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Multiple fibroid's in uterus, cysts in ovaries. CT, MRI done. Wants to do LAVH for removing ovary, cysts. Should I remove my uterus also?

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hi. I am getting one ovary and complex cyst removed through LAVH. Uterus also has multiple fibroids in the fundal region. I am 46 years old. Is a hysterectomy a good idea due to multiple fibroid issue? since LAVH is being performed anyway for removing ovary and cyst? what are after effects of hysterectomy, esp if one ovary is left in? thanks. should I only remove the ovary/cyst and keep the uterus for now? knowing that some treatment is needed in future for fibroids? what are the negative effects of removing a uterus at this age? MRI and ct scan showed multiple fibroids; and haemorrhaging endometreotic cyst in left ovary. CA-125 result was 140. but other two tumor markers CEA and AFP were within acceptable ranges. no evidence of pelvic lymphadenopathy. right ovary is normal in size.
my question is regarding the uterus removal. whether it is a good strategy along with cyst/ovary removal. thanks.
Posted Sun, 6 May 2012 in Vaginal and Uterus Health
Answered by Dr. Minoo Bhagia 2 hours later

Thanks for the query

LAVH is ‘laparoscopically assisted vaginal hysterectomy’. In this procedure, the cornual structures and uterines are ligated from abdominal route laproscopically and rest of the procedure is done vaginally.

Since there are multiple fibroids in addition to ovarian cysts, it would be better operation to opt for total laparoscopic hysterectomy (TLH) instead of TAVH. In this procedure, whole procedure is done abdominally except vaginal closure which can be done abdominally or vaginally depending upon surgeon's choice.

The most important function of uterus is limited to fertility. At the age of 46 (when one has completed her family), there are no major after effects of uterus removal. So do not worry about uterus being removed.

However, if I were to be your doctor I would prefer to treat you with “total hysterectomy with bilateral salpingoopherectomy” in view of highly elevated CA125. It would be riskier to leave the ovaries behind though your other tests are normal. The procedure would be followed ‘histopathological study’ of the specimen.

Hope my answer is both useful and informative. Any further query is most welcome.
Please accept my query if you do not have any further queries.

Take care and Best wishes
Above answer was peer-reviewed by
Follow-up: Multiple fibroid's in uterus, cysts in ovaries. CT, MRI done. Wants to do LAVH for removing ovary, cysts. Should I remove my uterus also? 2 hours later
Dear Dr. Bhagia,

Thank you for responding to my query. It is very clearly written and understandable. Here is my follow up question: since all tests are showing the right ovary as normal (ultrasound, MRI and CT scan), would it not be better to leave it in for now? If it lasts a few years, at least the estrogen part is taken care of for the next 3-4 years (until the ovary continues to work and ceases eventually due to lack of target)? I had heard that hormonal balancing is a tough act if both ovaries are removed. Is there a specific reason (future disease?) why you would recommend removing the healthy ovary as well?

2) TLH -- I will ask my doctor about it tomorrow. Is it commonly performed? Are the pieces removed vaginally even if the procedures are done through an abdominal laproscopy? (I am in Bangalore).

Thank you.
Answered by Dr. Minoo Bhagia 11 hours later

Welcome back

It is better if you leave the decision upon your surgeon regarding the removal of ovary

I suggested to remove as you are having raised CA levels , the symptoms of menopause and later on developing a pathology like cancer, requiring another surgery are to be weighed.
Surgeon who is seeing the gross appearance is the best judge

As far as TLH is concerned , uterus and adenexae are removed vaginally when we do anterior colpotomy and push the uterus and other parts in toto through vagina so as to prevent the leakage of the gas and vault can be stiched either abdominally or vaginally depending upon surgeon's skill

I was against LAVH as there will be unnecessary pulling of the tissues as you are having multiple fibroids and if better methods are available why not to go for them, Unnecessary pulling can give rise to vault prolapse later on

It's all surgeon's choice , some are skilled in LAVH , some in NDVH , some in TLH
You can not tell surgeon which method they will be adopting as the end result is same.

Take care , do not take stress , everything will be fine

Any further query is most welcome

Above answer was peer-reviewed by
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