Ovarian and Fallopian tube surgeries
Depending on the type of problem, gynecological surgeries can be performed using various surgical methods. These include laparoscopic surgeries, during which therapeutic interventions take place in the abdominal cavity, hysteroscopic interventions, i.e., uterine mirroring, where we reach the uterine cavity through the vagina, and situations can arise where open abdominal surgeries are needed. You can read in detail about these surgical methods by clicking here.
In the following, we provide information about the most common surgeries performed on the ovaries and fallopian tubes.
Laparoscopic surgeries for ectopic pregnancy
We speak of an ectopic pregnancy when the fertilized egg implants outside the uterine cavity in an abnormal way and begins to develop. Ectopic implantation most often occurs in the wall of the fallopian tube (horn pregnancy), but it can also occur in the ovaries (ovarian pregnancy), the cervix (cervical pregnancy) and the abdominal cavity (abdominal pregnancy). Ectopic implantation occurs in approximately 1% of pregnancies.
Unfortunately, fetuses implanted in these abnormal places are unable to develop due to lack of adequate environment and blood supply, and since this condition endangers the life of the mother, the embryo implanted outside the uterus must be removed.
Key information about ectopic pregnancy and its surgery
Ovary Removal
Oophorectomy or ovariectomy is a surgical procedure in which one (unilateral oophorectomy) or both ovaries (bilateral oophorectomy) are removed. In the latter case, the so-called surgical menopause occurs immediately after the surgery. If the fallopian tubes also have to be removed along with the ovaries, we speak of salpingo-oophorectomy.
Key Information on Ovarian Removal Surgery
Possible reasons for ovary removal:
- tubo-ovarian abscess, i.e., an abscess affecting the fallopian tubes and ovaries (which is a pus-filled cavity)
- ovarian cancer
- endometriosis with ovarian involvement (chocolate cyst)
- benign ovarian tumors, cysts
- prevention of ovarian and breast cancer in high-risk women
- torsio ovarii, i.e., ovarian torsion
The ovary can be removed by laparotomy (abdominal incision) or, depending on the type of disease that indicates the surgery, by laparoscopy. Ovariectomy can be performed on its own, but it is often combined with hysterectomy, i.e., uterus removal, if the patient is already postmenopausal, or if she has no future family planning. In case of confirmed ovarian cancer or high risk of its development, the intervention is extended to the removal of fallopian tubes (salpingo-oophorectomy).
Risks of the surgery:
Ovary removal is a relatively safe procedure that rarely causes complications, which may include:
- bleeding
- infection
- damage to surrounding organs
- tumor disintegration and scattering of released cancer cells
- remaining ovarian cells after surgery, which in the case of endometriosis, can cause symptoms again in premenopausal women (e.g., pelvic, lower abdominal pain)
- intestinal obstruction
In the case of removing both ovaries – for women of childbearing age – menopause sets in immediately. The symptoms are caused by the decreased level of female hormones:
- hot flashes
- vaginal dryness
- depression
- increased propensity for heart disease
- memory loss
- decreased libido
- osteoporosis, bone fractures
Hormone therapy can be considered for treating the above symptoms, which is usually continued until the age of 50.
How to Prepare for Surgery?
Before the operation, your doctor may give you the following advice, the adherence to which can help ensure the success of the operation:
- consumption of a laxative solution the day before the operation, which helps to clean the intestines
- on the day of surgery (or 8-12 hours before the operation), do not eat and limit your fluid intake
- the medications you regularly take may need to be taken differently, or you may need to switch to other medications before and after the operation
- you may need a detailed ultrasound and/or CT scan to accurately plan the intervention
How to Plan for a Hospital Stay?
After an oophorectomy, a few days of hospitalization may be needed. The duration of hospitalization depends on the type of intervention (laparotomy, laparoscopy), the indication for it, and the patient's general health condition. Your treating doctor can provide personalized information on the necessary duration of hospitalization. For the time spent in the hospital, you might want to bring the following:
- slippers, bathrobe
- hygiene tools, e.g., toothbrush
- tools suitable for passing the time, such as books, magazines, tablet
How to Prepare for Possible Infertility Before the Surgery?
If you want to have children after the operation, consult your doctor about this possibility. If only one ovary is removed, you can still have children naturally in the future, and your menstrual cycle will also remain. If both ovaries are removed but the uterus is left in place, you can still get pregnant with the help of assisted reproductive methods. A fertility specialist can help with the details.
What to Expect?
The operation is performed under anesthesia. There are two methods of intervention:
- Traditional, open abdominal surgery (laparotomy): During a laparotomy, an incision in the abdominal wall provides access to the ovaries. The surgeon detaches the ovary from the supplying vessels and surrounding tissues, then removes it.
- Laparoscopy, keyhole surgery: During laparoscopy, the intra-abdominal organs can be reached through 3 or 4 small incisions in the abdominal wall using special tools. The surgeon inserts a camera through the first hole and the necessary tools for the operation through the others. Using these tools, the ovaries are detached from the supplying blood vessels, then placed in a bag and removed through one of the small holes.
The choice of surgical method depends on the nature of the underlying disease. The laparoscopic method involves less postoperative pain and a shorter recovery time, but in case of tumors, laparotomy is usually the safer procedure. Sometimes it may happen that laparoscopy is converted to an open surgery during the intervention (e.g., in the case of a large tumor or severe bleeding during the operation).
After the operation, you can expect the following:
- you will be under observation until the anesthetic wears off
- afterwards, you will be placed in your room, where depending on the type of surgery you will need to stay for 24 hours to a few days
- during recovery, try to move, get up as soon as possible, as this promotes faster healing
- recovery time depends on the type of intervention, its indication, and your general condition
- after the operation, most patients can return to their preoperative duties, activities on average within 6 weeks; in fact, this time can be reduced to two weeks in case of laparoscopic surgery
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