L‘Intervention by hysterectomy is the one in which we proceed to removal of the uterus affected by both benign and malignant pathologies. We are talking about it these days in the media and on social media in relation to the hypotheses of the reason for thespeech by the Princess of Wales, Kate Middleton, on which however no details are (rightly) provided. But what is it, when is it necessary and what does it entail? We talked about it with Doctor Raffaela Di Pace, gynecologist, PhD in Physiopathology of Menopause and sexologist consultant.
In which cases is hysterectomy necessary?
«Certainly all malignant tumors of the uterus are “treated” through the removal of the organ, which is made up of a lower portion, which emerges in the vagina and which is called cervix and from a more cranial one, which is where the pregnancy takes place. Here, every month the tissue that prepares for its implantation grows and then falls apart causing menstruation, which is instead called the body of the uterus.
These two different portions have a different constitution and are also affected by two completely different tumors, but in both cases the Removal of the cancer site is generally the first stage of treatment» explains the expert. Sometimes, however, it is necessary to proceed with the removal of this organ even for benign pathologies.
Other causes besides tumors: fibroids
Hysterectomy is not only necessary in case of malignant tumors. «The most frequent case is certainly that of uterine fibroids or myomas, benign tumors of the uterus that form and grow in the wall of the uterus and which, depending on their size and location, they can be absolutely asymptomatic or create problems particularly heavy bleeding you hate painful menstruation”specifies Dr. Di Pace.
Endometriosis and hysterectomy
“Also there adenomyosis most often and endometriosis (two different forms of the same process that leads to the localization of endometrial tissue, which is normally only inside the uterus, outside of it). In the myometrium which constitutes the wall of the uterus in adenomyosis or outside the entire uterus in endometrios, they can be the cause of hysterectomy”, explains the gynecologist.
Hysterectomy only if necessary
«If in past years hysterectomy was used much more frequently even only for benign pathologies, today we try to be much more conservative and is now reserved only for the few situations that cannot be resolved with pharmacological treatment.”
What techniques for hysterectomy?
Once upon a time, the removal of the uterus was a very complex operation and required a long hospital stay and convalescence. «Much has been done in recent years also for reduce the aggressiveness of the intervention and hospital stay times. In the majority of cases we have moved from the laparotomy technique (complete incision, usually with a wound of at least 8-10 cm on the abdomen) to the laparoscopic one. This second technique requires two or three small cuts on the abdomen to introduce the instruments which then allow the removal of the uterus. This, once freed from the relationship with the other pelvic organs, is physically removed vaginally”, explains Doctor Di Pace.
Shorter times and fewer consequences
«This type of operation usually allows us to reduce surgery times, blood loss and therefore also the days of hospitalization following the operation with shorter recovery times, usually just a few days.
The only conditions that still require open belly surgery with laparotomy are those in which either the uterus is very large or we are faced with a malignant pathology.”
What side effects does hysterectomy involve?
«If you carry out the removal of the uterus onlythis does not involve major changes, especially from a hormonal point of view for the patient who she will continue to have functioning ovaries despite no longer seeing her period due to the lack of a uterus. Only if the ovaries are also removed at the same time, but this only happens if these are also the site of a pathology, especially ovarian cysts, then their removal also involves the immediate onset of menopause with all the consequences of the case”, he concludes the gynecologist.
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