Adenomyosis Treatment in Delhi

Indications

Surgical intervention for adenomyosis is considered in the following situations:

• Severe Symptoms: Persistent heavy menstrual bleeding, pelvic pain, and discomfort that significantly impacts quality of life.
• Failed Conservative Treatment: Symptoms that do not respond adequately to medications or hormonal therapies.
• Desire to Preserve Fertility: For women who wish to maintain their ability to conceive.

Types of Surgical Procedures for Adenomyosis

1. Hysterectomy
   • Procedure: Hysterectomy involves the surgical removal of the uterus, which eliminates adenomyosis. Depending on the extent of the condition and patient preferences, it may also involve removal of the cervix (total hysterectomy) or ovaries (total hysterectomy with bilateral salpingo-oophorectomy).
   • Indications: Hysterectomy is considered the definitive treatment for adenomyosis and is recommended for women who have completed childbearing or do not desire future pregnancies.
2. Conservative Surgery
   • Procedure: Conservative surgical approaches aim to remove or reduce adenomyosis while preserving the uterus. These procedures include:
     • Adenomyomectomy: Surgical removal of adenomyotic tissue from within the uterine muscle. This approach is more challenging than traditional myomectomy due to the diffuse nature of adenomyosis.
     • Endometrial Ablation: A procedure that destroys the lining of the uterus (endometrium), which may alleviate symptoms of adenomyosis such as heavy bleeding. It is less commonly used for adenomyosis compared to fibroids.
     • Uterine Artery Embolization (UAE): Minimally invasive procedure where small particles are injected into the uterine arteries to block blood flow to adenomyosis, causing it to shrink and alleviate symptoms.

Procedure Steps

1. Preoperative Preparation
   • Evaluation: Comprehensive medical evaluation, imaging studies (e.g., ultrasound, MRI) to assess the extent and location of adenomyosis.
   • Discussion: Detailed discussion with the healthcare provider regarding surgical options, risks, benefits, and expected outcomes.
   • Anesthesia: General anesthesia is typically used for hysterectomy and some adenomyomectomy procedures. Local or regional anesthesia may be used for less invasive procedures.
2. Surgical Procedure
   • Incision: Depending on the type of surgery, an incision is made in the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or through small incisions in the abdomen (laparoscopic or robotic-assisted hysterectomy).
   • Tissue Removal or Ablation: Removal of the uterus (hysterectomy), removal of adenomyotic tissue (adenomyomectomy), or destruction of the uterine lining (endometrial ablation).
   • Closure: Incisions are closed with sutures or staples, and dressings are applied as needed.
3. Postoperative Care
   • Pain Management: Pain relief medications are administered to manage discomfort.
   • Hospital Stay: The length of hospitalization varies depending on the type of surgery and individual recovery.
   • Recovery: Instructions on wound care, activity restrictions, and follow-up appointments are provided.
   • Monitoring: Regular follow-up visits to monitor healing, manage any complications, and assess symptoms.

Risks and Complications

• Infection: Risk of infection at the surgical site.
• Bleeding: Postoperative bleeding or hematoma formation.
• Adverse Anesthesia Reactions: Potential reactions to anesthesia medications.
• Damage to Nearby Organs: Rare risk of injury to nearby organs or structures during surgery.
• Blood Clots: Risk of deep vein thrombosis (DVT) or pulmonary embolism (PE), especially after abdominal surgeries.

Recovery and Outlook

• Immediate Recovery: Patients typically experience some discomfort and may need pain relief medications. Recovery time varies depending on the type of surgery performed.
• Long-Term Outlook: Most women experience relief from symptoms after surgery. Hysterectomy provides a definitive cure for adenomyosis, while conservative surgical approaches aim to alleviate symptoms while preserving fertility.

Conclusion

Surgical treatment for adenomyosis should be carefully considered in consultation with a healthcare provider, weighing the benefits, risks, and individual circumstances. Advances in surgical techniques, including minimally invasive approaches, have improved recovery times and outcomes for many women undergoing surgery for adenomyosis. Regular follow-up care is essential to monitor healing and ensure optimal postoperative recovery and symptom management.