When to choose open access
Laparotomy is justified if an open myomectomy, removal of a large cyst or plastic surgery of the abdominal wall is simultaneously performed, with dense adhesions after many operations, or severe cardiopulmonary diseases that make pneumoperitoneum undesirable. A Pfannenstiel incision (along the bikini line) of 8–10 cm gives direct access to the ligaments: they are sutured and fixed to the aponeurosis with reliable tension; if necessary, the uterus is sutured to the peritoneum. The cosmetic seam is hardly noticeable; recovery is longer than after laparoscopy, with a restriction of heavy lifting for 3 months. The uterus is preserved, pregnancy is possible in the future.
Indications
- prolapse and incomplete prolapse of the uterus in women who want to preserve the organ;
- pronounced backward bending of the uterus (retroflexion) with pain, infertility, recurrent miscarriage when other causes are excluded;
- prolapse after childbirth and with weak ligaments in combination with vaginal plastic surgery;
- contraindications: planning pregnancy in the near future (individually), cancer, acute inflammation.
The essence of the operation
Ventrofixation - suturing the uterus (its round ligaments or body) to the anterior abdominal wall or shortening and fixing the ligaments to the aponeurosis, which brings the uterus into the correct position and keeps it from prolapse; modern options include fixation to the sacrum with a mesh prosthesis (sacrogysteropexy). Laparoscopic access allows this to be done through punctures with minimal trauma, while laparotomy allows for combined open operations. The method preserves the uterus and is suitable for women who do not want a hysterectomy. Often combined with plastic surgery of the vaginal walls during prolapse.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
