea. Try to drink at least 1 glass (8 oz. (240 ml)) every hour while you are awake.

Drink magnesium citrate at 2:00 pm the day before your surgery.

Record the time at which the operation is scheduled

An admissions officer will call you after 2:00 pm the day before your surgery.If your surgery is scheduled for a Monday, you will receive a call the previous Friday. If no one contacts you by 19:00, please call 212-639-5014.

A staff member will tell you when you should come to the hospital for your surgery. You will also be reminded how to get to the ward.

The operation will be performed at one of the following addresses:

• Come to the Presurgical Center,
  ^{which is located at 1275 York Avenue (between East 67 th Street and East 68 th Street),
  New York, NY 10065
  2nd Floor , lift M.}
• Come to the Presurgical Center,
  ^{which is located at 1275 York Avenue (between East 67 th Street and East 68 th Street),
  New York, NY 10065
  6- th floor, lift M.}

Shower with a 4% CHG antiseptic cleanser (e.g. Hibiclens®)

The evening before the day of surgery, shower with a 4% CHG antiseptic cleanser.

1. Wash hair with regular shampoo. Rinse your hair thoroughly.
2. Wash your face and genital area with your usual soap. Rinse your body thoroughly with warm water.
3. Open the vial with 4% CHG solution. Pour a small amount into your hand or onto a clean washcloth.
4. Move away from the water jet. Massage the 4% CHG solution lightly into the body from neck to feet. Do not apply it to your face or genital area.
5. Return under tap water and rinse with 4% CHG solution.Use warm water.
6. After showering, dry yourself with a clean towel.
7. Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Sleep

Go to bed early and try to get a good night’s sleep.

Instructions for eating before surgery

Do not eat after midnight before your surgery. This also applies to candy and chewing gum.

Morning before surgery

Instructions for drinking drinks before surgery

You may drink a maximum of 12 ounces (350 ml) of water between midnight and 2 hours before your arrival time at the hospital.Don’t drink anything else.

Do not drink any liquid two hours before your scheduled arrival time at the hospital. This also applies to water.

Take medication according to instructions

If your healthcare provider tells you to take some medicines in the morning before your surgery, take only those medicines with a small sip of water. Depending on the medications, this may be all or some of the medications you usually take in the morning, or you may not need to take them at all.

Shower with a 4% CHG antiseptic cleanser (such as Hibiclens®)

Shower with 4% CHG antiseptic skin cleanser before leaving the hospital. Use the same remedy as the night before.

Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Points to Remember

• Wear comfortable, loose-fitting clothing.
• If you wear contact lenses, remove them and put on glasses. During surgery, contact lenses can injure your eyes.
• Do not wear metal objects. Remove all jewelry, including body piercings. The equipment used during the operation may cause burns if it comes into contact with metal.
• Do not use any lotion, cream, deodorant, makeup, powder, perfume or cologne.
• Leave valuables at home (such as credit cards, jewelry, and a checkbook).
• If your period (period) starts, use a sanitary towel, not a tampon. You will be given disposable underwear and a pad if needed.

What to take with you

• Your own breathing apparatus for the prevention of sleep apnea (eg CPAP apparatus), if available.
• An emergency inhaler (eg albuterol for asthma), if you are using it.
• Incentive spirometer, if you have one.
• A Health Care Proxy Form, if you have completed it.
• Mobile phone and charger.
• A small amount of money that you may need for small purchases (for example, to buy a newspaper).
• A bag for storing personal items (such as glasses, hearing aids, dentures, dentures, wig, and religious items), if you have them.
• List of medicines you are taking.
• These are recommendations.Using these guidelines, your healthcare team will guide you on how to take care of yourself after your surgery.

Where to park

MSK Garage is located at East 66 ^th Street between York Avenue and First Avenue. For parking prices, call 212-639-2338.

To enter the garage, turn onto East 66 ^th Street from York Avenue. The garage is located approximately a quarter block from York Avenue, on the right (north) side of the street.A pedestrian tunnel leads from the garage to the hospital.

There are other garages located at East 69 ^th Street between First Avenue and Second Avenue, East 67 ^th Street between York Avenue and First Avenue, and East 65 ^th Street between First Avenue and Second Avenue.

Upon arrival at the hospital

You will be asked to state and spell your first and last name several times, as well as indicate your date of birth. This is for your safety.People with the same or similar names can be operated on on the same day.

Change for operation

When it’s time to change for your surgery, you will be given a hospital gown, gown, and non-slip socks.

Nurse appointment

You will meet with the nurse before your surgery. Tell her / him the doses of all medications you took after midnight and when you took them (including all prescription and over-the-counter medications, patches, creams, and ointments).

A nurse may place an intravenous (IV) line into one of the veins, usually in the arm or hand. If the nurse does not give you an IV, your anesthesiologist will do it when you are in the operating room.

Meeting with anesthesiologist

You will also meet with your anesthesiologist before your surgery. This specialist:

• will review the medical record with you;
• will ask if you have had any problems with anesthesia in the past, including nausea or pain;
• will talk about your comfort and safety during the operation;
• will tell you about the type of anesthesia you will receive;
• will answer your questions about anesthesia.

Preparation for surgery

Before surgery, you will need to remove your hearing aid, dentures, dentures, wig, and religious paraphernalia (if you have any of the above).

You will go to the operating room yourself, or a staff member will take you there on a gurney. A member of the operating team will help you lie down on the operating table and put compression boots on your shins. They will inflate and deflate smoothly to improve blood flow in your legs.

When you are comfortable on the table, the anesthesiologist will administer anesthesia through an IV line and you will fall asleep. Your IV line will also give you fluids during and after your surgery.

During operation

When you fall asleep, a breathing tube will be inserted through your mouth into your windpipe to help you breathe. You will also have a urinary catheter (Foley) placed to drain urine from your bladder.

After surgery is complete, surgical staples or stitches will be placed on your incision.In addition, Steri-Strips ^™ (thin strips of surgical tape) will be applied to your incisions. The incision site may be covered with a bandage. The breathing tube is usually removed while you are still in the operating room.

to come back to the beginning

After operation

The information in this section will let you know what to expect after surgery, while you are in the hospital, and when you leave home. You will learn how to safely recover from surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

What to expect on the day of your procedure

After your surgery, you will wake up in the Post Anesthesia Care Unit (PACU).

You will receive oxygen through a thin tube under your nose called a nasal cannula. The nurse will monitor your body temperature, heart rate, blood pressure, and oxygen levels.

A Foley catheter will be inserted into your bladder to track the amount of urine you are making. In most cases, it is removed 2 days after surgery. In addition, compression boots will be worn on the shins. When you can walk, they will be removed.

You can also have a Jackson-Pratt ^® drain (JP drain) installed. This drain is used to collect excess fluid, which helps reduce the risk of infection and promotes healing. In most cases, the drain is removed after a few days.If the drain remains with you after discharge, your nurse will teach you how to care for it.

If necessary, you will be given medication for pain relief and general comfort. These drugs can be administered in a variety of ways.

• Epidural catheter. For some people, pain medication may be given through an epidural catheter in the spine. This can be a patient-controlled analgesia (PCA) machine. The analgesic machine uses a computerized pump to inject pain medication into a vein.For more information, read the resource Patient-Controlled Analgesia (PCA).
• Nerve block. Some patients may have a nerve block procedure before or during surgery.
  During this procedure, the doctor injects the medication into a specific nerve to relieve pain after surgery.
• Intravenous drugs. For some people, pain medication may be injected directly into a vein through an IV line.
• Oral medicines. In some cases, oral pain relievers (medicines taken by mouth, such as tablets) are used.

After your surgery, you may be given medication in one of these ways, or several methods may be given at once. They are all effective pain relief methods, and your doctor will discuss them with you before choosing the option or options that work best for you.

After your stay in this wake-up room, one of the staff will transfer you to the hospital room.Shortly after you are brought into the room, you will be helped out of bed and into a chair.

A nurse will tell you how to recover from surgery. Below are some guidelines to help make this process safer.

• It is very important that you walk after the operation. It would be nice to set yourself the task of walking every 2 hours. This will help prevent blood clots in your legs.
• Use an incentive spirometer.This will help expand the lungs, which will prevent pneumonia from developing. For more information, read the resource How to Use Your Incentive Spirometer.

Frequently Asked Questions

Will I have pain after surgery?

After surgery, you will experience some pain at the incision sites. The doctor and nurse will regularly ask you about your pain. If necessary, you will be given medication to relieve pain.If pain persists, tell your doctor or nurse. Pain relief is imperative so that you can cough up, breathe deeply, use an incentive spirometer, and get out of bed and walk.

Will I be able to eat?

The day after the operation, you will be able to suck up the ice chips. After that, you can start drinking the clear liquids in small sips. As you recover, you will gradually return to your normal diet.

How long will I be in the hospital?

In most cases, patients are hospitalized within 2 days after laparoscopic surgery and within 5 days after open surgery, but this will depend on the operation that was performed.

Will I feel pain when I get home?

The duration of the presence of pain and discomfort is different for each person. You may feel pain when you return home, and you may be taking pain medication.Follow the guidelines below:

• Take your medicine as directed and as needed.
• Call your doctor if the prescribed medication does not relieve pain.
• Do not drive or drink alcohol while you are taking prescription pain medication.
• As the incision heals, the pain will decrease and you will need less pain medication. Mild pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) can help relieve pain and discomfort.However, taking large amounts of acetaminophen can damage the liver. Do not take more acetaminophen than what is listed on the bottle, or as directed by your doctor or nurse.
• Pain medications should help you get back to your normal routine. Take enough medication so you can exercise comfortably. Pain medications are most effective 30 to 45 minutes after you take them.Keep track of the timing of your pain medication. It is better to take the medicine when the pain first appears and not wait for it to intensify.

Pain medications may cause constipation (less frequent bowel movements than usual).

How can I prevent constipation?

• Go to the toilet at the same time every day. Your body will get used to emptying your bowels during this time.
• If you feel like using the toilet, don’t put it off.Try going to the bathroom 5-15 minutes after meals.
• We recommend emptying your bowels after breakfast. During this time, reflexes in the large intestine are strongest.
• Exercise if you can. Hiking is great exercise.
• If you can, drink 8 glasses (8 ounces (240 ml) each, 2 L total) of liquid daily. Drink water, juices, soups, milkshakes, and other decaffeinated drinks. Caffeinated beverages, such as coffee and soda, flush fluid from the body.
• Gradually increase your dietary fiber content to 25-35 grams per day. Fiber is found in fruits, vegetables, whole grains, and cereals. If you have a stoma or recently had bowel surgery, check with your doctor or nurse before making any dietary changes.
• Prescription and non-prescription medications are used to treat constipation. Start with one of the following over-the-counter medicines:
  • Polyethylene glycol (MiraLAX ^® ) 17 grams daily.
  • Senna (Senokot ^® ), 2 tablets at bedtime. It is a stimulant laxative that can cause cramping. If you haven’t had a bowel movement in 2 days, call your doctor or nurse.

How do I care for my incision?

The location of the incision will depend on the type of surgery performed. If the skin under the incision is numb, this is normal, because some of the nerve endings were cut off during the operation. After a while, the numbness will disappear.

• By the time you are discharged from the hospital, your surgical incision will begin to heal.
• Check your incision with your nurse before discharge to see what it looks like.
• If there is discharge from the incision, record the amount and color. Call your doctor’s office and talk to your nurse about incision discharge.

The nurse will talk with you about the signs of an infection.

If a bandage is applied to the incision at discharge, change it at least once a week, or more often if it gets wet from discharge.If the cut has stopped flowing, you can leave it open.

If Steri-Strips are applied to your incision at discharge, they will come off and fall off on their own. If they do not fall off after 10 days, you can take them off.

If glue is applied to the stitches during discharge, it will also come off and peel off by itself, like Steri-Strips.

Is it normal to feel tired after surgery?

Yes, feeling tired (weak) is common after surgery and can last from 6 to 8 weeks.Over time, the weakness will gradually disappear. Try to increase your activity level daily to help overcome weakness. Get out of bed, get dressed, and walk. You may need to get some sleep during the day, but try to stay awake as long as possible so that you will sleep well at night.

How will my diet change after surgery?

After surgery, you may experience loss of appetite and quick satiety after eating. These phenomena are expected and should disappear over time.Try to eat your favorite foods in small portions throughout the day. It is very important to get enough calories and protein to prevent weight loss and speed up your recovery.

Can I take a shower?

Yes, you can take a shower after you return home. A warm shower relaxes and helps relieve muscle pain. When showering, use soap and gently wash your incision. After showering, pat these areas dry with a towel and do not bandage the incision (if there is no discharge).Call your doctor if you notice redness or discharge from your incision.

Do not take a bath until you discuss it with your doctor at your first visit after surgery.

When is it safe for me to drive?

You must not drive while taking pain medication. Talk to your doctor about when you can drive again.

What exercises can I do?

Exercise will help you gain strength and improve your well-being.Hiking is great exercise. Gradually increase the distance you walk. Check with your doctor or nurse before proceeding to more vigorous exercise.

When can I lift weights?

Consult your doctor before lifting weights. In most cases, you should not lift anything heavier than 10 pounds (4.5 kg) for at least 6 weeks. Ask your doctor how long you should refrain from lifting weights.

When will my first visit to the doctor after surgery take place?

Your first postoperative visit is usually scheduled 1–2 weeks after you leave the hospital.
The nurse will give you directions on how to make an appointment, including the phone number to call.

How can I deal with my feelings?

After surgery for a serious illness, you may experience a new feeling of depression. Many people say that at some point they felt like crying, had to experience sadness, anxiety, nervousness, irritation and anger.You may find that you are unable to contain some of these feelings. If this happens, try to find emotional support.

The first step on this path is to share your feelings. Friends and family can help you. A nurse, doctor, and social worker can reassure and support you and give you advice. Be sure to tell these professionals about your emotional state and about the emotional state of your friends and loved ones. Numerous materials are available for patients and their families.Whether you are in the hospital or at home, nurses, doctors and social workers are ready to help you, your friends, and loved ones deal with the emotional aspects of illness.

What if I have other questions?

If you have any questions or concerns, talk to your doctor or nurse. You can reach them Monday through Friday, 9:00 am to 5:00 pm.

After 5:00 pm, and on weekends and holidays, call 212-639-2000 and ask the doctor who is on duty in your place.

to come back to the beginning

When to contact your healthcare provider

Tell your healthcare provider if you have:

• Temperature 101 ° F (38.3 ° C) or higher
• redness or discharge from the incision;
• pain has arisen or has increased sharply;

90,019 nausea and vomiting;

• diarrhea (loose or watery stools).
• Constipation
• have problems or issues with the use of JP drainage;
• a new or unusual symptom has appeared;
• have any questions or concerns.

to come back to the beginning

Support services

This section provides a list of support services that can help you prepare for and recover from surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

MSK Support Services

Admitting Office
212-639-7606
Call if you have questions about hospitalization, including requesting a single room.

Anesthesia Department
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you would like to become a blood or platelet donor.

Bobst International Center
888-675-7722
MSK accepts patients from all over the world. If you are from another country, call for help arranging your treatment.

Chaplaincy Service
212-639-5982
At MSK, chaplains are ready to listen, support family members, pray, reach out to local clergy or religious groups, or simply provide comfort and a helping hand. Anyone can apply for spiritual support, regardless of their formal religious affiliation. The Interfaith Chapel is located next to Memorial Hospital’s main lobby and is open 24 hours a day.If you have an emergency, call the hospital operator and ask to speak to the duty chaplain.

Counseling Center
646-888-0200
Psychological counseling helps many people. We provide counseling for individuals, couples, families and groups of individuals, and we provide medications to help you cope with anxiety or depression. To make an appointment, ask your healthcare provider for a referral or call the phone number above.

Food Pantry Program
646-888-8055
The Food Pantry Program provides food to low-income patients during cancer treatment. For more information, contact your healthcare provider or call the phone number above.

Integrative Medicine Service
646-888-0800
The Integrative Medicine Service offers a variety of services to complement traditional health care.These services include music therapy, mind / body therapy, dance and movement therapy, yoga and tactile therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or contact library staff for more information on a particular type of cancer. Alternatively, you can check out the LibGuides section on the MSK library website at libguides.mskcc.org.

Patient and caregiver education
www.mskcc.org/pe
Visit our patient and caregiver education website to search for educational materials in our virtual library. You can find learning resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may be encouraged to talk to someone who has received treatment like yours. Through our Patient and Caregiver Peer Support Program, you can talk to a former MSK patient or caregiver.Such conversations are confidential. You can communicate in person or by phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about a health care power of attorney or concerns about caring for you.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about who MSK will share your information with during surgery.

Private Duty Nursing Office
212-639-6892
You can request the assistance of a Private Duty Nursing Office or Companions. Call for more information.

Resources for Life After Cancer [RLAC] Program
646-888-8106
At MSK, patient care does not end after active treatment is completed. The Resources for Life After Cancer (RLAC) program is designed for patients who have completed their treatment and for their families. This program offers a variety of services such as workshops, workshops, support groups, and post-treatment counseling.She also helps with health insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health. MSK’s Sexual Health Program can help you take action and address sexual health issues before, during, and after treatment.

• Our Women’s Sexual and Reproductive Medicine Program can help you if you have cancer-related sexual health problems such as premature menopause or reduced fertility.For more information or to make an appointment, call 646-888-5076.
• Our Sexual and Reproductive Medicine Program for Men can help you if you have a cancer-related sexual health problem such as erectile dysfunction (ED). For more information and to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, their families and friends cope with the challenges of cancer.They provide one-on-one counseling and support groups during your treatment and can help you connect with your children and other family members. Our social workers can also refer you to local agencies and programs, and provide information on additional financial resources if you are eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help.Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK Virtual Programs offer online training and support for patients and caregivers, even if you cannot come to MSK in person. Through interactive activities, you can learn more about your diagnosis and what to expect during treatment and how to prepare for the different stages of cancer treatment. Classes are held confidentially, free of charge and with the involvement of highly qualified medical professionals.If you would like to join a virtual training program, visit our website at www.mskcc.org/vp for more information.

For more information online, see the Cancer Types section of www.mskcc.org.

External support services

Access-A-Ride Organization
web.mta.info/nyct/paratran/guide.htm
877-337-2017
MTA New York offers ridesharing and escort services for people with disabilities who are not can take the bus or metro.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Shelter ( Hope Lodge is a free stay for patients and their caregivers during cancer treatment.

Cancer and Careers Website
www.cancerandcareers.org
A resource for educational materials, tools and information on various activities for working people with cancer.

Cancer Organization Care
www.cancercare.org
800-813-4673
275 Seventh Avenue (between West 25 ^th Street and 26 ^th Street)
New York, NY 10001
Consulting, groups support, educational workshops, publications and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and educational materials for people facing cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides educational materials and support for people caring for loved ones with a chronic illness or disability.

Organization Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel for medical treatment around the country through available seats on corporate flights.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women and children with cancer receive social and emotional support through communication, workshops, lectures and social events.

Good Days Organization
www.mygooddays.org
877-968-7233
Offers financial assistance to cover copayments during treatment. Patients must have health insurance, they must meet a number of criteria, and they must be prescribed medications that are on the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover co-payments, health insurance premiums, and deductibles for certain drugs and treatments.

Joe’s House
www.joeshouse.org
877-563-7468
Provides cancer patients and their families with a list of places to stay near treatment centers.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT tolerant clinical trials.

LIVESTRONG Fertility Organization
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to help you learn more positively perceive your appearance.For more information or to sign up for a workshop, call the above phone number or visit the program website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free Cancer Legal Advocacy Program.

National LGBT Cancer Network
www.cancer-network.org
Provides educational materials, training courses and advocacy for LGBT patients who have had cancer and are at risk.

Needy Meds Resource
www.needymeds.org
Provides a list of programs that support patients in obtaining generic and registered brand drugs.

NYRx Organization
www.nyrxplan.com
Provides prescription drug benefits to eligible current and former New York State public sector employees.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps eligible patients who do not have prescription drug coverage get drugs for free or purchase them at a low cost.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides co-pay assistance for insured patients.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to medical care, financial assistance, insurance assistance, job security and access to a national resource directory for people with insufficient health insurance.

Organization RxHope
www.rxhope.com
877-267-0517
Provides assistance with getting drugs that people may not have enough money for.

to come back to the beginning

Educational resources

This section provides a list of the training materials that have been referenced in this manual. These materials will help you prepare for your surgery and recover safely from it.

As you read these resources, write down the questions you want to ask your healthcare provider.

to come back to the beginning

90,000 How to recover from a hysterectomy?

Do I need to wear a postoperative bandage?

If recommended by your doctor. He, after all, saw your inner world.

Can I go in for sports after removing the uterus?

Not only possible, but also necessary. It reduces stress, strengthens muscles, prolongs youth and improves vitality. It is unlikely that you are involved in high-performance sports, but if so, it is worth getting an additional recommendation from your doctor.Strengthening the pelvic floor will be especially important after the removal of the uterus. Experts recommend performing Kegel exercises or performing other gymnastics of a similar functionality several times a day.

ADVERTISING – CONTINUED BELOW

How soon can I start taking a bath?

Swimming or bathing is not recommended until the incisions are completely healed. However, you can usually shower almost immediately after surgery.

How soon can you start having sex after surgery?

Doctors usually recommend not having sex for one and a half to two months after removing the uterus. The same is true for using tampons. Some experts advise returning to sexual activity four weeks after the bleeding has completely stopped.

What if I don’t want to tell the man that my uterus has been removed?

This is your right.