Adnexectomy (removal of the uterine appendages)

Neoplasms and severe diseases of the uterine adnexa sometimes require not only medical treatment but also surgery. In such situations, one of the possible methods of surgical treatment is adnexectomy — an operation to remove the ovary and fallopian tube on one or both sides. Although for most women the prospect of such an intervention causes anxiety, modern surgical techniques make it possible to perform the operation as safely as possible and shorten the recovery period.

At the «Oxford Medical» medical center, operations on the adnexa are performed by experienced gynecological surgeons using modern equipment. Whenever possible, preference is given to minimally invasive methods that help reduce the traumatic nature of the intervention and accelerate rehabilitation. If surgery has been recommended to you or it is necessary to determine the optimal treatment strategy, you can make an appointment for a gynecologist consultation by calling the contact center or through the online appointment form on the website.

The following types of adnexectomy are distinguished:

• unilateral — the ovary and fallopian tube are removed on the right or left side;

• bilateral — the ovaries and fallopian tubes are removed on both sides.

In some cases, adnexectomy is performed simultaneously with removal of the uterus, for example, in cases of widespread malignant neoplasms or other complex diseases.

According to the method of surgical access, adnexectomy can be:

• laparoscopic — the operation is performed through several small punctures of the anterior abdominal wall using a laparoscope and special instruments;

• laparotomic — the intervention is performed through an incision in the anterior abdominal wall if minimally invasive access is impossible or impractical.

Each of these methods has its own indications, so the method of performing the operation is chosen after examining the patient.

Doctors at «Oxford Medical» explain: when planning the operation, surgeons always assess the possibility of preserving the adnexa. If this is safe and does not reduce the effectiveness of treatment, preference is given to organ-preserving intervention. Adnexectomy is recommended only when surgery to remove the adnexa is the most effective and safe method of treatment.

Before elective adnexectomy, the doctor evaluates the examination results and the patient's general health condition to make sure that the operation can be performed safely. If conditions that may increase the risk of complications are identified, surgical intervention is postponed until they are eliminated or the condition is stabilized.

The main contraindications include:

• acute infectious diseases;

• severe blood clotting disorders;

• decompensated diseases of the cardiovascular or respiratory system;

• a severe general condition of the patient in which the risk of the operation exceeds its expected benefit.

Doctors at «Oxford Medical» explain: the listed contraindications primarily apply to elective operations. In emergency conditions, the doctor evaluates the risks individually, since in some situations postponing the operation may be more dangerous than performing it.

Adnexectomy is performed under general anesthesia. The duration of the operation depends on its extent, the chosen surgical access, and the complexity of the clinical case.

The main stages of the operation:

1. Creation of surgical access. During laparoscopic adnexectomy, the surgeon makes several small punctures in the anterior abdominal wall, through which a laparoscope — a thin optical device with a video camera — and special surgical instruments are inserted. The image is displayed on a monitor, which makes it possible to precisely control each stage of the operation. During laparotomic adnexectomy, access to the pelvic organs is provided through an incision in the lower abdomen.

2. Isolation of the adnexa. The doctor sequentially separates the ovary and fallopian tube from the surrounding tissues and closes off the blood vessels to prevent bleeding.

3. Removal of the adnexa. After this, the ovary and fallopian tube are removed. If necessary, the adnexa are removed on both sides.

4. Completion of the operation. The surgeon checks whether there is any bleeding, after which the instruments are removed, the punctures or surgical incision are sutured, and a sterile dressing is applied. During open surgery, if necessary, a drain may be placed to allow fluid to drain from the surgical wound.

In most cases, preference is given to laparoscopic access because it is less traumatic and usually provides faster recovery. At the same time, in cases of large neoplasms, an extensive adhesive process, or other complex clinical situations, laparotomic access may be more appropriate, as it provides a better view and access to the surgical field.

Doctors at «Oxford Medical» explain: the method of performing adnexectomy is determined at the stage of planning the operation. If circumstances arise during laparoscopy that do not make it possible to safely complete the intervention through small punctures, the surgeon may switch to open surgery. Such a decision is made only when it is necessary for the patient's safety.

After the operation, the patient stays in the hospital for some time. After laparoscopic adnexectomy, discharge is most often possible after 1–2 days, while after laparotomic surgery, hospitalization usually lasts 3–5 days.

Already on the first day after the intervention, if her condition allows, the doctor recommends gradually restoring physical activity. Early getting up and short walks contribute to faster recovery and help reduce the risk of some postoperative complications.

After discharge, it is important to follow the doctor's recommendations. It is usually recommended to:

• regularly take the prescribed medications;

• gradually increase physical activity while avoiding significant physical exertion;

• not lift objects weighing more than 5 kg for 4–6 weeks;

• refrain from sexual intercourse until the follow-up examination by a gynecologist;

• not take a bath or visit a swimming pool or sauna until the postoperative wounds have completely healed.

According to Royal College of Obstetricians and Gynaecologists, after laparoscopic gynecological operations, most women return to their usual way of life in approximately 2–3 weeks. After laparotomic surgery, the recovery period usually lasts 4–6 weeks.

After returning home, it is important to carefully monitor your well-being. If the body temperature rises above 38 °C, the pain intensifies, heavy bloody discharge, redness, or discharge from the postoperative wound appears, it is necessary to consult a doctor as soon as possible. Sudden chest pain, shortness of breath, or severe swelling of one leg also require immediate medical attention.

Like any surgical intervention, adnexectomy is associated with a risk of developing complications. These include:

• bleeding;

• infection of the postoperative wound;

• damage to neighboring organs;

• formation of blood clots;

• adhesions in the pelvis.

Most complications occur rarely, and their risk can be reduced through careful preparation for the operation, modern surgical techniques, and compliance with the doctor's recommendations in the postoperative period.

The consequences of removing the ovary and tube may differ depending on whether the adnexa were removed on one or both sides. After removal of the ovary and fallopian tube on one side, the second ovary usually continues to produce sex hormones and egg cells. In most women, the menstrual cycle is preserved, and the possibility of becoming pregnant remains.

After removal of the ovaries and tubes on both sides, natural pregnancy becomes impossible. Due to a sharp decrease in estrogen levels, surgical menopause develops, which may be accompanied by:

• hot flashes;

• night sweats;

• dryness of the vaginal mucosa;

• sleep disturbances;

• mood changes.

Doctors at «Oxford Medical» explain: if symptoms of surgical menopause appear after bilateral adnexectomy, you should not postpone a consultation with a gynecologist. In the absence of contraindications, the doctor may recommend treatment that will help alleviate these manifestations and improve quality of life.

The medical center «Oxford Medical» has a high-tech surgery department equipped with the latest expert-class equipment. It makes it possible to successfully perform minimally invasive and open operations of any complexity. Thanks to this, as well as the involvement of a team of surgeons who have many years of experience and are experts in their fields, patients can be confident in the effectiveness and safety of surgical treatment.

The price of adnexectomy at the «Oxford Medical» clinic may vary depending on the type of operation, the complexity of the case, and the need for additional procedures. You can find out in advance what the adnexectomy price is here. The doctor will advise you more precisely on this issue during the preliminary consultation. Make an appointment at a time convenient for you by phone or fill out an application on the website.