Oophorectomy (from the Greek ??????? , > ophÃÆ'³ros , 'egg-bearing' ?????? , ektom? , 'a cutting out of') is the surgical removal of the ovaries or ovaries. Surgery is also called ovariectomy , but the term is widely used in reference to animals, eg. surgical removal of the ovaries from laboratory animals. The removal of a woman's ovaries is the biological equivalent of male castration; the term castration is only occasionally used in medical literature to refer to female oophorectomy. In veterinary medicine, the removal of the ovaries and uterus is called ovariohysterectomy (spay) and is a form of sterilization.
Partial oophorectomy or ovariotomy is a term sometimes used to describe surgeries such as removal of ovarian cysts, or ovarian resection. This kind of surgery is the maintenance of fertility, although ovarian failure may be relatively frequent. Most long-term risks and consequences of oophorectomy are not or only partially present with partial oophorectomy.
In humans, oophorectomy is most often performed due to diseases such as ovarian cysts or cancer; as prophylaxis to reduce the likelihood of ovarian cancer or breast cancer; or along with a hysterectomy (removal of the uterus).
The removal of the ovaries together with Fallopian tubes is called salpingo-oophorectomy or unilateral salpingo-oophorectomy ( USO ). When both ovaries and both Fallopian channels are removed, the term bilateral salpingo-oophorectomy ( BSO ) is used. Oophorectomy and salpingo-oophorectomy are not the most common forms of birth control in humans; more common is tubal ligation, where the Fallopian tubes are blocked but the ovaries remain intact. In many cases, surgical removal of the ovaries is performed simultaneously with a hysterectomy. The official medical name for removal of the entire female reproductive system (ovaries, Fallopian tubes, uterus) is "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (TAH-BSO); a more relaxed term for such an operation is "ovariohysterectomy". "Hysterectomy" is the removal of the uterus (from the Greek ?????? hystera "uterus" and "ektomia" cut "without cutting the ovaries or the oviduct.
Video Oophorectomy
Technique
Oophorectomy for benign causes is most commonly done with abdominal laparoscopy. Abdominal or robotic surgical laparotomies are used in complex cases or when malignancy is suspected.
Maps Oophorectomy
Statistics
According to the Centers for Disease Control, 454,000 women in the United States underwent oophorectomy in 2004. The first successful operation of this type, the account published in Eclectic Repertory and Analytic Review (Philadelphia) in 1817, was conducted by Ephraim McDowell (1771-1830), a surgeon from Danville, Kentucky. McDowell was dubbed the "father of ovariotomy". This came to be known as Operation Battey, after Robert Battey, a surgeon from Augusta, Georgia, who championed the procedure for various conditions, most successfully for ovarian epilepsy.
Indication
Most bilateral oophorectomies (63%) were performed without medical indication, most (87%) performed together with hysterectomy. In contrast, unilateral oophorectomy is generally performed for medical indications (73%, cysts, endometriosis, benign tumors, inflammation, etc.) and less frequently with hysterectomy (61%).
Specific indications include some groups of women with an increased risk of ovarian cancer, such as BRCA carriers of high-risk and women with endometriosis who also often suffer from ovarian cysts.
Bilateral oophorectomy has traditionally been done with the belief that the benefits of preventing ovarian cancer will outweigh the risks associated with removal of the ovaries. However, it is now clear that prophylactic oophorectomy without reasonable medical indications lowers long-term survival rates substantially and has a long-term effect on damaging health and well-being even in post-menopausal women. This procedure has been postulated as a possible treatment method for female sex offenders.
Cancer prevention
Oophorectomy can significantly improve survival for women with high-risk BRCA mutations, for whom prophylactic oophorectomy around age 40 reduces the risk of ovarian and breast cancer and provides significant and substantial long-term survival benefits. On average, previous interventions do not provide additional benefits but increase risk and side effects.
For women with a high-risk BRCA2 mutation, oophorectomy around the age of 40 years has relatively modest benefits for survival; the positive effects of reduced risk of breast and ovarian cancer are almost balanced with side effects. The survival advantage is greater when oophorectomy is performed together with a prophylactic mastectomy.
It is important to understand that the risks and benefits associated with oophorectomy in BRCA1/2 mutation carriers differ from that of the general population. Prophylactic salpingo-oophorectomy prophylaxis (RRSO) is an important choice for high-risk populations to consider. Women with BRCA1/2 mutations undergoing salpingo-oophorectomy have lower rates of all-cause mortality than women in the same population who did not undergo this procedure. In addition, RRSO has been shown to decrease mortality rates specifically for breast cancer and ovarian cancer. Women who underwent RRSO were also at lower risk for developing ovarian cancer and first-time breast cancer. Specifically, RRSO provides BRCA1 mutant carriers without breast cancer before 70% decreased risk of ovarian cancer. BRCA1 mutation carriers with previous breast cancer can benefit from an 85% reduction. High-risk women who did not have breast cancer previously could benefit from 37% (BRCA1 mutation) and 64% (BRCA2 mutation) breast cancer risk reduction. This benefit is important to highlight, as it is unique to this BRCA1/2 mutation carrier population.
Endometriosis
In rare cases, oophorectomy can be used to treat endometriosis by eliminating the menstrual cycle, which will reduce or eliminate the spread of existing endometriosis and reduce pain. Because endometriosis occurs due to overgrowth of the uterine lining, removal of the ovaries as a treatment for endometriosis is often performed simultaneously with hysterectomy to reduce or eliminate further recurrence.
Oophorectomy for endometriosis is only used as a last resort, often in conjunction with hysterectomy, as it has severe adverse effects for women of reproductive age and low success rates.
Partial oophorectomy (ie, removal of ovarian cysts involving total oophorectomy) is often used to treat mild cases of endometriosis when non-surgical hormone treatments fail to stop cyst formation. Removal of ovarian cysts through partial oophorectomy is also used to treat extreme pelvic pain due to chronic hormonal-related pelvic problems.
Risk and adverse effects
Surgical risks
Oophorectomy is an intraabdominal surgery and serious complications originating directly from surgery are rare. When performed together with hysterectomy, it has an influence on the choice of surgical techniques because joint surgery is much more likely to be performed by vaginal hysterectomy.
Laparotomic adnexal surgery is associated with a high level of adhesive small bowel obstruction (24%).
A rare complication is to injure the ureter at the level of the ovarian suspensory ligaments.
Long-term effects
Oophorectomy has serious long-term consequences that are largely derived from the hormonal effects of surgery and extend far beyond the menopause. Reported risks and side effects include premature death, cardiovascular disease, cognitive or dementia disorders, parkinsonism, osteoporosis and fractures, decreased psychological well-being, and decreased sexual function. Hormone replacement therapy does not always reduce adverse effects.
Mortality
Oophorectomy is associated with significant long-term mortality, unless it is used for cancer prevention in high-risk BRCA carriers. This effect is particularly pronounced for women undergoing oophorectomy before the age of 45 years.
The effect is not limited to women who have oophorectomy performed before menopause; the impact on survival is expected even for surgery done until the age of 65 years. Surgery at age 50-54 reduces the likelihood of survival until the age of 80 to 8% (from 62% to 54% survive), surgery at age 55-59 by 4%. Most of these effects are due to excessive cardiovascular risk and hip fractures.
The removal of the ovaries causes similar hormonal and symptomatic changes, but is generally more severe than, menopause. Women who already have oophorectomy are usually encouraged to take hormone replacement drugs to prevent other conditions often associated with menopause. Women younger than 45 who have their ovaries removed face a 170% higher risk of death than women who retain their ovaries. Maintaining an ovary when a hysterectomy is performed is associated with better long-term survival. Hormone therapy for women with oophorectomy performed before age 45 improves long-term outcomes and all causes of mortality.
Menopause effects
Women who have undergone bilateral oophorectomy surgery lose most of their ability to produce estrogen and progesterone hormones, and lose about half of their ability to produce testosterone, and then enter what is known as "surgical menopause" (compared with normal menopause, which occurs in natural in women as part of the aging process). In natural menopause the ovaries generally continue to produce low levels of hormones, especially androgens, shortly after menopause, which may explain why surgical menopause is generally accompanied by a more sudden and heavier onset of symptoms than natural menopause, a symptom that may continue until the age of menopause. These symptoms are usually treated through hormone therapy, utilizing various forms of estrogen, testosterone, progesterone, or a combination.
Cardiovascular Risk
When the ovaries are removed, a woman is at a seven times greater risk of cardiovascular disease, but the mechanism is not known for certain. The production of ovarian hormones is not currently adequately copied by drug therapy. The ovaries produce hormones that women need throughout their lives, in required amounts, when needed, in response to and as part of a complex endocrine system.
Osteoporosis
Oophorectomy is associated with an increased risk of osteoporosis and fractures. The potential risk for oophorectomy performed after menopause is not fully explained. Reduced testosterone levels in women are predictive of height loss, which may occur as a result of reduced bone density. In women under the age of 50 who have undergone oophorectomy, hormone replacement therapy (HRT) is often used to offset the negative effects of sudden hormone loss such as early onset osteoporosis as well as menopausal problems such as hot flushes that are usually more severe than those experienced by women experiencing natural menopause.
Adverse effects on sexuality
Oophorectomy substantially damages sexuality. Substantially more women with both oophorectomy and hysterectomy reported loss of libido, difficulty with sexual arousal, and vaginal dryness than those who had less invasive procedures (either hysterectomy alone or alternative procedures), and hormone replacement therapy was not found to improve the symptoms. these symptoms. In addition, oophorectomy greatly reduces testosterone levels, which are associated with greater sexual desire in women. However, at least one study has shown that psychological factors, such as relationship satisfaction, are still the best predictors of sexual activity after oophorectomy. Sexual intercourse is possible after oophorectomy and coitus may continue. Reconstructive surgery remains an option for women who have experienced benign and malignant conditions.
Managing the side effects of prophylactic oophorectomy
Non-hormonal treatments
Side effects of oophorectomy can be relieved by drugs other than hormone replacement. Non-hormonal bisphosphonates (such as Fosamax and Actonel) increase bone strength and are available as pills once a week. Selective low dose serotonin reuptake inhibitors such as Paxil and Prozac reduce the symptoms of vasomotor menopause, that is, "hot flashes".
Hormonal treatments
In general, hormone replacement therapy is somewhat controversial because of the known carcinogenic and thrombogenic properties of estrogen; However, many physicians and patients feel the benefits outweigh the risks to women who may face serious health problems and quality of life as a consequence of early surgical menopause. Estrogen, progesterone, and testosterone ovarian hormones are involved in the regulation of hundreds of body functions; It is believed by some doctors that hormone therapy programs reduce the side effects of surgical menopause such as increased risk of cardiovascular disease, and female sexual dysfunction.
Short-term hormone replacement with estrogen has a negligible effect on overall mortality for high-risk BRCA carriers. Based on computer simulations, the overall mortality rate appears to be slightly higher for short-term HRT after oophorectomy or slightly lower for short-term HRT after oophorectomy in combination with mastectomy. These results may be generalizable to other women at high risk for whom short-term treatment (ie one or two years) with estrogen for acceptable hot flashes.
- Glossary
See also
- Ovarian cyst
- Tubal ligation
- Birth control
- Hysterectomy
- Hormone replacement therapy (menopause)
- Orchiectomy (removal of the testis)
- Estrogen deprivation therapy
- List of operations by type
References
External links
- List of available hormon replacements currently available in the US
- List of currently available hormonal changes in the UK
- MedlinePlus Encyclopedia Hysterectomy
- Survivor's Guide to Menopause Surgery: Gathering information about managing post-surgical menopause conditions
- Encyclopedia of Surgery Articles on Hysterectomy
Source of the article : Wikipedia
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