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.
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:
Fibroids can cause miscarriages and problems when trying to become pregnant.
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.
Pelvic Floor Repair - 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.
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.
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.
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.
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?
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.
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.
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.
Cesarean risks for the mother include:
The other option is vaginal (normal) delivery.
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.
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.
The surgery takes about 1-2 hours. The average hospital stay after surgery is 2-3days.
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:
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.
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.
The procedure takes about 20 minutes to complete after which you maybe taken to the ward for observation and then allowed to go home.
The procedure is safe and generally well tolerated.
An alternative would be open surgery or laparascopic (keyhole) surgery.
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