> LIGATURE OF THE FALLOPIAN TUBES
The ligature of the fallopian tubes, also known as tubal ligation, is a surgical procedure used to close the fallopian tubes. These tubes connect the ovaries to the uterus. A woman who has undergone this procedure is unable to become pregnant naturally.
Reasons for undergoing a tubal ligation
- In cases where adult women do not wish to have future pregnancies
- In order to reduce the risk of going on to develop ovarian cancer
The tubal ligation procedure
The surgeon makes small incisions in the abdomen through which a probe is introduced with a camera as well as the instruments required to carry out the internal surgery.
The stomach is inflated with gas, in order that the surgeon can clearly see the uterus and the fallopian tubes.
The tubes are then blocked using various techniques: cortarisation or by sealing them with a small clip or band.
Type of surgery and anesthesia
This is a minimally invasive surgery (laparoscopic). It lasts approx 30 minutes.
The procedure is carried out using general anesthesia.
The patient normally remains in hospital for 24 hours.
The recuperation is fast, but it is recommended that the patient does not lift heavy objects for 3 weeks.
After one month an ultrasound examination is carried out in order to verify that the tubes are blocked. During this period it is advisable to use some form of contraception.
The ligature of the fallopian tubes is not a reversible procedure.
In some specific cases a major surgery, called recanalisation, can restore the capacity to become pregnant.
However an hysteroscopic tubal occlusion is very difficult to reverse.
Therefore it is posible to freeze the ovum prior to sterilisation as a method of preserving fertility.
IVF is an alternative to recanalisation.
> HYSTERECTOMY: REMOVAL OF THE UTERUS (PARTIAL HYSTERECTOMY – TOTAL HYSTERECTOMY)
Reasons for undergoing an hysterectomy:
- Cancer of the uterus, cervix cancer of the uterus, cancer of the ovaries
- Uterine fibroids: fibroids
- Uterine prolapse
Depending on the individual case, a hysterectomy may include the removal of various organs of reproductive organs:
- The total hysterectomy – removal of the uterus and the cervix
- The subtotal hysterectomy – uterus removal
- The radical hysterectomy – removal of the uterus and the lymphatic ganglions
- The hysterectomy with adnexectomy : removal of the uterus, the ovaries and fallopian tubes
There are various techniques for removing the uterus:
- Abdominal incision:
An incision in the abdominal wall is performed either horizontally or vertically (depending on the case), to remove the uterus.
- Vaginal surgery:
The uterus is removed through the vagina. This technique can be performed by laparoscopy, and just with small abdominal incisions.
Type of surgery and anesthesia:
Depending on the type of surgery, the characteristics of the pathology, and the individual, this intervention can be performed with general or locoregional anesthesia
- In the case of the of abdominal hysterectomy, surgery usually lasts for approx. 1 hour and the patient remains in hospital for 4 to 7 days
- In the event of vaginal or laparoscopic hysterectomy, the patient remains in hospital for 2 to 4 days.
Post-operative care after a hysterectomy:
Visit to the doctor is recommended 1 month after the surgery.
> HYMENOPLASTY – RECONSTRUCTION OF THE HYMEN
Procedures for a hymenoplasty
There exist various techniques for reconstructing the hymen:
- A technique which joins the remainder of the hymen to the vagina:(#0190A.1)
This is the easiest technique, but does not result in the most secure reconstruction.
Ideally it is recommended that this is carried out between 3 days -1 week prior to the wedding.
- The Alloplant technique:
Alloplant is a biological material. This membrane is implanted at the entrance to the vagina, as if it were the hymen.
As with the stitching of the hymen, this can be carried out shortly before the wedding night.
- A more complicated technique is vaginal plastic surgery.
This consists of taking a small portion of the vaginal mucosal tissue and stiching it. The surgeon makes an incision in both sides of the vaginal tissue and joins it together.
In this case it is recommended that the surgery is carried out a month prior to the wedding night. This will allow sufficient time for the wounds to heal.
A full study of the patient will indicate which method is best suited to their requirements.
Type of surgery and anesthesia
These are generally short, straight forward surgeries which can be carried out under local anesthesia.
Patients do not require hospitalisation following these procedures.
The stitches are dissolvable.
It is recommended that patients have a check-up 15 days after the procedure.