The operation of Wertheim: the course of the operation, consequences, complications, reviews

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2018-03-20 05:01:15

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One of the peculiarities of operations in oncopathology is radical, i.e. remove not only the tumor itself but also a significant amount of healthy tissue located near the pathological focus. In addition, together with the tumor excised lymph nodes and empties into them the lymphatics.

Radical treatment of cancer of the cervix and uterine body

The Operation of Wertheim fully complies with the requirements mentioned above. Its essence lies in removing the uterus with appendages (fallopian tubes and ovaries), the upper third of the vagina and uterus supporting ligaments and the surrounding fat tissue with the lymph nodes.

operation of Wertheim

Indications for surgery are cancer of the cervix and uterus. But in some cases surgical intervention is not recommended:

  • In the presence of distant metastases;
  • In the case of the huge size of the tumor, with invasion of vessels and adjacent organs, and sometimes the walls of the pelvis;
  • In severe concomitant disease;
  • Old age.

The Wertheim Operation for cancer of the cervix

If we talk about the treatment of this disease, it should be noted that the mentioned operation can be applied both independently and as part of combination therapy.

In the case of diagnosing a highly differentiated squamous cell cancer (stage T1bN0M0) the specified operation could radically solve the problem without involving techniques such as chemotherapy and radiation therapy. However, most of the Wertheim operation is a component of the combined treatment.

Endometrial cancer (even in stage IB) are always assigned to other therapies besides surgical intervention.

Operation Wertheim: operation

Wertheim operation for cancer of the cervix

Surgery for a radical removal of the uterus with appendages includes several stages. These include:

  1. Access.
  2. The intersection of the uterine ligaments.
  3. Mobilization of the fallopian tubes and ovaries.
  4. Mobilization of the bladder.
  5. Ligation and the intersection of the main feeding vessels.
  6. The Removal of tissue from the front surface of the cervix.
  7. The intersection of the ligaments, fixing the uterus at the back (Sacro-uterine).
  8. The intersection of the ligaments of the cervix.
  9. Resection of the cervix.
  10. Haemostasis of the stump of the vagina.
  11. Periodizacija.

Surgical access

The Operation of Wertheim – extensive intervention requiring good visualization of the surgical field and the possibility of manipulation, is not accompanied by the difficulties or limitations. Therefore, the incision should be adequate. Mini-access and endoscopic surgery in this case do not fit. In matters of treatment of cancer cosmetic result on significance is in last place.

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Normally performed midline longitudinal laparotomy (incision of the anterior abdominal wall at the white line of the abdomen and bypass the navel) or mobile access (transversal laparotomy with incision of the rectus abdominis).

Mobilization of the uterus

With this purpose, cross the round ligament of the uterus, own and suspensory ligament of the ovary and the uterine end of the tube. All of the education needs to be crossed, if possible, in areas devoid of vessels. This will reduce blood loss. The uterus is taken on the clamps and hung to the side.

Wertheim Operation: operation

After crossing the suspensory ligament of the ovary becomes possible salpingo-oophorectomy. Most importantly, to mobilize them - not to damage the ureter. For this operation mandatory palpation of the broad ligament of the uterus. On the back of the sheet is usually easily ureteric fold. This maneuver allows mobilization of the uterus and appendages without damaging the ureter.

After opening the vesico-uterine folds of the bladder the buds are separated from the anterior wall of the cervix. This should be done without deviating from the Central line to reduce the risk of injury to the vascular plexus.

If the bladder is adherent to the uterus adhesion, separation can be challenging. Start the manipulation in this case, from the round ligament and the neck are the areas with the highest mobility, separating the bubble with scissors.

Next, the operation of Wertheim involves the ligation of vessels. The main vascular bundle of the uterus-the uterine artery and the accompanying vein, running along the edge of the uterus. Ligation is at the level of the internal OS.

For additional mobilization of the uterus is performed the dissection predposylki fascia and the displacement of the blunt tissue from the anterior surface of the cervix down. Next, cross the cords that were previously inaccessible to manipulation: the Sacro-uterine ligaments and cervix. After hysterectomy this goes to the final stage.

The Actual hysterectomy, hemostasis and periodizacija

The Vaginal vault is opened, the cervix is taken on the clamps and gradually cut off from the vagina. After this run the hemostasis and peritonization. The stump of the vagina cannot be closed tightly, it can serve as a natural drainage in case of any pathological processes in the pelvic cavity and there is accumulation of pus or blood.

complications after the operation of Wertheim

The Vaginal tube is treated in a special way. The walls of the vaginasew with vesico-uterine and recto-uterine folds, and the Sacro-uterine ligaments, thus achieving hemostasis and peritonization.

Postoperative period

How the patient feels after the operation of Wertheim? Such radical surgery may not pass completely unnoticed. Without a doubt, it affects the health, both physical and mental.

That entails the operation of Wertheim? The consequences of this method of treatment can be divided into early and late.

Complications in the early postoperative period

The Postoperative period can be complicated:

  1. Infection of the joints (not only skin but also internal).
  2. Peritonitis and sepsis.
  3. Bleeding from the seams, including the inside.
  4. The Hematoma region of the seam.
  5. Dysuria.
  6. Pulmonary embolism (pulmonary embolism).

Even the strictest sterility is not always possible to avoid purulent complications. This is because the surgery is performed on patients whose organism is so weakened by the fight cancer, the immune system is down. So the inflammation of joints from them – is possible. To prevent this condition in the postoperative period, the mandatory course of antibiotics.

Wertheim Operation: the consequences

Bleeding and the appearance of hematomas is evidence of insufficient hemostasis. The appointment of hemostatic drugs is not always enough, sometimes requires repeated surgical intervention – audit the wound and sewing of bleeding vessels.

Dysuria-frequent and painful urination. The appearance of this symptom may damage the mucosa of the urethra by the catheter and the occurrence of traumatic urethritis.

Pulmonary embolism may occur as a complication of thrombosis of the lower extremities. Therefore, in the postoperative period are assigned to anticoagulation ("Heparin") and we recommend wearing compression stockings or elastic bandages.

Effects late period

There are certain complications after the operation of Wertheim, developing in the late period:

  1. Emotional problems: fear of possible changes of appearance and loss of libido (after all, the ovaries are removed, and thus, the level of sex hormones changed), frustration about the inability to get pregnant, ugly scar on the anterior abdominal wall.
  2. Adhesions of the abdominal cavity.
  3. Menopause.
  4. Prolapse.
  5. Education retroperitoneal lymphocyst.

The experience of women regarding the consequences of hysterectomy is quite understandable. Therefore, in the postoperative period is very important the support and understanding of loved ones.

With some complications (postoperative scar, the inability to have children) have to live with. Other fears can and must be fought, as they often unfounded. Removal of the ovaries does not entail any dramatic changes in appearance or sexual sphere. However, you may experience discomfort during intercourse if after hysteretomy left too short a stump of the vagina.

Adhesions after the operation of Wertheim are formed the same as after any abdominal surgery. This is due to the traumatization of the peritoneum during the operation, leading to the formation of connective tissue strands between leaves and internal organs.

Adhesions in abdomen may cause abdominal pain, disorders of urination and defecation, and in some cases even lead to intestinal obstruction. To prevent formation of adhesions in the postoperative period is an important early activation of the patient and conduct physical therapy in the first days after surgery.

After the operation of Wertheim

Menopause after hysterectomy occurs because of the removal of the ovaries. Postoperative menopause, is transferred heavier than natural, because in this case, hormonal changes occur dramatically. To reduce discomfort, apply hormone replacement therapy.

A vaginal prolapse after the operation of Wertheim becomes possible because of a ligament (a necessary condition to perform a hysterectomy) and displacement of the pelvic organs in place of the absent uterus. To prevent such complications, the patient is recommended to perform special exercises, wearing a brace, limit your physical activity for at least 2 months after the operation.

Often in the retroperitoneal space is formed lymphocyst after the operation of Wertheim. Treatment her surgical. However, it is much better to prevent this complication at the stage of the operation than to cure. With this purpose, there are different methods of drainage of the retroperitoneal space.

What they say about the operation of Wertheim

Radical deliverance from cancer of the cervix or uterine body to apply the operation of Wertheim. The reviews about it.

Operation Wertheim: reviews

Doctors and patients have noted the positive aspects after the operation:

  1. Increased life expectancy.
  2. Guaranteed absence of diseases of the uterus, including cancer.
  3. Contraception, not allowing even a small probability of unwanted pregnancy.
  4. Operation does not reduce efficiency, it is possibleto return to normal life.

Cons operations:

  1. Inability to have children.
  2. An Ugly scar on the anterior abdominal wall.
  3. The Possibility of complications, both early and remote (described above).

To Summarize

Hysterectomy by Wertheim – effective radical treatment of malignant tumors of cervix and uterus. This operation is not only able to rid the patient of cancer, but in some way enhances the quality of life.

Of Course, like any surgery, hysterectomy can lead to the development of complications. However, if the competent organization of the postoperative period and maintenance of the necessary preventive measures to avoid them.


Article in other languages:

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BE: https://tostpost.com/be/zdaro-e/2482-aperacyya-vertgeyma-hod-aperacy-nastupstvy-skladnenn-vodguk.html

DE: https://tostpost.com/de/gesundheit/2480-operation-vertgeyma-ablauf-der-operation-folgen-komplikationen-erfahru.html

ES: https://tostpost.com/es/la-salud/2485-la-operaci-n-de-vertgeyma-curso-de-las-operaciones-las-consecuencias-l.html

HI: https://tostpost.com/hi/health/1444-wertheim.html

JA: https://tostpost.com/ja/health/1443-the-operation-of-wertheim-the-course-of-the-operation-consequences-com.html

KK: https://tostpost.com/kk/densauly/2483-operaciya-vertgeyma-barysy-operaciyalar-saldary-as-ynulary-p-k-rler.html

PL: https://tostpost.com/pl/zdrowie/2486-operacja-vertgeyma-przebieg-operacji-konsekwencje-powik-ania-opinie.html

PT: https://tostpost.com/pt/sa-de/2483-a-opera-o-vertgeyma-o-andamento-da-opera-o-as-conseq-ncias-as-complica.html

TR: https://tostpost.com/tr/sa-l-k/2488-operasyon-vertgeyma-cerrahi-kursu-sonu-lar-komplikasyonlar-yorumlar.html

UK: https://tostpost.com/uk/zdorov-ya/2485-operac-ya-vertgeyma-h-d-operac-nasl-dki-uskladnennya-v-dguki.html

ZH: https://tostpost.com/zh/health/1539-wertheim.html






Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."

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