Wertheim–Meigs operation

Wertheim–Meigs operation, also known as radical hysterectomy, is a surgical procedure that involves the removal of the uterus, cervix, upper vagina, and parametrium (the fibrous tissue surrounding the uterus) along with the pelvic lymph nodes. This operation is primarily performed as a treatment for early-stage cervical cancer, although it may also be indicated in certain cases of endometrial cancer and sarcoma of the uterus. The procedure is named after Ernst Wertheim, an Austrian gynecologist who developed the technique in the early 20th century, and Joe Vincent Meigs, an American gynecologist who later popularized a similar procedure.

Indications

The Wertheim–Meigs operation is indicated for patients with early-stage cervical cancer (stages IA2, IB, and IIA) where the cancer has not spread beyond the cervix and the immediate surrounding tissues. It may also be considered in select cases of endometrial cancer and uterine sarcoma where the disease is confined to the uterus and immediate vicinity, and there is a need for extensive surgical removal to achieve clear margins.

Procedure

The Wertheim–Meigs operation is a complex and extensive surgical procedure that involves several key steps:

1. Removal of the uterus and cervix (hysterectomy): The uterus and cervix are surgically removed.
2. Removal of the parametrium and uterosacral ligaments: The tissues surrounding the uterus and the ligaments supporting it are also removed to ensure that any microscopic disease is eliminated.
3. Removal of the upper part of the vagina: A portion of the vagina surrounding the cervix is removed to ensure clear margins.
4. Pelvic lymphadenectomy: The lymph nodes in the pelvic region are removed and examined for signs of cancer spread.

Complications

As with any major surgical procedure, the Wertheim–Meigs operation carries risks and potential complications. These may include:

• Blood loss and the need for transfusion
• Infection
• Damage to surrounding organs such as the bladder, ureters, and rectum
• Lymphedema (swelling due to lymph fluid buildup) in the legs
• Sexual dysfunction due to the removal of sexual organs and nerves
• Urinary incontinence or difficulty urinating

Recovery

Recovery from the Wertheim–Meigs operation can be lengthy and may require several weeks to months. Patients may need to stay in the hospital for several days post-surgery for monitoring and pain management. Follow-up care is crucial to manage any complications and to monitor for signs of cancer recurrence.

Prognosis

The prognosis following a Wertheim–Meigs operation largely depends on the stage and grade of the cancer, the patient's overall health, and whether the cancer has spread beyond the surgical margins. Early detection and treatment of cervical cancer can significantly improve the chances of a successful outcome.

See also

• Hysterectomy
• Cervical cancer
• Endometrial cancer
• Pelvic lymphadenectomy