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Removal of uterine polyp by hysteroscopy

Surgery such as removal of the endometrial polyp is a frequent gynecological procedure. Education itself is the outgrowths of a tissue that differs in structure and structure. Has a benign nature. Let us consider the violation in more detail, select the features of the operation and therapy, talk about the nuances.

Endometrial Polyp Removal

The method of therapy is radical. With a small amount of education (up to 2 cm), hormones can be prescribed beforehand. In the absence of a result, - conduct surgical treatment. Endometrial polyp in the uterus, which is removed under anesthesia, is diagnosed by ultrasound. It determines not only assess the size, structure of education, but also its exact localization, which is important when drawing up a plan of radical therapy.

Endometrial polyp removal - hysteroscopy

This method is common. It involves the use of a special optical system. Detects very small foci. Part of the material is often placed in a sterile tube for histological examination. Hysteroscopy - removal of a polyp without incisions. Access is through the vagina, which eliminates the need for additional trauma. After the establishment of mirrors, enter the extender, then the device itself and carry out the removal of the endometrial polyp. The end of it has special forceps, with the help of which the tumor is cut off.

Endometrial polyp removal by laser

Laser removal of endometrial polyp is one of the least traumatic surgical procedures. The beam not only cuts off the altered tissues, but also conducts cauterization of the wound, which significantly reduces blood loss. In the future, the regeneration processes proceed much faster. The neoplasm is cut off in layers, the entire course of surgical manipulation is controlled with the help of video equipment. Lasts no more than 20 minutes. Scars on the site of incisions is not formed, which does not interfere with conception in the future.

Endometrial polyp curettage

Such manipulation as curetting of a polyp in the uterus is carried out as part of hysteroscopy, under the direct control of the optical apparatus. Carry out under anesthesia. The disadvantage is the fact that severe tissue injury occurs. This requires a subsequent long recovery period, medication. Used for extensive lesions of the uterine layer.

Preparation for endometrial polyp surgery

Initially, a woman undergoes a gynecological examination. At the same time, the state of the vaginal walls, cervix is ​​assessed, infection is excluded. Carried out the collection of smears. According to the results exclude contraindications. The very same preparation for hysteroscopy (removal of a polyp), implies the observance of the following rules:

  • ban on the use of vaginal suppositories, pills, intimate hygiene products throughout the week,
  • abstaining from sexual intercourse 3 days before the manipulation,
  • compliance with the recommendations and instructions issued by the doctor.

Preparing for scraping, laser exposure, implies the same rules. In this case, a woman a few days before the operation can be placed in the hospital for examination. In some cases, - she just comes to the clinic at the appointed time. These interventions are so minimally invasive that already after a day, the girl goes home.

Recovery after removal of the polyp in the uterus

Such a procedure is well tolerated. After removal of the endometrial polyp, the recovery period begins, the duration of which is on average 6-8 months. So much time is required for the full normalization of the reproductive system. The recovery process itself includes:

  • visiting the gynecologist once a month
  • hormonal drugs,
  • compliance with medical recommendations.

Immediately after the manipulation, the woman is recommended:

  • refrain from sexual intercourse for 1 month
  • a week not to go to the sauna, bath, do not take a bath.

Treatment after removal of the endometrial polyp in the uterus

Therapeutic interventions are individual. Treatment after removal of the endometrial polyp involves:

  • prescription of hormonal drugs: Utrozhestan, Duphaston,
  • anti-inflammatory drugs: Indomethacin, Meloxicam, Diclofenac, Celecoxib, Piroxicam,
  • douching antiseptic solutions: Chlorhexidine, decoctions of chamomile, calendula, sage.

An integral part are periodic inspections. In order to prevent and detect recurrences in time, a woman undergoes an ultrasound examination once a month. In case of re-formation, curettage of the uterine cavity is performed. During the recovery period, the woman is recommended to refrain from sexual intercourse - this once again injures the vaginal mucosa and prevents its normal healing.

Monthly after removal of the endometrial polyp

After the procedure, many women experience problems with the cycle. Because of this, the question of how menstruation goes after the removal of an endometrial polyp, gynecologists often hear from girls. According to medical observations, menstrual flow can be delayed up to 30 days. Important is the age of the patient, the nature of the changes, the volume of affected tissues.

After the endometrial polyp has been removed, bleeding is noted that has no connection with cyclical changes. It is necessary to ensure that its duration does not exceed 10 days. This may indicate the presence of parts of the removed tumor in the cavity. This is rarely observed. Repeated cleansing eliminates such a problem. Progesterone drugs are prescribed to normalize the cycle.

Pregnancy after endometrial polyp removal

Violation is an obstacle to the implantation of the ovum. As a result, the onset of gestation is difficult. Even before the scheduled, patients are interested in whether they can become pregnant after removing the endometrial polyp. Doctors point out that this greatly increases the chances of fertilization. At the same time, they note the need to exclude unplanned pregnancy.

In the period of taking hormones and restoring uterine tissue, there is a need to use contraceptive barrier agents. The duration of the period of returning the body to its former state can be delayed up to 4-6 months - this is how much is required for the complete restoration of the uterine inner layer. Planning for pregnancy is started with the permission of a doctor who ascertains the normal thickness of the tissue, the absence of new lesions.

Endometrial polyp (removal) - effects

The most effective way to treat a disorder is the removal of an endometrial polyp (hysteroscopy), the consequences of which are few. These include:

  • vaginal discharge,
  • the appearance of moderate pain in the lower abdomen,
  • changing cycle, nature of menstrual flow,
  • slight increase in body temperature.

Elimination of education with a laser has almost no negative consequences. The relatively low prevalence of this method of removal of the endometrial polyp is due to the need for the presence in the staff of the medical institution of highly qualified personnel and equipment. With the observance of all algorithms, proper implementation of the manipulation, the consequences are completely excluded. In this case, the regeneration of damaged tissue proceeds faster.

Scraping is rarely performed because:

  • high risk of postoperative infection,
  • there is a possibility of damage to the deep layers of the uterus,
  • has a long recovery period.

What is hysteroscopy?

The examination allows you to identify, and also immediately eliminate many of the pathologies present in the uterus. So, for example: taking a biopsy, removing foreign bodies, removing polyps.

Hysteroscopy has many positive points, such as:

  • at the same time examination and treatment (no cuts are made on the body),
  • all interventions are controlled by vision,
  • easy portability of the procedure
  • practically does not require a woman's stay in the hospital (basically, the doctor can leave the woman under control for 1 day in the hospital).

Contraindications for hysteroscopy

Contraindications to the procedure:

  • acute period of the inflammatory process of the pelvic organs,
  • infectious process of the pelvic organs,
  • newly treated sexually transmitted infections,
  • third or fourth degree vaginal smear for purity,
  • pregnancy,
  • acute infectious disease (non-genital): sore throat, flu, bronchitis, etc.
  • having somatic pathology of severe degree (associated with cardiovascular disease, kidney disease, liver).

  • uterine bleeding of unknown etiology,
  • cervical cancer,
  • constriction of the cervix.

Indications for hysteroscopy

Indications for hysteroscopy polyp:

  • permanent menstrual irregularities
  • pathological discharge mixed with blood or pus,
  • diagnosis of infertility,
  • suspected polyp formation in the uterus,
  • not carrying a pregnancy.

Removal of uterine polyp

Examination before the procedure

Initially, the doctor examines a woman in a gynecological chair, then, based on the results of the examination, the doctor prescribes a course of examination, which may consist of:

  • ultrasound diagnosis of the pelvic organs,
  • diagnostic examination of the vagina, cervix, vaginal machine using a special device - Kolposkop,
  • delivery of the general blood test, biochemical blood test,
  • fluorography,
  • ECG,
  • giving blood tests for such infections as syphilis, RV, HIV, viral hepatitis B, C, HbcAg, a-HCV,
  • Vaginal smear for purity
  • cervical cytology smear,
  • Consultations of medical specialists: therapist, cardiologist.

Preparing for hysteroscopy to remove a polyp

To carry out the removal of a polyp from the uterus, it is necessary to correctly calculate the days of the menstrual cycle. So to perform this procedure, it is preferable to choose the first phase of the menstrual cycle. But there are exceptions. For example, a woman who takes hormonal combination oral contraceptives can perform manipulation on any day of the menstrual cycle.

The main training recommendations include:

  • one day before the operation do not make douching,
  • do not use any vaginal suppositories for a day,
  • remove existing hair in the intimate area,
  • for the night (according to the recommendation of the doctor) a cleansing enema,
  • in the morning not to have breakfast, not to drink, not to take any pills.

The operation takes place at the hospital. Therefore, it is necessary to bring with you the necessary things, such as a bathrobe, sneakers, spare pants, sanitary pads, a bottle of drinking water.

How to remove a polyp from the uterus

Removal of polyps of small and medium sizes is not considered difficult, it is manipulated in a small operating room. Large fibrous polyps are removed already in a large operating room. Such manipulation is attributed to a complex operation.

How it all goes:

  • A nurse will accompany the patient for hysteroscopy before surgery.
  • Before entering the operating room, the woman passes all her belongings to the nurse and puts on special sterile clothes.
  • In the operating room, the patient lies down on the gynecological chair, where she is put on sterile boot covers.
  • Then they begin to prepare the handling area (external genital organs, the inner surface of the thighs) with a special solution.
  • Then the woman is given an intravenous injection, after which she is immersed in a brief anesthesia.
  • In general, the operation lasts for 15-25 minutes.

Removal of uterine polyp by hysteroscopy

Diagnostic hysteroscopy

The doctor with the help of a special gynecological mirror opens the cervix, while disinfection is performed. With the help of the expander Gegar stretches the cervical canal to the required size of the hysteroscope and then the equipment is inserted into the uterine cavity. Inspection of the uterus is strictly clockwise, where it is carefully inspected:

  • the bottom of the uterus,
  • pipe corners,
  • side walls of the uterus,
  • isthmus,
  • cervical canal.

Also evaluated:

  • the shape of the uterus,
  • condition of the walls of the uterus (relief),
  • endometrium
  • availability of fallopian tubes.

Types of polyps

Polyps in the uterus can be:

  • Fibrous - single forms of polyps of small size up to 1.5 cm. They are an oval with a smooth surface and dense structure. It is rare to see large fibrous polyps.
  • Glandular - they can be divided into glandular-cystic and glandular-fibrous. Basically, there are large sizes, irregular shapes, with a smooth surface (dark purple vascular tips are clearly pronounced on the surface). They reach sizes up to 6 cm.
  • Adenomatous - polyps of small size, up to 1.5 cm. They are loose, regular-shaped balls. There are both one by one and in groups. This form of polyps can develop into malignant neoplasms.

Removal of the small size of polyps occurs with the help of an electrode. In this case, the leg of the polyp is excised under strict control of vision. The polyp body itself is incised and removed from the uterus with forceps.

If a polyp is located in the mouths of the fallopian tubes, then such polyps are removed using a resectoscope loop or may resort to a laser light guide.

Removal of large sizes of polyps is carried out by mechanical or electrosurgical method.

After removal of the polyp, repeated hysteroscopy is performed, where it is assessed:

  • whether the polyp was completely excised,
  • force of bleeding
  • tissue damage.

Postoperative period

Treatment after hysteroscopy of the endometrial polyp. After the end of the whole procedure, the patient is transferred from the chair to the gurney and placed for 2-5 hours in the ward, where it is observed by medical workers. The postoperative period itself is divided into the following:

  • rupture of the uterus,
  • uterine bleeding,
  • damage to the pelvic organs,
  • allergic reaction,
  • gas embolism
  • exacerbation of existing chronic diseases of the pelvic organs,
  • strong pain.

2 - a special mode is assigned:

  • not allowed to use blood thinners (aspirin),
  • observation of excreta
  • no physical activity, it is forbidden to engage in fitness, sports,
  • forbidden sex life
  • it is forbidden to use tampons
  • It is forbidden to use douching.

This mode is prescribed for 1 month after surgery.

3 - hormonal correction

Usually, doctors prescribe a course of hormonal drugs for a period of from 3 to 6 months. Use these drugs to normalize the menstrual process. It should be remembered that all cysts are hormonal diseases.

4 - antibacterial therapy

To prevent the development of infection after surgery, antibiotics and antimicrobials are prescribed.

5 - health monitoring, recovery.

The main aspects in the postoperative period are:

  • A woman must constantly come to the appointment with a gynecologist.
  • Be sure to undergo ultrasound examination of the pelvic organs every 2 months.
  • It is necessary to find out the results of the analysis for histology.
  • Follow the rules of personal hygiene.
  • It is forbidden to overcool the body.
  • It is forbidden to visit the pool.

Discharge after hysteroscopy

Immediately after this manipulation, discharge is always observed and this is considered the norm:

  • scanty discharge with blood,
  • Duration not more than 3-4 weeks
  • discharge has small pieces of mucus (excised pieces).

If you notice that the discharge has impurities of pus or bleeding of abundant nature has begun, then this is a reason for an emergency visit to the doctor.

Pregnancy after hysteroscopy endometrial polyp

If the pregnancy did not occur because of a polyp in the uterus, then after the excision of the polyp the onset of the desired pregnancy usually occurs without problems. At the same time, the pregnancy itself is quite calm and without complications. But do not forget that after such a manipulation as hysteroscopy, it is necessary to plan the pregnancy no earlier than 3 months after the operation.

If the desired pregnancy does not occur, the polyp was not the cause of infertility.

Brief description of the operation

Uterine hysteroscopy refers to minimally invasive techniques. The operation is performed using a special hysteroscope. It is equipped with a mini-camera, with which the image of the mucous membrane of the body is displayed on the screen. The hysteroscope has a hollow tube into which surgical instruments are inserted for manipulation. The method has several advantages over other methods of removing polyps:

  • action targeting
  • minimal risk of recurrence
  • has no age limit for mature women,
  • does not interfere with conception and childbirth,
  • minimal tissue damage
  • speed of operation,
  • The procedure can be performed on an outpatient basis.
  • minimal risk of complications (mostly their absence),
  • no long sick leave required.

Hysteroscopy varies by species. Depending on the equipment is divided into:

  1. Radiosurgical. The formation is evaporated using radio waves.
  2. Mechanical.Polyp is excised or spun with surgical instruments.
  3. Electrocoagulation. The polyp is separated from the mucous membrane with the help of an electrode having the shape of a loop. Under the current soft tissue melt.
  4. Laser. Polyp evaporates quickly, after which there is no scar.

Standard hysteroscopy of the uterus is done without hospitalization, without painkillers, under short-term anesthesia. If the polyp is large, and the area of ​​the lesion is large or there are additional pathologies (endometriosis, fibroids, bleeding disorders, etc.) this is considered a difficult case. The operation is performed in the hospital, after the patient is given general anesthesia.

Depending on the inside of the means for unfolding the uterine walls, hysteroscopy is divided into gas (with carbon dioxide) and liquid (with physiological or 5% glucose solution).

Assignments and prohibitions to operations

Hysteroscopy of the uterus is indicated for menstrual failures, bleeding, or discharge (including if the cause is polyps). The operation is assigned in the presence of:

  • intrauterine synechiae
  • myoma node,
  • cancer affecting the mucous or cervix,
  • polyposis,
  • not carrying,
  • adenomyosis,
  • abnormal development
  • infertility
  • perforation of the uterus,
  • foreign bodies
  • remnants of the shell from the ovum.

Also, hysteroscopy is performed to examine the uterus before surgery, to evaluate and monitor treatment. The procedure is mandatory when preparing for IVF or after complicated labor.

Preparation and progress of the operation

The operation requires advance preparation. First, the patient donates blood and urine, biochemistry is done. They take strokes from the cervix and vagina. From the hardware diagnostic methods are used:

The doctor is notified in advance of the presence of chronic diseases and allergies to specific drugs. If colpitis is detected, vaginal repair is done. 7 days before the operation, douching stops, and for three - sexual contacts. At least a week before hysteroscopy of the uterus, a woman should not use vaginal suppositories.

Before the operation, an enema is done, the bladder is emptied. Directly on the day of the patient is forbidden to eat. The operation is performed 5-7 days after the end of menstruation, when the mucous membrane has not yet recovered, and the surface of the uterus is bare.

How is a polyp removed?

The patient is immersed in anesthesia, the genitals (inside and out) are treated with an antiseptic. Then, with the help of a gas or liquid, the uterine cavity expands and a hysteroscope is inserted into it. Estimated organ, its mucous membrane, the area occupied by polyps. If foreign fragments are present, they are pulled out by clamps that are inserted through the hysteroscope tube. In the same way tissue is taken for analysis. With the help of special tools removed polyps. Then the cavity is disinfected, the hysteroscope is removed. The patient is gradually removed from anesthesia.

Possible complications

Complications after the procedure include pain in the abdomen (inside) of a pulling nature. This is a natural reaction of the human body to surgery, as well as a small discharge of blood without a strong odor. Due to the introduction of anesthesia and discharge into the air cavity, small flatulence may occur. Sometimes there is a short-term pain in the shoulders.

Serious consequences include relentless severe pains that are not stopped by even painkillers, or abundant leakage of mucus from the blood, with a putrid odor. Also, the pathological sign is considered and the complete absence of discharge.

When removing polyps, soft tissues or uterine cervix can be injured, vascular hemolysis appears. A very rare complication is air embolism, when vesicles enter the blood. This can lead to the death of the patient. Sometimes chronic diseases are exacerbated, defects in the uterus, hydrosalpinxes are formed. However, any complications are extremely rare.

Who shows removal of polyps

Small-sized epithelial formation that occurs on the intestinal wall when tissue regeneration is impaired is considered the safest: only 1% of such polyps (they are called hyperplastic) tend to turn into a malignant tumor. If it is less than 1 cm, does not grow, does not overlap the intestinal lumen, the treatment will be conservative. All other cases mainly involve the removal of polyps, but especially often patients with the following conditions receive an appointment for an operation:

Indications for removal of polyps

Contraindications for the removal of polyps by the selected method

Persistent discomfort, lower abdominal pain, stool instability

Colonoscopy (diagnostic and therapeutic as needed)

  • broad base of polyps
  • multiple polyposis

Heavy bleeding from the anus, secretion of mucous secretion

  • bleeding tendency,
  • bleeding disorders,
  • acute inflammatory process in the affected area,
  • epilepsy,
  • diabetes,
  • the presence of a pacemaker
  • acute infectious diseases

Malignancy (tendency to rebirth) of the tumor, multiple polyposis, large size of the neoplasm

How is surgery performed to remove a rectal polyp

The choice of the type of surgery depends on the clinical picture of the pathology, the individual characteristics of the patient. The most commonly used operations to eliminate polyps are:

  • electroscission of a polyp (endoscopic),
  • transanal excision (alternative endoscopy),
  • laparoscopy,
  • segmental resection (partial removal of the intestine).

Endoscopic Polypectomy

A minimally invasive method of removing small tumors involves performing an operation under local anesthesia. Rehabilitation is fast, nutritional restrictions are less than with other methods of surgical intervention. Intestinal polypectomy is performed by endoscopic instruments inserted through the anus. There are three methods of endoscopic polypectomy:

  • Electrocoagulation - cutting of a polyp is carried out with the help of a current, therefore the wound immediately burns and closes. If necessary, it is additionally treated with an electrode. After the doctor removes the removed polyp.
  • Excision - is carried out by forceps, which are used only for large tumors (if the loop can not be thrown).
  • Laser removal - a polyp is burned in 30 minutes or less, the wound heals faster, but the laser leaves no material to study the nature of the neoplasm. On the colonic wall and in the cecum due to the risk of damage to the organ itself, the method is not applied.

Laparoscopy

For tumors larger than 2.5 cm, intervention is not performed through the anal passage: in this case, doctors choose laparoscopy. It involves incisions in the peritoneum of up to 1.5 cm, through which the endoscope and other surgical instruments are inserted. The general principle is the same as for the polypectomy through the anus, but the patient is given general anesthesia. The rehabilitation period is long.

Laparotomy

If laparoscopy and endoscopy are unacceptable (ineffective), laparotomy is prescribed: removal of the neoplasm through a longitudinal incision with a scalpel or with an electric knife of the wall of the affected organ. The operation is performed under general anesthesia. Localization of the polyp is detected by touch, after its removal and part of the adjacent mucosal tissues are sutured to the intestinal and abdominal walls. Rehabilitation of the patient occurs in the hospital under the supervision of doctors.

Removal of a part of the intestine together with multiple formations is prescribed in rare cases: at high risk of malignancy, the presence of several sections of polyposis. The operation is performed under general anesthesia and requires long-term rehabilitation.

Surgical intervention is carried out through the incision of the peritoneum, the scheme depends on the location of the polyps:

  • The upper anterior resection - polyps above the anus 12 cm, it is necessary to remove sections of the rectum and sigmoid colon, the edges of the remaining zones are stitched together. The functioning of the reproductive, urinary systems and intestines is fully preserved.
  • Abdominal-anal - polyps above the anus at 4-6 cm, removal of the rectum and the sigmoid, anal passage is done, a temporary stoma is placed for 2-3 months: an artificial opening that promotes the release of intestinal contents. For polyps at a distance of 6-12 cm, the scheme is similar, but the anus is not cut.
  • Abdominal-perineal - removal of the sigmoid colon and pelvic floor muscles, the full rectum, and anal passage is shown. To compensate for the eliminated zones, a permanent stoma is formed.

Causes of polyp formation in the uterus

The growth of the endometrium can be caused by various reasons.

  • Endometriosis is a common disease that occurs in 15% of women from 25 to 44 years.
  • Sexually transmitted infections.
  • Cervical erosion. Also found quite often.
  • Injuries to the internal genital organs.
  • Metabolic disease.
  • Weak immunity of women.
  • Complications after difficult childbirth or abortion.
  • Intrauterine device.
  • Chronic diseases of internal genital organs.

Whatever the reasons for the formation of polyps in the uterus, these are always pathological disorders that cannot be ignored. And, in addition to the removal of tumors, a woman usually also needs special treatment aimed at eliminating these very causes and at restoring normal hormonal levels.

By the way! Polyps formed after childbirth or abortion are called placental. Because they are pieces of the placenta or fetal membranes, on which blood accumulates, and then connective tissue is formed. Such polyps are also subject to removal.

Symptoms of polyps in the uterus

Doctors are not psychics and do not have X-ray vision. They cannot detect polyps without a diagnosis. And for her to take at least the patient's complaints. This may be an irregular cycle, too heavy bleeding during menstruation, non-menstrual bleeding, lower abdominal pain (if the polyp is very large), inability to conceive.

All of these symptoms are non-specific and can be attributed to almost any female disease, so polyps are rarely diagnosed in the early stages. And most often they are detected by chance during a vaginal ultrasound examination, appointed because of the suspicion of a completely different pathology.

A special method for examining the uterine cavity for polyps is called hysteroscopy. This is a technologically complex procedure that requires special preparation, so it is carried out with almost 100% certainty that polyps are there in order to assess their size, quantity and condition. There is also the concept of “operating hysteroscopy,” when, in addition to the examination, neoplasms are also removed at the same time.

What are dangerous uterine polyps

Polyp is a benign formation, but medicine still refers them to precancerous. Therefore, oncology is considered the most dangerous complication. If histology shows at least one cancer cell, treatment is already being carried out according to all principles of treatment of oncological formations up to the removal of the uterus.

Another risk associated with uterine polyps is infertility. Due to the strong proliferation of the inner walls of the uterus, the egg can not attach to them, so every ovulation is meaningless. But even if the pregnancy comes, the polyp will prevent the development of the embryo, absorbing all the nutrients. Result: missed abortion or stillbirth.

There is also good news: infertility caused by a polyp can be cured. But it must be done on time. Removal of excessive mucous membranes and a course of hormonal therapy help a woman to restore the ability to conceive and successfully bear a child.

Is it possible without surgery

After the recommendation of the doctor for surgical treatment, 90% of patients ask the question: can we somehow do without surgery? But this is exactly the case when surgical removal of a polyp in the uterus is the only way to avoid complications and to return a normal life to a woman. After all, an irregular cycle is a direct path to infertility.

And the risk of cancer, too, should not cause doubts about whether to do the operation or not. It is better not to take time to “think” either, because polyps can grow very quickly. And the sooner their removal is carried out, the higher the probability of restoring women's health without any problems.

In rare cases, polyps in the uterus can be eliminated in a conservative way. Medical hormonal and anti-inflammatory therapy can be used in case the formations have a glandular or cystic nature.

Course of operation

There are two main ways to remove polyps in the uterus: curettage (curettage) and laser surgery. Sometimes these techniques are combined, i.e. polyps are cut and removed, and their base is burned with a laser.

The procedure is usually performed under local anesthesia, but for severe complications, the patient can be immersed in general anesthesia, so that during the manipulations there is no movement on her part. All this time the woman is on the gynecological chair.

The first thing to do is uncover the cervix so that you can insert instruments there. For this purpose, a special liquid or gas preparation is introduced into the vagina, which provokes disclosure. Then a dilator is inserted into the cervix, which keeps the uterus open.

The hysteroscope, which is inserted into the uterine cavity, has a miniature camera at the end that displays an image on the monitor and allows the doctor to see the size and location of the polyps. With a special tool, a polyp is cut off (if the leg is thin) or is scraped gradually (if it fits tightly against the walls of the uterus). Then laser cauterize the place of removal to stop the bleeding and at the same time disinfect the wound.

Removal of polyps in the uterus with a laser (without scraping or cutting) is carried out if the formations are numerous and small. The laser beam quickly and effectively acts on every small polyp, allowing it to get by with little blood and maintain maximum tissue integrity.

By the way! Often, simultaneously with the removal of polyps in the uterus, a biopsy is taken: a piece of tissue is taken for analysis to accurately exclude the presence of cancer cells in it.

Rehabilitation

After getting out of anesthesia and in the absence of complications (heavy bleeding, feeling unwell), the patient goes home. But within 4-6 days you need to follow the recommendations of the doctor and take the prescribed drugs. These are usually antibiotics and hormones. The first day is desirable to completely comply with bed rest. You should also avoid physical exertion, do not take a bath (only a shower), refuse to have sex.

Spotting during the rehabilitation period is normal. You just need to use feminine hygiene products. Minor pains and cramps in the lower abdomen are also temporary. In extreme cases, you can take an anesthetic pill, but not on the basis of acetylsalicylic acid (because it dilutes the blood).

Attention! If symptoms increase, fever, heavy bleeding - you should contact the doctor who performed the operation, or call an ambulance.

After removing the polyps in the uterus, the menstrual cycle may change slightly. The first 2-3 months it may be irregular, but over time, everything returns to normal. In order to avoid relapse, the patient is prescribed medication therapy, and she visits the gynecologist at least once every 2-3 months.

How to remove uterine polyp

Many studies have shown that diagnostic curettage does not allow in all cases to get rid of these structures. Polyps composed of dense tissues — muscular, fibrous (especially for a glandular fibrous polyp, you can learn more from our previous article) are removed especially badly in this way — their frequency after curettage is only 12%. Even simultaneous endoscopic control does not allow to avoid the recurrence of the disease.

Effective removal of pathological tissues should affect the entire endometrium, located under the formation, up to its deep basal layer. This can only be achieved by performing a hysteroscopic intervention.

Endometrial polyp removal methods involve the use of conventional hysteroscopic equipment, as well as the use of electrosurgical techniques or laser conductor. Removal of the endometrial polyp with a laser is a modern technology that allows you to completely get rid of unwanted tissue, reduce the likelihood of bleeding from the removal point, reduce the frequency of relapses. However, the usual hysteroresectoscopy, with proper preparation and execution, has very good results.

How to prepare for surgery

Before removing uterine polyps, the following diagnostic measures are performed:

  • examination of the cervix in the mirrors, which helps to assess its condition, the shape of the cervical canal, the presence of an inflammatory process or damage to an organ, this is important, because it is through the cervical canal that instruments for manipulation in the uterus will be introduced,
  • бактериологическое исследование мазков с поверхности шейки и стенок влагалища для доказательства, что у женщины нет бактериального воспаления половых органов, ведь иначе есть риск занести инфекцию в матку, что вызовет эндометрит,
  • мазок на цитологию,
  • transvaginal ultrasound examination, in which the sensor is placed in the vagina and examine the uterus without interference, which creates the abdominal wall,
  • general clinical examination - blood tests (general and biochemical) and urine, microreaction for syphilis, blood test for HIV, markers of viral hepatitis, electrocardiogram, pulmonary fluorography, examination by a therapist.

Contraindications for removal of a polyp:

  • inflammatory diseases of the vagina, cervix, uterus or appendages caused by both banal flora and sexually transmitted infections (for example, chlamydia) - the operation is performed after getting rid of these diseases,
  • exacerbation of genital candidiasis (thrush) or bacterial vaginosis (vaginal dysbiosis),
  • intense bleeding from the genital tract, caused by endometrial hyperplasia or other causes, before it stops,
  • pregnancy,
  • pathology of the cervix, which prevents the holding of hysteroscopic instruments into the uterus (cancer, stenosis, severe cicatricial deformity after breaks in labor, etc.),
  • severe concomitant diseases in the stage of decompensation (for example, diabetes mellitus with high blood glucose and glycated hemoglobin, arterial hypertension with high blood pressure numbers) or exacerbations (for example, gastric ulcer, bronchial asthma and others),
  • acute respiratory infection.

Special preparation for the removal of the endometrial polyp is not required. During the week prior to the procedure, sexual rest or condom use is desirable. It is better not to use douching, vaginal tablets, suppositories and creams for any purpose.

On the day before the operation for lunch, you can take digestible food, eliminating black bread, cabbage, beans, and from dinner it is better to refuse or drink a glass of kefir. Liquid is not limited. In the morning of the operation should not eat breakfast and drink. In the evening and in the morning, a cleansing enema is performed as prescribed by the doctor.

A suitable operation time is determined by the doctor, usually it is 2-3 days after the end of the menstruation, that is, 6-9 days of the cycle, because at this time the endometrium has not yet recovered, but its menstrual rejection has already been completed. These days polyps are better visible, they are easier to remove, less often surgery is accompanied by complications, such as bleeding.

Operative intervention

Surgery to remove an endometrial polyp is usually performed in a hospital. The duration of hospitalization is short, not exceeding several days.

The patient is located on a gynecological chair, she begins the introduction of pain medication intravenously. In this case, the woman falls asleep and feels nothing. General intravenous anesthesia can be replaced with spinal anesthesia or even endotracheal anesthesia. The decision on the type of anesthesia is taken by the anesthesiologist depending on many factors, including:

  • the probable duration of the manipulation and its volume,
  • accompanying illnesses,
  • intolerance to drugs, cases of allergies to the introduction of painkillers,
  • the possibility of complications during the operation.

In any case, adequate anesthesia is necessary, as pain and other negative reactions may occur when the cervical canal is dilated to inject a hysteroscope.

Period after surgery

Normally, within 2-3 days after removal of the endometrial polyp, the patient has discharge.. They are scanty, “smearing” and pass by themselves, as soon as the place of removal “heals”. The patient may experience slight discomfort in the lower abdomen and in the external genital area, it is not dangerous and is associated with the restoration of the cervix.

If the stomach aches after the intervention, the doctor prescribes painkillers. You can use tools in the form of rectal suppositories, they are safer and no less effective than conventional painkillers.

If you increase the pain and the increase in bleeding, as well as their duration more than 5-6 days, an urgent need to consult a doctor. Such signs indicate complications of the procedure.

Negative effects of hysteroscopy and polyp removal:

  • perforation (perforation) of the uterine wall,
  • endometritis,
  • bleeding from the place of removal of education.

During the first 2-3 days a woman may have a fever. Most often this is a consequence of exacerbation of the chronic inflammatory process in the fallopian tubes. In addition, after the removal of multiple polyps, aseptic (germ-free) inflammation occurs in the uterine wall - a natural reaction of the body, aimed at restoring the integrity of the mucous membrane.

With the appearance of complications, repeated hysteroscopy is often performed, as well as curettage of the uterus, antibiotics, detoxification drugs, and hormones are prescribed.

Recommendations after removal of education for the prevention of inflammatory complications:

  • sexual rest during the week, while the cervix is ​​being restored,
  • avoiding the use of vaginal tampons,
  • douching and the use of vaginal dosage forms should not be performed without a doctor's prescription.

What can not be done during the first week after surgery:

  • go to sauna, bath,
  • take a hot bath
  • to go to the pool or solarium,
  • do sports, do hard physical work.

When will menstruation begin?

Despite the removal of the formation, the hormonal background of the woman is not disturbed; therefore, menstrual periods after the removal of the endometrial polyp occur on time, only a slight deviation in the timing of the onset of menstruation is possible.. Abundant monthly - a variant of the normal course of the recovery period. However, if they pass into uterine bleeding, an urgent need to consult a doctor.

When can you get pregnant?

Pregnancy after removal of the endometrial polyp may occur already in the current cycle, if hormone therapy does not begin. However, this is not entirely favorable development of events, because a woman needs rehabilitation for full recovery.

The optimal period for which the inner layer of the uterus is fully restored is 3 months. It is for this period that combined oral contraceptives are prescribed. Their cancellation causes the so-called re-play effect, due to which the likelihood of pregnancy increases. If endometrial polyps were the cause of infertility, it is at this time that the most favorable moment for conception occurs.

What treatment is prescribed after removing the endometrial polyp?

The question of the advisability of prescribing hormonal drugs remains controversial. Some doctors believe that drug therapy can be avoided when a small polyp is removed. Others argue that hormone therapy is appropriate because it affects the restoration of normal endometrial function. Hormones are prescribed for functional glandular polyps, adenomatous formations, as well as for the combination of polyps with endometrial hyperplasia.

Usually, combined oral contraceptives or progestogens (Duphaston) are prescribed. The choice of drug, its dosage and duration of admission is determined by the doctor. Usually it is 3 months. Often, women are offered to install an intrauterine device containing Levonorgestrel - Mirena. These activities, in addition to the restoration of endometrial function, are aimed at planning pregnancy.

Clinical supervision of the patient who underwent the removal of the polyp, carried out during the year.

Removal of endometrial polyp: how to perform an operation, preparation for it and the consequences - all about diseases of the genital area, their diagnosis, operations, problems of infertility and pregnancy on MedNews.info

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