Ovarian resection - what is it and is pregnancy possible after surgery? Ovarian resection - what is it and why is it done? Wedge resection of ovaries pregnancy

In the field of gynecology, ovarian resection is a fairly common manipulation, which is carried out for the purpose of treating or diagnosing various pathologies. The term “resection” translated from Latin means excision. So, excision is a surgical procedure whose purpose is to remove organs or bones. Today we’ll talk about the main indications for such surgery, the rehabilitation period and possible complications.

Main indications

Surgeries on the ovary are the most common gynecological procedures. In most cases, such an operation is prescribed in the case of diagnosing an ovarian cyst of a different nature, which cannot be treated with conservative methods. However, this is not all the evidence. Below is a more detailed list of the main indications for ovarian resection.

The following indications for therapeutic resection are:

• Ovarian contusion and apoplexy. Excision is performed in case of emergency to prevent severe bleeding.
• Neoplasms – fibromas, ovarian thecomas.
• Ovarian sclerocystosis.

Very often, ovarian resection is one of the stages of infertility treatment, which is observed with polycystic ovary syndrome. Wedge resection is widely used to treat polycystic ovary syndrome.

Modern therapy

Until quite recently (literally 5-10 years ago), almost any surgical intervention took place through the conventional method, more precisely, laparotomy. This intervention is characterized by a traditional incision several centimeters long. Of course, this method has the following negative consequences and is characterized by:

• High level of injury to the body.
• Great emotional stress.
• High percentage of various complications.
• Long recovery period.

At the moment, the above method is used extremely rarely. The doctor may use laparotomy if access to the organ is immediate due to severe bleeding.

Need to know! It is impossible to cure malignant ovarian tumors with resection. This is possible through laparotomy. Malignant formations are characterized not only by complete removal of the gonad, but also of regional lymph nodes and the greater omentum. Specialists also conduct a detailed examination of neighboring organs to detect metastases.

The essence of laparoscopy

The standard method has been replaced by a modern technology called laparoscopy. This technology is confidently and for a long time penetrating into every area of ​​medicine, including the field of gynecology.

Today, ovarian resection is performed using laparoscopy. The doctors chose endoscopy due to the absence of severe pain due to minimal incisions. In addition, the recovery of the female body is much faster and easier.

Laparoscopic surgery is usually performed under general anesthesia.

As for the duration of the operation, it is identical in time to the traditional method. The main difference between laparoscopy and conventional surgery is the duration of preparation. In conventional surgery, an incision is made to allow the doctor access to the organ. While with laparoscopic resection, first of all, it is necessary to prepare instruments and optical devices before insertion into the abdominal cavity. This operation requires several incisions, the length of which does not exceed two centimeters. These incisions are necessary to insert special metal tubes (trocars) into the abdominal cavity. Trocars are used to introduce instruments and video cameras into the abdominal cavity. With the help of cameras, what is happening is projected onto the monitor screen.

The surgeon removes the damaged tissue using an electric knife or an electrical regulator. At the same time, bleeding stops.

After part of the ovary has been excised, it is removed using a special instrument. Then the abdominal cavity is drained with tampons, and the quality of homeostasis is checked. Next, the instrument is removed from the abdominal cavity.

In case of minor damage, wedge resection is prescribed.

This operation is performed with the aim of temporarily releasing the egg and successfully conceiving a child.

Recovery period

The rehabilitation period after laparoscopic surgery is characterized by speed and absence of severe pain. Due to the fact that small incisions were made in the abdominal wall, the patient does not experience severe pain: both in a supine position and in movement. After the surgical intervention, the patient is prescribed painkillers to reduce pain and antibiotics. This is necessary to prevent the development of infectious complications.

As a rule, the stitches are removed after a week.

The occurrence of a side effect after a subsequent operation can be caused directly by the surgical intervention itself (complications) or by the functional state of the ovary (consequences). We'll talk about this below.

Possible complications

In most cases, after surgery, the patient faces a problem such as a decrease in the number of follicles.

The danger of this consequence lies in the complete cessation of the independent formation of eggs. As a result, the remaining follicles stop developing. This situation causes an absolute cessation of the functioning of the ovary not only as a sex gland, but also as an endocrine gland.

According to numerous studies, the likelihood of conceiving a child has been established. After surgery on the ovaries, a woman’s likelihood of becoming pregnant decreases by the same amount as the volume of the organ was reduced. Therefore, first of all, reproductive specialists insist on performing a gentle operation so that the patient can become pregnant in the future.

Regardless of the type of intervention, whether traditional or laparoscopic, some complications are allowed, manifested in the following findings:

• Deterioration of the patient's condition may be caused by anesthesia.
• Involuntary injury to internal organs with a special instrument.
• Injury to blood vessels.
• The body's reaction to the injected gas.
• Complications caused by various infections.
• The occurrence of hematomas.
• Fever.
• The occurrence of adhesions and postoperative hernias.

Result of surgery

The consequences of removing one of the ovaries are manifested in a decrease in the number of not only follicles, but also hormones. This leads to complete cessation of ovarian function and decreased fertility. Removal of a significant amount of tissue is accompanied by the development of conditions such as menstrual and endocrine imbalance. The latter manifests itself in passivity, lethargy, lack of interest in sexual activity, psychosis and tearfulness. Also, surgical intervention can be complemented by problems of the cardiovascular system and early menopause. Women who have undergone ovarian surgery should be aware that the natural strength of the ovaries has been reduced and therefore, in order to become a mother, she needs to become pregnant as soon as possible.

As can be seen from the above, laparoscopic surgery is accompanied by less pain, an easier recovery period and a lower percentage of various complications. It is very important that such an operation is characterized by a positive cosmetic effect. It helps to avoid long scars.

Forecast

If a woman wants to get pregnant on her own, then he has six months or a year to do this. If pregnancy does not occur during this period, you can turn to specialists and become pregnant using IVF.

Women often experience deterioration in their health, which develops against the background of hormonal imbalance. Patients are often diagnosed with gynecological pathologies. In particular, fluid can accumulate under the outer lining of the ovary, after which cysts and tumors form. In such situations, ovarian resection is recommended - let’s try to figure it out in detail.

The proposed manipulation involves removing the affected area partially or completely. Surgical intervention is also performed for women who have been diagnosed with polycystic ovary syndrome if the goal is to preserve reproductive abilities.

Ovarian resection is a type of operation during which the surgeon performs partial or complete removal of the affected area of ​​the organ, while tissues not involved in the pathological process remain untouched. Since, in most cases, the reproductive glands are not completely removed during the manipulation, the woman can subsequently become pregnant naturally, carry and give birth to a child.

In addition, in some situations, resection of the left or right ovary significantly increases the chances of conceiving a child. In order to undergo surgery, the patient must have clear indications for this, due to the fact that without intervention the woman’s health condition will only worsen.

Before resection, the patient is carefully examined. This is necessary to exclude various contraindications to surgical treatment. The information obtained will also help shorten the recovery period and reduce the risk of complications. If a girl wants to get pregnant after removal of the ovary, the doctor will prescribe treatment that will be aimed at stimulating the reproductive system and increasing the production of eggs.

Many women are interested in what resection of the right ovary is. This type of operation differs from other interventions only in that it is performed from a certain side. However, it is worth understanding that when the organ on the right is removed, the likelihood of a subsequent pregnancy is significantly reduced, since, often, it is in this part that the egg matures in women, ready for fertilization.

Kinds

In medicine, this type of surgery is divided into three main types:

1. Partial resection;
2. Wedge resection of the ovaries;
3. Oophorectomy.

Each type of operation is performed according to the indications for its implementation.

Partial

Let us consider in more detail in what situations resection of the right or left ovary is indicated. The operation is performed on patients who have a single large cyst, when conservative methods of therapy are not effective. Intervention will also be carried out in case of diagnosis of a dermoid cyst and hemorrhages in the ovarian tissue.

Partial resection is prescribed in case of an actively progressing inflammatory process, and if the organ is saturated with pus, then the operation must be emergency. Tumor formations must be removed, which is confirmed by a biopsy; for example, in the case of cystodenoma, it should be excised.

Indications for partial resection include injuries to the pelvic organs when the ovaries were affected, especially if operations on the urinary tract or intestines are planned. Urgent intervention is carried out in case of rupture of an ovarian cyst, which is accompanied by bleeding into the intestines, in case of torsion of its leg (severe pain is present), in case of ectopic pregnancy.

Wedge-shaped

If polycystic ovary syndrome is detected, resection is performed using a wedge-shaped method. Thanks to this intervention, it is possible to stimulate the onset of ovulation in a woman. During the intervention, the patient has a piece of tissue removed in the form of a triangle, the base of which is directed towards the organ capsule. It is this part that is thickened in PY.

The result of the resection is the opening of an exit for the egg, which can subsequently meet with the sperm and be fertilized. The duration of preservation of the obtained therapeutic effect ranges from six months to 12 months, and the probability of conception is 84-89%.

This operation was carried out until recently, when doctors began to implement the technique of pinpoint dissection of thickened tissues. This also allowed the oocytes to leave the egg. Resection is performed using a special laser, but the effectiveness of the technology is no more than 72%, which is significantly lower than in the previous version.

Such an intervention can be prescribed not only for diagnosed polycystic disease. Ovarian resection, as doctors' reviews confirm, is quite effective when the task is to perform a biopsy. For example, if an ultrasound examination reveals a tumor, it is necessary to do a biopsy to determine whether it is malignant or not.

Answering the question, resection of the right ovary - what is it, experts talk about partial removal of the affected organ tissue. Considering that blood supply and metabolism are improved in this zone, due to the close location of other internal organs, ovulation occurs here more often. During resection, this process may be disrupted and the patient may be diagnosed with infertility.

Oophorectomy

This type of surgery involves complete removal of the ovary. The main indication for its implementation is cancerous tumors on the organ. In this case, part of the uterus and its tubes must be excised. If the patient is already 45 years old, then oophorectomy is performed for widespread endometriosis, an abscess of the gland that arose as a consequence of invasive intervention.

It is worth saying that the surgeon can perform the operation already during the intervention itself, if it was previously planned to perform a partial resection, provided that only at this moment it became clear that this cyst is not a retention cyst, but a glandular pseudomucinous cystoma. To prevent the development of malignant tumors, after 40 years of age, both reproductive glands are removed.

Bilateral resection is performed in situations where the tumor affects the right and left ovaries simultaneously, and endometriotic cysts or iron pseudomucinous cysts begin to form in the organ. If a papillary cystoma is diagnosed, which has a high probability of transformation into a malignant tumor, both ovaries are removed regardless of the patient’s age.

Technicians

To perform ovarian resection, surgeons resort to laparotomy or laparoscopy. In the first case, all manipulations will be performed through an incision made with a scalpel, the length of which is no more than five centimeters. The operation is visually controlled by the doctor and his assistants, and medical instruments such as a clamp and tweezers are also used.

Recently, more and more specialists and patients prefer laparoscopic operations. This type of intervention is considered more gentle, since all manipulations are performed through several punctures, the length of which does not exceed one and a half centimeters.

After making such incisions, special tubes are inserted into them, which serve as a kind of entrance. The doctor inserts an instrument into one hole that injects a special sterile gas necessary to move the internal organs away from each other, the second hole is made to insert a camera that visualizes all the doctor’s actions on the monitor.

The remaining one or two incisions are intended for the insertion of medical instruments. With their help, the surgeon performs all the necessary manipulations for ovarian resection. When the surgery is complete, the tubes are removed and the incisions are sutured.

Preparation

Regardless of the type of surgical intervention prescribed, the patient must be thoroughly examined. To determine your health status, the following tests are prescribed:

• Blood sampling and subsequent study of biochemical parameters;
• Determination of antibodies to viruses in the blood, the presence of which contributes to the deterioration of clotting ability;
• Detection of hepatitis C or B;
• Determination of human immunodeficiency virus.

Next, the woman is sent for fluorography and a cardiogram. To perform the operation, doctors use general anesthesia. Since all muscles relax during such anesthesia, there is a risk of stomach contents reflux into the esophagus, and subsequently into the respiratory tract, which will lead to the development of pneumonia.

Actually, taking this factor into account, experts categorically do not recommend eating later than eight o’clock in the evening on the eve of the operation. The liquid can be consumed for the last time before 22:00. Girls are also advised to cleanse the intestines of feces using an enema to reduce the risk of negative substances being absorbed into the blood and poisoning the body.

Progress of the operation

Since the doctor performs all manipulations after the administration of general anesthesia, when the anesthesia enters the patient’s blood, she will fall asleep and will not feel anything. After this, the specialist makes an incision, depending on the type of intervention chosen (one large or several small ones).

The further algorithm of actions is as follows:

1. The ovary and cyst are freed from adhesions and internal organs located in the immediate vicinity;
2. The doctor then places clamps on the ligament that supports the ovary;
3. Making an incision in the ovarian tissue (slightly above the pathological area);
4. Stopping bleeding by suturing or cauterizing blood vessels;
5. The remaining gland is sutured using self-absorbable threads;
6. A thorough examination of all pelvic organs, as well as the second ovary;
7. Detection of non-healed and bleeding vessels, stopping bleeding, suturing vessels;
8. Installation of drainage elements in the pelvic cavity;
9. Suturing the initial incisions.

Before the start of all surgical interventions, the patient must be informed that if the doctor finds cancerous tumors, purulent formations, and inflammatory processes during laparoscopy, he can proceed to perform a laparotomy.

Such actions are due to the fact that preserving the patient’s life is a priority for doctors. It is also worth understanding how compatible ovarian resection and pregnancy are.

Removal (video)

Consequences

The operation, performed laparoscopically, in which a small amount of affected ovarian tissue is removed, is not associated with the development of serious complications and the patient can count on a quick recovery. The most likely consequences of the intervention are the onset of early menopause, provided that the surgeon had to remove a lot of affected tissue from both ovaries.

It is also possible that adhesions may form after surgery. Most often, such elements are formed between the intestines and organs that regulate reproductive function. If there is a lot, then pregnancy may not occur after resection of the ovaries.

In certain situations, there is a risk of infection of the pelvic organs; hematomas may also form, internal bleeding may occur, and hernias may form after surgery.

Recovery period

After the operation, 5-6 hours later, the woman begins to feel severe pain in the intervention area. To eliminate these sensations, doctors give an injection. The injections are prescribed to be performed for another four days, but, depending on the condition and severity of pain, the period can be reduced or increased.

It is very important that the patient monitors her condition. Women should definitely contact their doctor if the pain does not go away within a week, since this symptom indicates the development of an adhesive process.

The doctor prescribes removal of sutures at 6-8 days during laparotomy, and at approximately 7-10 days during laparoscopy. Final recovery occurs within a month. The patient should not be afraid that after the operation she will have vaginal discharge that resembles menstruation.

Gradually, their intensity should decrease (within 3-5 days), as for menstruation, after such treatment they will come with a delay, while the norm of deviation in the cycle is considered to be from 2 to 21 days. In case of longer absence of monthly bleeding, you should consult a gynecologist.

Ovulation occurs after about 14 days, as indicated by basal temperature readings, as well as ultrasound examination. If it is necessary to take hormonal medications, ovulation may not be observed this month.

Pregnancy

In those situations, if during the intervention a lot of ovarian tissue was not removed, then pregnancy is likely. With polycystic ovary syndrome, experts recommend not delaying conception, since the highest probability of fertilization lasts for 6-12 months.

During the first month after resection, any kind of sexual contact should be excluded. This is necessary for the normal healing of all injured tissues. After this period, doctors advise some patients to abstain from sex for another 1-2 months.

If you study the reviews of women who were planning a pregnancy, but they needed to undergo ovarian resection, the majority indicate that conception occurred in the next year, and they were able to carry and give birth to a child without any complications.

The ovaries in the female body are the basis of its ability to conceive a child. Their constant activity in the form of maturation, descent through the fallopian tubes into the uterus and excretion of eggs after fertilization has not occurred, ensures the menstrual cycle. This also explains the fluctuations in hormonal levels that are observed naturally in women until menopause.

The ovaries constantly produce estrogen hormones, which form the female background. But they can also get sick both for reasons that cause any organs of the body to get sick (injuries, infections), and because of their own “disagreements” with other organs that synthesize sex hormones. For example, in addition to the main glands (in men these are the testes), both sexes also have the adrenal cortex in their bodies - the producer of many corticosteroids, including hormones of the opposite sex.

Testosterone serves the female body in the same capacity as estrogen serves the male body. Namely, as an estrogen antagonist and stimulator of ovarian activity. When testosterone levels rise, they respond by increasing their activity. In addition, the presence of “opposite” hormones allows us not to turn into asexual creatures after menopause.

However, if during puberty the balance of these two scales is disturbed, the consequences are reflected primarily on them. That is why problems with procreation are among the most stubborn to all attempts to cure them.

What is ovarian resection

Any diseased organ is a source of constant complications in the body. And the gonads are especially dangerous due to their ability to form cysts - initially benign tumors, which can then undergo malignancy (degeneration into cancer) under the influence of hormones.

Cysts are troublesome tumors. In addition to the tendency to malignancy, they often produce hormone-like substances themselves or accumulate hormones of the opposite sex from the blood. They also fester, grow and throw out a lot of other dangerous “things”. From a medical point of view, the only good thing about them is their susceptibility to therapy with the same hormones, even after degeneration into cancer.

Therefore, it would be safest to remove ovaries that cannot function normally. But now such a decision is made less and less often. Modern monitoring systems give gynecologists a certain confidence that a life-threatening process will be noticed on time. This means that it will always be possible to completely deprive a woman of her chances of having another or even her first child - for example, after an unsuccessful attempt to preserve reproductive function. For this purpose, the resection method was developed - cutting them off, so to speak, instead of completely removing them.

Of course, they “cut off” everything that poses a threat to the patient’s life or an obstacle to the normal activities of the rest of them. Healthy tissue and intact eggs are preserved as much as possible.

Ovarian resection is indicated for the following diseases:

• Extensive adhesions resulting from inflammation;
• Single cyst (only this will be removed);
• Multiple cysts (polycystic), usually appearing either due to obstruction of the fallopian tubes or under the influence of high testosterone;
• Other benign tumors;
• Ovarian apoplexy (urgent surgery, performed due to the onset of bleeding due to rupture of blood vessels);
• Injuries, especially local or affecting only the right/left ovary.

But it is contraindicated in the following cases:

• If malignant foci are present/identified during surgery;
• If there are indications for removal of the fallopian tubes or uterus (preserving them after this is pointless and dangerous);
• With an ectopic pregnancy.

There are two types of resection based on the method of intervention.

1. Laparoscopic. This is the least traumatic way for surrounding tissues, in which an incomplete opening of the abdominal cavity is performed in the area above the pubis, and the work is carried out using 3-4 very small (up to 1.5 cm long) incisions. A set of hollow tubes called trocars are then inserted through these incisions. One of them is always used to inject gas into the abdominal cavity. The surgeon needs space to manipulate, and to do this, he must first lift the abdominal wall, which is what happens when gas is pumped into the working area. The remaining trocars are used to introduce a light source, video camera and surgical instruments through them into the abdominal cavity. The surgeon works while looking only at the monitor;
2. Laparotomy, in which the surgeon gains access to them in a standard way - through a wide (up to 8 cm) incision, followed by removal of the ovaries themselves. This method is much more traumatic, but it allows you to examine them in more detail and notice what can be missed during laparoscopy. In this case, only tissues affected by the pathological process are also excised.

What is wedge resection of the ovaries

This special type of resection of the right or left ovary (and more often, both) is usually performed for polycystic disease - a symptom and at the same time a result of too high testosterone. In such cases, initially they formed quite normally and even try to work as they should. But the constantly elevated “opposite” background subsequently forced the eggs to protect themselves from it by increasing the density of their membranes. As a result, a completely healthy and mature egg, as they say, like clockwork, cannot “hatch” and descend into the uterus for fertilization.

As we have already understood, resection of the ovaries for polycystic disease is intended to at least temporarily help the eggs to mature and descend into the uterus normally. Then this period can be used to conceive a child, even if it does not last long, and after it ends it will become impossible to get pregnant again. In such cases, the surgeon gains access to the ovaries by laparoscopy or laparotomy, and then makes wedge-shaped incisions (“with the point toward the egg”) in the membranes of the immature eggs.

It is assumed that after this the path of the eggs out will be facilitated simply by the exit made with a scalpel through the compacted membranes. And to stimulate their rapid ripening and balance high testosterone, estrogen therapy is carried out. Usually it is recommended to start trying to get pregnant after 3 months. after operation. The optimal period for pregnancy is the first six months after it. If it was not possible to get pregnant within 1 year after the intervention, the chances of conceiving a child in the future are already equal to the same as they were before it.

Disadvantages of ovarian resection

In principle, it has no more disadvantages than any other intervention. But they exist, and the main one is that some of the existing eggs inevitably have to be removed.

As you know, the female body contains a certain number of eggs, and new ones do not appear in them during life - only the existing ones mature. Therefore, although the resection is intended to improve a woman's chances of pregnancy in the immediate future, it significantly reduces them in the long term. This happens because it involves removing a certain percentage of eggs that could hypothetically still mature and be fertilized later. Due to this, menopause is also approaching - after resection it should be expected before 45 years.

The ovaries perform a complex sexual function, participating in the synthesis of hormones. Without the normal functioning of these organs, a woman becomes unable to conceive. Under certain factors, the ovaries cease to function fully, and sometimes various types of tumors develop in them. Typically, neoplasms, depending on the etiology, require urgent or planned surgical intervention.

Resection of the ovary eliminates the complete removal of the organ, which preserves the woman’s ability to further conceive and maintain hormonal levels. The main lobe of the ovary recovers quickly after surgery and functions normally throughout life.

Resection requires a complete gynecological examination. Usually one ultrasound and several tests are enough to make a diagnosis that requires surgery. The woman’s age, general health, the presence of chronic diseases and the severity of the disease are taken into account.

When is resection necessary:

• benign tumors;
• single cysts;
• multiple cysts;
• proliferation of the endometrium on the ovary;
• trauma with tissue ruptures.

Regardless of the indications for the operation, its goal is to maximize the preservation of healthy tissue areas capable of producing eggs.

Types of operations

Modern technologies and equipment make it possible to perform ovarian surgery on a woman using laparoscopy. Minimally invasive resection involves several small incisions through which instruments are inserted into the abdominal cavity. The progress of the operation is displayed on the monitor. The abdominal cavity is raised with gas, which is supplied through a tube. This allows increased access to the ovary. A large percentage of operations are carried out without complications, but in some cases the manipulators are removed and an incision is made on the abdominal wall. Typically, the transition to abdominal surgery is carried out in case of severe internal bleeding, detection of complications, suppuration and other indications. During laparotomy, the surgeon urgently makes a decision on simple resection or complete removal of the organ. An indication for a peritoneal incision may be a widespread endometrial lesion, a malignant tumor, a large benign formation, or an abscess.

Peculiarities

1. For a benign tumor, the surgeon removes it taking into account minimal impact on the gland. The shell of the organ is opened, and a small piece of tissue is excised to access the formation. The tumor is isolated with a special instrument and excised. This seamless operation eliminates the postoperative scar on the ovary. It heals faster and restores its functions. For bleeding vessels, a coagulator is used. They cauterize the vessels in the wound. The operation is performed under standard operating room conditions, using regional anesthesia or general anesthesia.
2. If a deep resection was performed, then during the operation it is formed using an absorbable thread. After removal of the purulent ovary, the cavity is sanitized and drained.
3. For numerous cysts, resection is done so that ovulation is stimulated. In this case, part of the dense shell of the organ is removed or several small grooves are made in different places.
4. During wedge resection of an organ, a triangular section of tissue is cut out, the base of which is adjacent to the capsule. This allows the desired portion of the organ to be removed while still leaving ample tissue for ovulation.
5. During surgery, tissue may be removed for biopsy. A small section of the organ is cut out and submitted for examination. No sutures are placed at the site of the ovarian incision.

Complications

Any operation includes risks of complications, resection is no exception. During surgery, extensive bleeding, organ perforation, or adverse effects of anesthesia may occur. After surgery, during healing, adhesions, postoperative hernias, or wound infection are observed. In some cases, they require repeated surgery.

Any type of surgical intervention leads to a decrease in ovarian tissue with immature eggs. Their number is determined genetically, and therefore the degree of possible conception after surgery is reduced. After the operation, the period of ability to conceive further decreases.

Postoperative period

Partial resection of the ovary by laparoscopy allows the woman to recover quickly. Complete healing and restoration of function is noted after two weeks. In case of complications and complete removal of the ovary, rehabilitation can take up to 8 weeks.

Due to a decrease in sex hormones during ovarian resection, the body releases additional hormones that increase stimulation of the organ. Healthy ovarian tissue begins to be intensively synthesized. To fully support the reproductive system, antimicrobial drugs, hormonal contraceptive pills and vitamin complexes can be prescribed. After the intervention, pain practically does not persist; painkillers can be prescribed on an individual basis. The stitches are removed after a week, but dressing and treatment with antiseptics can take much longer.

Normal menstruation begins immediately after surgery. This happens the next day. Ovulation occurs after 14 days, and if the readings are normal, the cycle is completely restored.

By nature, the right ovary functions more than the left, therefore, when tissue of the right organ is resected, the ability to conceive sharply decreases. Sometimes this figure is 30%. The safest technique for resection is considered to be wedge excision. Such a gentle intervention leaves a great chance of quickly restoring hormonal levels.

Fertility

Usually, the opportunity to conceive a child after surgery appears immediately, since the production of eggs decreases slightly. If pregnancy does not occur with constant sexual contact with a healthy partner, additional examinations are prescribed or methods are suggested to improve hormone production.

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Ovarian resection is one of the most common gynecological operations, which involves the removal of a fragment of an organ. Resection is used for a variety of pathological conditions - benign tumors, cysts, apoplexy, polycystic ovary syndrome.

Removal of part of the ovary is usually indicated for young women of reproductive age. Without presenting any great technical difficulties, the operation, however, cannot be considered harmless, even if performed in a minimally invasive manner by laparoscopy.

The possibility of hormonal imbalance and difficulty conceiving are the most common problems that women who have undergone resection have to face. Gynecologists always remember these consequences and take a very balanced approach to determining the indications for surgery. Only after making sure that resection is the only treatment option will the doctor prescribe an intervention.

As a rule, ovarian resection is carried out plannedly after appropriate preparation, but emergency treatment is also possible for cyst rupture, when the patient is a young woman who does not exclude the prospect of having children in the future and wants to preserve at least part of the ovary and fertility. Anesthesia is always general, but access may vary. Traditional laparotomy is increasingly being abandoned in favor of laparoscopic techniques, which have a number of undeniable advantages.

Indications and contraindications for ovarian resection

Surgery to remove a fragment of the ovary is prescribed when conservative methods do not bring the desired result or hormonal treatment is contraindicated. In such cases, the only option is to have surgery. Indications for resection are:

• Benign ovarian tumors of any nature;
• Ovarian endometriosis that is not amenable to conservative treatment;
• Polycystic disease and, accordingly, infertility;
• Cysts (both pathological and functional);
• Rupture of a corpus luteum cyst or hemorrhage into the ovarian parenchyma - apoplexy (emergency intervention);
• Ovarian injuries.

It is worth noting that some specialists pay insufficient attention to drug treatment or do not even try to carry it out, while the woman does her best to keep the ovaries safe and sound. For example, this happens with endometriosis. In these cases, vigilance and the desire of the patient herself to do without surgery are important, therefore, if you do not trust one gynecologist, you can safely turn to another, more experienced and qualified one.

Contraindications to ovarian resection are also available, because general anesthesia and penetration into the body cavity are to be performed. These include:

1. Severe bleeding disorders with the risk of massive bleeding during the intervention or, conversely, thrombophilia, when tissue incision can provoke inadequate thrombus formation;
2. Severe concomitant pathology of the cardiovascular, respiratory system, kidneys or liver (rare due to the relatively young age group of those undergoing surgery);
3. Malignant tumors (the entire appendage with surrounding tissues must be removed);
4. Acute infectious pathology (flu, intestinal infections, etc.) - surgery is postponed until complete recovery, except in emergency, life-threatening cases;
5. Acute inflammatory process in the pelvis is subject to conservative treatment, and surgery is performed only after the source of inflammation has been eliminated.

Preparing for surgery

Preparation for surgery is not much different from that for other types of interventions. When the question of the feasibility of resection has been decided, the patient will have to undergo the necessary preoperative studies:

• Take a general blood and urine test, a biochemical blood test, and possibly blood tests for sex hormones and tumor marker CA-125;
• Undergo a blood clotting test (coagulogram);
• Be screened for infections (HIV, hepatitis, syphilis, sexually transmitted diseases);
• Visit a gynecologist to take a smear from the vagina and cervical canal;
• Perform an ultrasound of the pelvic organs;
• Undergo fluorography and, if indicated, an ECG.

Emergency operations involve a minimum of studies, which begin in the emergency room from the moment the patient is admitted and include general clinical blood and urine tests, a coagulogram, ultrasound of the pelvic organs, and examination by a surgeon to exclude acute surgical pathology of the abdominal cavity.

When all the necessary diagnostic procedures have been completed before the planned resection, the woman goes to the therapist, and he, based on the presence or absence of concomitant diseases, gives his permission to perform the operation. All concomitant pathology must be cured as much as possible or brought to such a state that the intervention becomes safe.

If you need to take any medications on a regular basis, you must inform your doctor about this. Before surgery, anticoagulants and other drugs that cause blood thinning are discontinued. Diabetes may require a switch to insulin, even if the patient is quite helped by glucose-lowering pills. When all risks have been excluded, the gynecologist sets a date for arrival at the hospital with the results of all examinations completed.

On the eve of the operation, the woman is advised to refrain from eating large meals, exclude all those foods that cause gas formation or fecal retention (chocolate, legumes, cabbage, pastries, etc.). 12 hours before the intervention, food and water are taken for the last time; if any medications need to be taken, the woman discusses this point with her doctor.

In the evening before the resection, you need to take a shower and change clothes, the pubic area and lower abdomen are shaved during the planned laparotomy. If there are problems with stool, a cleansing enema will be offered. This is not only a measure to facilitate the operation, but also the prevention of postoperative complications, in particular constipation. In case of severe anxiety, sedatives or mild sleeping pills are prescribed at night.

Methods of ovarian resection

As a rule, resection of the left or right ovary is performed under general anesthesia, which largely determines the importance of preoperative preparation and attention to the general condition of the woman. In some cases, local anesthesia can be used (if there are contraindications to anesthesia, allergies to certain drugs, etc.).

ovarian resection

The operation can be unilateral or resection of both ovaries is performed. The need for bilateral intervention is dictated by diagnosed polycystic disease or neoplasms or cysts on both sides at once.

Removal of the ovarian fragment can be performed laparoscopically and by standard laparotomy. Laparotomy until recently was the main method of access to the pelvic organs, but today it is confidently replacing it laparoscopy, which has a number of significant advantages:

1. Minor tissue trauma;
2. Faster recovery and easier course of the postoperative period, which shortens the period of disability to a minimum;
3. Excellent cosmetic result;
4. Lower incidence of complications after intervention.

Laparotomy access is mainly used for emergency interventions, when there is no time for adequate preparation and examination of the pelvis. In addition, in such situations, the nearest hospital may not have the necessary equipment or trained specialist. If there is a strong adhesive process in the pelvis, laparoscopy is completely contraindicated, so the gynecologist has no choice - the operation is performed through open access through a wide skin incision.

After processing the surgical field, the surgeon begins to perform stages of the operation:

• An incision in the suprapubic area in the transverse direction or along the midline of the abdomen, going from top to bottom;
• Penetration into the pelvis, examination of the appendages, isolation of the ovary, dissection of adhesions if present;
• Applying a clamp to the ovarian pedicle carrying the feeding arteries;
• Economical excision of damaged parenchyma with maximum preservation of healthy tissue;
• Suturing the ovarian wound with absorbable threads, stopping bleeding and ligating blood vessels;
• Inspection of the abdominal cavity for bleeding, unligated vessels;
• Suturing the skin wound in the reverse order.

Suprapubic laparotomy more cosmetic and indicated for small ovarian formations, with single laparotomy used for large cysts or tumors. If a purulent focus is found in the ovary, then rinse with chlorhexidine solution and install drainage tubes to drain the discharge. Drainage is also indicated for inflammation in the pelvis or abdominal cavity.

Wedge resection of the ovary involves excision of its part in the form of a wedge, with its base facing the periphery (capsule) of the organ. In this case, the surgeon dissects the parenchyma deeply in the direction of the ovarian gates, but without reaching them, so as not to cause circulatory problems in the remaining part of the organ. The resulting defect is sutured using thin needles so as not to injure the very fragile tissue. The threads should not be tightened too tightly as this may cause them to break through with the risk of complications. Bleeding vessels are bandaged.

wedge resection of the ovary

Ovarian cyst resection can be carried out through a similar access. After removing it into the wound, the cyst is delimited using a napkin. The ovarian incision is made at the border between the cystic cavity and healthy parenchyma, carefully so as not to damage the tissue. The cyst is separated from the ovary without much effort, and the thin bridge that connects it to the organ is crossed.

When resecting a cyst, it is important to act extremely carefully, since a large cavity can push the ovarian tissue to the periphery and make it look like a thin plate, and then there is a risk of removing such a changed, but still functioning, organ simultaneously with a pathological formation.

After excision of the cyst, the integrity of the remaining fragment of the ovary is restored, sutures are placed on the vessels, the pelvic cavity is examined and the abdominal wall is sutured in the same way as with wedge resection.

Resection of the ovary for polycystic disease is one of the main methods of treating the pathology, since conservative therapy does not always bring at least some effect. The operation is performed on two ovaries at once, removing at least two-thirds of each organ. Its technique does not differ from that of wedge resection.

The purpose of surgical treatment of polycystic disease is to remove sclerotic tissue and follicles “walled up” in them and, thereby, provoke normal maturation of eggs. This method allows you to achieve ovulation and conception in case of infertility due to polycystic disease, as well as normalize a woman’s hormonal levels.

Laparoscopic resection of the left ovary or a fragment of the right it takes approximately the same amount of time as an open operation and also requires general anesthesia. The main difference between laparoscopy and laparotomy is the absence of a large incision and scar in the future, that is, a very good cosmetic result, which is achieved through the use of special instruments.

Preparation for laparoscopy is the same as for open surgery, but the patient pays special attention to the condition of the intestines and its careful emptying. Filled intestinal loops during laparoscopy can complicate the process of pumping gas into the abdominal cavity and impair the surgeon's visibility.

After placing the patient under anesthesia, the surgeon makes three small incisions (about 2 cm) in the anterior abdominal wall, through which he inserts instruments, a video camera, and a light source into the abdomen. To improve visibility and raise the abdominal wall, carbon dioxide is injected into its cavity.

laparoscopic ovarian resection

Dissection of the ovarian parenchyma and removal of the fragment is performed using an electrocoagulator, through which a high-frequency electric current flows. The coagulator does not damage the surrounding tissue, but “cuts” the area where the surgeon directs its action. In addition, the high temperature created in the area of ​​action of the coagulator promotes sealing of the lumens of small vessels, minimizing the risk of bleeding.

After the desired section of the ovary is cut off, the surgeon removes it and examines the pelvic area using a video camera for bleeding or other pathological changes. If everything is in order, the instruments are removed and the small skin incisions are sutured.

Postoperative period and possible complications

The postoperative period following ovarian resection is usually quite favorable. After laparoscopy it is noticeably lighter and shorter than after open laparotomy. In the first days after the intervention, the patient may be prescribed painkillers, anti-inflammatory drugs, and antibiotics if there is a high risk of infectious complications.

By the end of the first day after the operation, the woman may well get up, and it will be even better if she tries to do this as early as possible. Timely activation, walking even within the ward or corridor can help prevent complications - thrombosis, embolism, intestinal disorders, and also helps to normalize blood circulation and rapid tissue regeneration.

Every day, the postoperative wound is treated with an antiseptic solution; if there are drainages, the surgeon controls the discharge through them and, when possible, removes it. If the postoperative period is uncomplicated, the sutures are removed on the 7th day, and the patient is discharged home. After laparoscopic surgery, the time spent in hospital can be reduced to 3-4 days.

When leaving home, the woman receives recommendations from her attending physician that will help her in her further recovery:

1. During the first month after surgery, it is recommended to use a special bandage and compression garments to speed up the healing of the abdominal scar (not necessary after laparoscopy);
2. Sexual activity should be avoided during the first month;
3. Until six months after ovarian resection, the doctor may recommend birth control;
4. If your health worsens, abdominal pain or discharge appears, you should immediately seek help from a doctor.

Complications possible both in case of open surgery and during laparoscopic ovarian resection. The most common are bleeding and hematoma formation, infection of the postoperative wound and pelvic organs. In rare cases, damage to nearby structures occurs with instruments during surgical procedures.

Among the long-term consequences, adhesive disease and infertility occupy a special place. Adhesive disease is directly related to surgical trauma and manipulation of the ovary; more often it occurs after laparotomy interventions. Infertility can be caused either by the removal of part of the follicles along with a resected fragment of the ovary, or by the formation of adhesions that compress the appendages.

Another consequence of ovarian resection, especially if it was performed on both sides, is considered to be a decrease in the production of sex hormones, which is manifested by menstrual irregularities and signs of premature menopause (dry skin and mucous membranes of the genital tract, hot flashes, depression, etc.).

Even those women who undergo resection to improve ovulation, for example, with polycystic ovary syndrome, face infertility. If it is not possible to restore the ability to conceive after surgery, the gynecologist offers auxiliary procedures, in particular, in vitro fertilization.

As part of rehabilitation after ovarian resection, many gynecologists recommend taking combined hormonal medications containing estrogens and a progestin component for a period of six months to 9 months. This allows you to normalize hormonal levels, preserve the remaining follicles and achieve pregnancy within a short period of time after discontinuation of hormone therapy.

Video: technique for performing ovarian resection