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Hysteroscopy Fibroid Resection


What Is Hysteroscopy Fibroid Resection?

It is a procedure of removing fibroids that occur on the inside of the womb (uterus), in the uterine lining via the vagina using an instrument called hysteroscope.

Why is it done?

Fibroids are ball-like swellings in the wall of your uterus. They are created from an overgrowth of muscle fibres. You may have one or more fibroids. They are common, forming in three to four in 10 of all women (30-40%). Most fibroids do not cause problems and do not require treatment. They are benign but can sometimes be troublesome.

You have fibroids in your uterus. These can cause a number of symptoms including:

  • Pain
  • Heavy periods, called menorrhagia
  • Pressure on your bladder, bowel or spine.

Fibroids can cause miscarriages and problems when trying to become pregnant.

What to expect after surgery?

Duration of procedure: varied around 30 minutes to 1 hour, depending on the size of the fibroid.

If your reason for the operation is heavy periods or irregular menstrual bleeding, then your periods will be likely lighter and more regular afterwards. You will see improvements over the next 2-3 months. If you received Endometrial Ablation at the same time of your hysteroscopic resection, reduction in bleeding will be even more pronounced.

If your fibroids had made conceiving difficult then your chance of getting pregnant is improved after hysteroscopic resection. Please remember that the ability to conceive depends on many factors and therefore it is difficult to predict who will be successful after TCRF.

You will be moved to the recovery room to be cared for by a specialist nurse until you are stable and then transferred to the ward.

You may have some cramping abdominal pains and pain relief is given for this. Some vaginal blood loss may occur but not too much to cause concern. Once you are fully recovered, you will be given a drink and a light meal.

What are the risks of the surgery?

  • You may get adverse reaction with anaesthetics.
  • Excessive bleeding during the operation: If bleeding is not controlled by diathermy coagulation, it may be necessary to use pressure from an inflated catheter that is inserted into the womb.
  • Infection of the womb: Small risk and usually presented as offensive vaginal discharge. This is treatable with antibiotics.
  • Organ perforation: Risk of puncture of the uterus occurs in 1-2 per 1000 operations. Sometimes, when this happens, there is a small risk of bowel injury at the same time.
  • Excessive fluid absorption: Occurs in 1-5% operations.

What are the alternatives to the surgery?

  • Drug treatment - You can take drugs to make the fibroids smaller, but this is unlikely to be permanent and the fibroids may grow back.
  • Keyhole surgery - We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is more commonly used for serosal or intra-mural fibroids.
  • Embolisation - This is a method of shrinking single fibroids by cutting off their blood supply.
  • Hysterectomy - This is an operation to remove your uterus. If you never want to become pregnant and do not mind losing your uterus then this will stop your bleeding problems permanently.


Pelvic Floor Repair - PFR:


What Is PFR?

Pelvic floor muscles are a wide group of muscles under your pelvis that form the pelvic ‘floor’. The muscles are banded together, a bit like a hammock, to protect and hold in place your bladder, uterus and bowels. The ‘floor’ has two openings in it by which it controls, by relaxing and tightening at will, your vagina and your anus (rectum). When the ‘floor’ relaxes and contracts the openings, fluids and solids such as urine and faeces are able to leave the body.

There are two types of PFR operations;

  • An anterior vaginal repair – if the front wall of your vagina has prolapsed
  • A posterior vaginal repair – if the back wall of your vagina has prolapsed.

You may be having, or have had, a pelvic-floor repair operation in conjunction with a hysterectomy, if your uterus (womb) has prolapsed into your vagina.

Why is it done?

The pelvic floor can be a problem area for some women. Giving vaginal birth to several children, prolonged coughing fits, old age, obesity, a reduction in your oestrogen level resulting in weaker muscles, can together or individually lead to a weakened pelvic floor. A weakened pelvic floor can, in turn, lead to leakage of urine when one laughs, coughs or sneezes.

More seriously, if the floor is weakened sufficiently it can mean that your uterus is unsupported by it. If your uterus hangs low enough this is known as a prolapsed (or fallen) womb. Problems with a low-slung or weakened pelvic floor can lead to, for example, urine and bowel leakage, kidney infections and more.

What to expect after surgery?

The operation to repair a sagging pelvic floor can take up to 1 to 2 hour to repair. It does, however, vary from person to person.

Your gynaecologist will use dissolvable stitches. They tend to dissolve anywhere between 1 to 3 weeks. Other types of stitching can take up to nearly 7 weeks but your surgeon will decide which stitching material to use.

It can take up to 3 months to fully recover from this type of surgery. It will, however, vary from person to person. During this period, you should not lift heavy items or indulge in strenuous exercise. Activities like swimming and walking are fine.

What are the risks of the surgery?

You may experience some painful constipation and difficulty urinating, together with minor back pain for the first few days.Bleeding and infection may occur but are not very common. If a laparoscopy is used to repair the pelvic floor the chances for complications will be greatly reduced.

What are the alternatives to the surgery?

  • Pelvic floor exercises or electrical implants - These may help to strengthen your pelvic floor muscles if your prolapse is minor.
  • Vaginal pessary - This is a plastic ring put inside your vagina to prevent any loose vaginal skin from coming down. It can be an effective and comfortable alternative to surgery, but does not work for everyone. With regular checking it may work for many years.
  • Laparoscopic surgery - This is an operation using keyhole instruments. We repair your pelvic floor through a number of small cuts in your abdomen rather than through your vagina.
  • Burch colposuspension - This is an abdominal operation to lift the bladder. If your bladder has prolapsed, especially when you also have problems with leaking urine, this may be the best treatment. There is a separate leaflet within this series covering this operation.


Caesarean Section


What Is a Caesarean Section?

A Caesarean section, (also C-section) is a surgical procedure in which an incision is made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead foetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed.

Why is it done?

A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.

What to expect after surgery?

After a routine cesarean section, expect to be monitored closely for the next 24 hours to make sure that you don't develop any problems. You will receive pain medicine and will likely be encouraged to begin walking short distances within 24 hours of surgery.

Walking can help relieve gas buildup in the abdomen. It is usually very uncomfortable to begin walking, but the pain will decrease in the days after the delivery.

Avoid strenuous activities, such as bicycle riding, jogging, weightlifting, and aerobic exercise, for 6 weeks or until your doctor says it is okay.

The typical hospital stay after a cesarean delivery is about 3 days. You can feed and care for your newborn as you feel able. Before going home, you'll receive postsurgery instructions, including warning signs of complications. It can take 4 weeks or more for a cesarean incision to heal, and it isn't unusual to have occasional pains in the area during the first year after the surgery.

What are the risks of the surgery?

Cesarean risks for the mother include:

  • Infection
  • Heavy blood loss.
  • A blood clot in the legs or lungs.
  • Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure).
  • Bowel problems, such as constipation or when the intestines stop moving waste material normally (ileus).
  • Maternal death (very rare). The risk of death for women who have a planned cesarean delivery is very low (about 6 in 100,000). For emergency cesarean deliveries, the rate is higher, though still very rare (about 18 in 100,000).

Cesarean risks for the infant include:

  • Injury during the delivery.
  • Need for special care in the neonatal intensive care unit (NICU).
  • Immature lungs and breathing problems, if the due date has been miscalculated or the infant is delivered before 39 weeks of gestation.
  • Higher infant mortality risk: in c-sections which are performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had c-sections, compared to 0.62 per 1,000 for women who delivered vaginally.

What are the alternatives to the surgery?

The other option is vaginal (normal) delivery.


Open Myomectomy Operation


What Is Open Myomectomy Operation?

This surgery involves removing fibroids from the wall of the uterus (womb). Fibroids are mostly noncancerous tumors in the muscle of the uterus.

Why is it done?

This operation has a long history and remains the only surgical option when the fibroids are numerous and/or large, and there is a wish to preserve the uterus (e.g. for future child bearing).

Myomectomy is done to relieve problems caused by fibroids without doing a hysterectomy (removal of the uterus). These problems can include: pelvic pain, back pain, pressure on the bladder, abnormal vaginal bleeding, difficulty becoming pregnant and discomfort during sexual intercourse.

What to expect after surgery?

The surgery takes about 1-2 hours. The average hospital stay after surgery is 2-3days.

  • You will have abdominal pain and discomfort for 7-10 days. Your doctor will give you pain medicine to help control the pain.
  • Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
  • Try to walk often. This will decrease the risk of blood clots.
  • Take medicines as prescribed by your doctor. If you had to stop medicines before the procedure, ask your doctor when you can start again.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.

What are the risks of the surgery?

Complications are rare, but no procedure is completely free of risk. If you are planning to have a myomectomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Surgical wound infection
  • Recurrence of fibroids
  • Damage to other organs
  • Wall of the uterus may be weakened if a large fibroid is removed
  • Reactions to anesthesia
  • Need for special precautions in pregnancy (eg. need to deliver by cesarean section)
  • Pelvic adhesions that can cause pain and/or bowel blockage
  • Problems found during surgery that make removal of the uterus necessary
  • Severe scarring, resulting in infertility

What are the alternatives to the surgery?

  • Drug treatment - You can take drugs to make the fibroids smaller, but this is unlikely to be permanent and the fibroids may grow back.
  • Hysteroscopic resection - We can remove submucous fibroids lying just beneath your endometrium using a special telescope, called a hysteroscope. We pass this into your uterus through your vagina. There is another leaflet within this series covering hysteroscopic resection of fibroids.
  • Keyhole surgery - We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is called a laparoscopic myomectomy.
  • Embolisation - This is a method of shrinking single fibroids by cutting off their blood supply. Under x-ray guidance we pass a fine tube, called a catheter, into an artery in your leg. We push it along to a position near the artery supplying blood to the fibroid. We inject tiny particles down the catheter to block the fibroid’s blood supply.
  • Hysterectomy - This is an operation to remove your uterus. If you never want to become pregnant and do not mind losing your uterus then this would be a certain way of dealing with the problem.


Cyst Aspiration


What Is Cyst Aspiration?

The surgeon makes small incisions through which a thin scope (laparoscope) can pass into the abdomen. The surgeon identifies the cyst through the scope and may remove the cyst or take a sample from it.

Why is it done?

Because ovarian cysts are commonly found in young women, many infertile women will also be noted to have ovarian cysts . An ovarian cyst is a small fluid-filled sac that grows in the ovary. Because the cyst usually resolves within one or two menstrual periods, it does not cause infertility. If the cyst does not disappear or respond to medical treatment, then rarely surgery might be considered, since a persistent cyst may be malignant, especially at an advanced reproductive age.

Most ovarian cysts don’t lead to symptoms, but when they do, these can include menstrual irregularities from a hormonal effect, pelvic or low back pain that can vary from mild, occasional pain to severe, persistent pain, pain during intercourse, a feeling of fullness or heaviness in the low abdomen or pelvis, and if the cyst is large enough, pressure on other organs like the bladder or bowel. Occasionally, cysts can twist on their stalks or rupture leading to sudden severe pain that should be evaluated ASAP.

When these symptoms appear a cyst will be either aspirated or removed for biopsy.

What to expect after the surgery?

The procedure takes about 20 minutes to complete after which you maybe taken to the ward for observation and then allowed to go home.

What are the risks of the surgery?

The procedure is safe and generally well tolerated.

  • There may be some discomfort, controlled with local anaesthetic, or a dull ache following the procedure, which may last a few hours.
  • Bleeding into the abdomen or vagina may occur, and can be associated with pain. It should stop quickly and need no treatment.
  • The bowl or bladder may be punctured, but the needle is thin and this should not cause any problem.
  • In some circumstances it may not be possible to complete the procedure. For example it may not be possible to drain the cyst fluid if it is very thick, or the procedure may not be possible if access to the cyst is too difficult.
  • After the aspiration, the cyst may recur, and refill with fluid, or new cysts may develop. It is not possible to know in advance where it will happen.

What are the alternatives of the surgery?

An alternative would be open surgery or laparascopic (keyhole) surgery.


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