Siempre nos preguntan los pacientes… Creen los pacientes que si toman Esmya, si se colocan el Mirena si toman acetato de medroxiprogesterona, si se inyectan Depo Provera, si toman Gonapeptyl Depot, o sea las hormonas, automáticamente además de que van a dejar de sangrar entonces ese mioma va a tender a disminuir o incluso desaparecer… El problema principal es que muchas veces no les explican. Cuando son tumores, ya lo hemos dicho en algunos videos, mayores de 6 cm, sí va a disminuir el tamaño de los miomas por un factor hormonal y entonces puede disminuir entre un 30% hasta un 40% su tamaño ¡Pero no va a desaparecer! Y el problema principal es: No puedes dar una terapia más de 6 meses principalmente y al terminar esa terapia hay una especie como de “rebote” decimos nosotros, porque ya empieza a ver otra vez producción estrogénica y empieza a crecer el tumor. Pero ya cuando empieza a crecer es cuando empieza a haber más problemas de degeneración, más vascularidad y entonces son miomas que son más difíciles de resecar y con más pronóstico de sangrados.

El día de ayer hicimos 2 cirugías muy parecidas entre sí, nada más que se las queremos mostrar porque una de ellas tomó Esmya, medicamento para disminuir los sangrados y los tumores, y otra no lo tomó. Entonces para que vean en la cirugía la dificultad a veces de la resección de los miomas cuando han tomado un medicamento llámese el Esmya o llámese Gonapeptyl Depot o cualquier medicamento que trate de disminuir los sangrados, inclusive las que se hacen embolización por ahí tengo una cirugía que después voy a subir. Lo más importante aquí es que recuerden: #SaberEsPoder.

I’m going to tell you, the first patient came from Chiapas at 33 years old, she has not had pregnancies and she only had the single subserous fibroid, anterior face, which we showed in the video, but the particularity was that she took the Esmya. So you can see in surgery how the resection is a little more difficult because the structure between the capsule and the muscle is lost, an adhesion becomes like fibrosis and then these are patients whose resection is more difficult and sometimes they bleed a little more.

She also had mild anemia and we had to transfuse her with a transoperative package, that is, during surgery to prevent her from decompensating once she was bleeding. Fortunately everything went well, the uterus was preserved, the ovaries and tubes can be seen very well there.

See we’re done, right ovary, right tube, how beautiful, the round ligament, left ovary, left tube, how beautiful, round ligament. I’m going to put it in so you can see, this is the entire uterine fundus, the posterior aspect and this would be the anterior aspect and here is the bladder. So that’s the little tumor that was removed.

The important thing here, before injecting any medication or substance, come with a second opinion or call Creafam and we can see you via Zoom and the second very important thing that catches my attention: The patient believes that when you remove the fibroids they are gone. to stop bleeding… No, remember that menstrual bleeding is normal from the moment menarche begins, that is, the first menstrual cycles, the woman will not stop until menopause comes. If it is true that patients with fibroids and bleeding, many times the medication can reduce and fix the bleeding and anemia a little.

What surgery will correct are bleeding and therefore also the subsequent anemia, that is, they recover very quickly, if it is a moderate or even severe anemia, they will reach adequate hemoglobin levels but we will not eliminate the bleeding, that is , she has to have menstrual cycles sometimes sometimes it is much smaller than the ones she had before when she had fibroids.

And the second patient, who is also very similar in size and location, also has a subserous fibroid, but this patient had a degenerated, non-solid cystic fibroid and also had a teratoma in the left ovary. At 26 years old, much younger, but the peculiarity of her is that I had to do tumor markers because the lesion had a 35% probability of being malignant.

In these patients specifically what we do is: We first remove the tumor, we send it to an intraoperative procedure to find out if it is a benign or malignant lesion, which fortunately was benign, it was a teratoma and then we focus on removing the fibroid.

Now we are infiltrating the fibroid with vasopressin, we have already removed the ovarian tumor, the left ovarian tumor. There was a little bit of stroma left but we are going to do an intraoperative procedure, she is very young and while we operate on the fibroid, although it is a little complicated because apparently it involves too much of the uterine muscle.

– There it is, there.

-Where you put your finger it came out perfect.

– Oh, yes Doctor, good afternoon, to report: It is a mature cystic teratoma, measuring 9 x 7.5, we have no data on malignancy. Oh and 2 endometriotic cysts!

– Yes, tell me, thank you very much doctor.

– Yes doctor, be very well.

The most important thing, for patients with ovarian cysts plus fibroids, is to always come in with all the studies such as: An MRI, tumor markers and also preferably do an intraoperative procedure if the tumor is larger than 6 or 7 cm, preferably even if they are young. . And on the other hand, the most important thing is to preserve fertility because neither of them has had pregnancies. Fortunately, since they are subserosal, the cavity is completely free and surely after 6 months they will be able to look for a pregnancy.

For more information you can visit creafam.com/cysts where we have talked about benign ovarian tumors, the characteristics, classifications of tumors and how to have surgery and, above all, save the ovary. On this occasion, in this patient we resected almost 80% because it practically covered the vast majority of the ovary but we left 20% of that ovary, as you can see in the video and part of that percentage that was left was stroma.

The ovary is divided into two parts: The cortex and the stroma, the stroma is like the nucleus and the cortex is like the periphery or capsule. So, the stroma is where the primordial follicles begin to develop, it means that this patient, that ovary is still going to be functional, obviously we have to evaluate later if the tubes can achieve a pregnancy or not but in the end we managed to rescue the 20 % of that ovary and the other ovary is completely healthy. We must remember that the ovary, when we have both, then month after month one side works, another side normally, but the moment they remove one ovary, the other ovary will mean that your cycles will be monthly, that is, That ovary is going to work double and then every cycle there will be an egg, every cycle there is a possibility of pregnancy and every cycle there will be menstrual cycles by having a folliculometry or a growing follicle and ovulation.

Esta pacientita ya se fue el día de ayer, tiene 26 añitos es muy joven todavía, pero yo les di la alta y les recomendé, primero: Al ser un tumor tan grande como lo ven en el video está muy cerca de los cuernos uterinos y de las trompas de falopio, entonces seguramente ella va a ser candidata a una fecundación in vitro tanto por un factor de que solo tiene un pedazo del ovario izquierdo y porque la trompa derecha, seguramente con las cicatrización de los puntos hemostáticos no va a estar permeable, sin embargo hay que estudiarla.

Pero si necesita una In Vitro puede visitar creafam.com/fertilizacion-in-vitro donde hablamos de fecundación In Vitro, de las técnicas y de algunas cuestiones de Inteligencia artificial que estamos utilizando al día de hoy. Vengan con nosotros, también nosotros nuestro fuerte o nuestra especialidad es hacer tratamientos de reproducción asistida, llámese de baja complejidad como la inseminación o técnicas de alta complejidad como la fecundación in vitro. ¿Para qué? Para hacer un sueño cumplido.