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Polypectomy

Polypectomy is a procedure that removes polyps from the lining of the uterus (endometrium).

The endometrial polyp is removed by hysteroscopic surgery, which is performed under general or local anesthesia. The patient is discharged immediately after the intervention.

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Polyps occur in 6% of premenopausal women and 12% of menopausal women. They are more common in women with infertility.

The decision on hysteroscopy is made after a gynecological and ultrasound examination when an endometrial polyp is diagnosed or suspected.

What are the indications for polyp removal?

Indications for polyp removal are:

-irregular and heavy bleeding;

- repeated spontaneous abortions;

-infertility;

-bleeding in menopause or diagnosed polyp in menopause.

Polypectomy at the Gyn-Fertility Clinic Milenković

Polyp operations are performed using the hysteroscopic method if the polyp is in the uterine cavity or by shaver or by simply “cutting" the polyp with an adequate surgical instrument if the polyp is on the cervix.

Hysteroscopy is performed as day surgery. The patient leaves the office no later than 2 hours after the surgery.

The intervention is performed in the period between 5 and 12 days of the cycle in women in the reproductive period, while in menopausal women it can be done at any time. When the patient is using birth control pills, hysteroscopy can be done at any stage of the cycle.

Preparation

Procedure

After hysteroscopy of polyps

Before the hysteroscopy, the patient fills out a detailed questionnaire about her health condition.
If the procedure is performed under general anesthesia, before the operation, a consultation is held with a doctor specializing in anesthesia and blood tests are performed. If there is an additional disease or risk factor, it is necessary to perform additional analyses and an additional examination by a doctor of another specialty, most often an internist.
Before hysteroscopy, the cervix is swabbed for chlamydia and gonococci, and depending on the clinical picture, some other bacteriological analysis is performed.
The patient receives an antiseptic shampoo in the Clinic, with which she will shower the night before and the morning before the intervention. In addition, the patient receives a tablet containing prostaglandins in the Clinic, which is placed in the vagina 6 hours before the hysteroscopy in order to "soften" the cervix and thus cause fewer traumas to the tissue.
6-8 hours before the hysteroscopy, the patient stops taking food and liquids.

Upon arrival at the Clinic, the patient goes to the patient room where she prepares to enter the operating room. A needle is inserted into the vein so that the patient can receive the necessary medication.
Hysteroscopy is performed on the operating/gynecological table. The vagina is treated with a saline solution or an antiseptic agent containing iodine or chlorine.
After receiving local or general anesthesia, the hysteroscope is "inserted" into the cervix. Through the hysteroscope, a saline solution is continuously injected into the uterine cavity, which allows the front and back walls of the uterus to be separated and enables visualization. Since the hysteroscope has a diameter of 5-9 mm, it is usually necessary to perform dilatation, that is, to widen the canal of the cervix with instruments so that the hysteroscope can reach the uterine cavity.
First, the cervical canal is examined, and then the uterine cavity itself to identify the polyp. The shape of the uterine cavity is also analyzed with special reference to the upper part or "roof" of the uterine cavity, the endometrium and the openings of the fallopian tubes.
Depending on the size and localization of the polyp, an instrument is chosen to remove the polyp so that damage to healthy tissue is minimal.
The removed polyp is sent for histo-pathological examination.

The patient moves to the patient room where she stays for up to 2 hours after the hysteroscopy.
First she gets water, and then a light meal.
Antibiotics are not necessary, but are usually prescribed after hysteroscopic removal of polyps.
Pain, which is usually in the form of cramps or menstrual pain, is treated with painkillers, most often paracetamol, ibuprofen and diclofenac.
Sometimes you feel nauseated and tired during the day as a result of anesthesia.
The patient is not advised to drive a car on the day of the intervention.
Vaginal bleeding usually stops 2-3 days after polyp surgery.
The patient can return to normal activities on the same day or the day after the surgery.
The use of vaginal tampons, bathing in the bathtub, swimming, as well as sexual intercourse is not recommended while the bleeding lasts.
The next period will come at the expected time.
The patient will be informed about the result of the histopathological findings 7-10 days after the hysteroscopy.

Benefits of polypectomy

Hysteroscopic polypectomy is a minimally invasive intervention where the polyp is removed quickly and without incisions.
The patient can return to normal activities the day after polyp surgery;
Menstrual bleeding is regulated;
Menopausal bleeding stops;
The patho-histological diagnosis is made;
The risk of spontaneous abortions is reduced.

Expert advice: frequently asked questions

Answers by: Milan Milenković, MD, PhD

Is the procedure painful?

Hysteroscopic polyp surgery is not painful. It is done under general or local anesthesia.

When is an endometrial polyp controlled?

When a woman has no symptoms, is not planning pregnancy and has not had miscarriages, when the polyp is smaller than 10 mm and there are no other risk factors for malignancy, the polyps are controlled. Sometimes they can disappear without treatment.

How long to rest after removal (curettage) of polyps?

The patient can return to normal activities the day after the surgery. Post-operative pain are similar to menstrual pains and disappear a few hours after the surgery.

Can polyps come back after removal?

Polyps can come back after surgery, but there is no telling what the risk is.

Does polypectomy increase the chances of pregnancy?

First of all, polypectomy reduces the risk of spontaneous abortion and thus increases the chance of a successful pregnancy.

Can a uterine polyp disappear without surgery?

An endometrial polyp can disappear without surgery.

Can an endometrial polyp be removed by curettage?

An endometrial polyp can be removed by curettage, but most often the change is not completely removed and the symptoms do not disappear. Hysteroscopy is the method of choice when diagnosing and removing a polyp.