What is hysterectomy?
Hysterectomy refers to the surgery for removal of uterus (womb, the area where a baby grows in a pregnant woman) in a woman, either partially or completely. There are different types of hysterectomy, and the type of surgery for a patient is determined by her medical history and reason for surgery:
- Partial (supracervical) hysterectomy – The upper part of the uterus is removed, leaving the cervix in place.
- Total hysterectomy – The entire uterus, along with the cervix is removed.
- Radical hysterectomy – This surgery is most commonly carried out in cancer patients. It involves removal of the uterus, upper cervix part of the vagina, and the tissue lining both sides of the cervix.
If the ovaries are removed during hysterectomy, a woman will go through menopause immediately after the surgery, regardless of her age. This is known as surgical menopause. If one or both the ovaries are left intact, menopause is likely to occur at a later stage, though it appears earlier than normal in most cases (generally within five years of having the operation).
Why does one need hysterectomy?
Hysterectomy is carried out to treat certain conditions that affect the female reproductive system. These include:
- Long-term pelvic pain
- Non-cancerous tumours or fibroids
- Menorrhagia, or heavy menstrual periods
- Cancer (ovarian, uterine, cervical, or of the fallopian tubes)
What are the screening tests and investigations before the surgery?
Before a hysterectomy surgery is scheduled, the surgeon will ascertain the patient’s medical status, find out about any condition that may interfere with the procedure or recovery, and generally check if the patient if fit to undergo the procedure. The patient must discuss any on-going medication being taken by her, in case it needs to be discontinued prior to the surgery.
What is the procedure for hysterectomy surgery?
There are three ways to carry out hysterectomy:
A. Vaginal hysterectomy
In this procedure, the uterus is removed through a cut in the top of the vagina. The patient may be administered general anaesthesia (so would not be awake for the entire surgery), or may be given a regional anaesthesia (spinal block) through medication to induce a sedative effect, or the patient may be awake during the surgery.
The surgeon makes an incision inside the vagina to reach the uterus. The uterus is separated from adjoining connective tissue, ovaries and fallopian tubes using long instruments to clamp these structures. The uterus is then removed through the vaginal opening, and absorbable stitches are used to control bleeding inside the pelvis.
B. Abdominal hysterectomy
The uterus is removed through a cut in the lower abdomen in this type of hysterectomy. The surgeon begins by making an incision in the lower abdomen, using either of the two approaches:
- Vertical incision, which starts in the middle of the abdomen and extends below the navel, above the pubic bone.
- Horizontal incision, which lies about an inch above the pubic bone.
The surgeon separates the uterus from the ovaries, fallopian tubes and upper vagina, along with the connective tissue and blood vessels around it. The lower part of the uterus (cervix) may or may not be removed (total or partial hysterectomy), as also the ovaries and fallopian tubes.
C. Laparoscopic hysterectomy (keyhole surgery)
Several small incisions are made in the lower abdomen to insert specialised instruments in the pelvic region to facilitate the removal of uterus. The surgery is a minimally invasive procedure that is carried out under the effect of a general anaesthetic. A lighted, tube known as laparoscope is inserted through one of the incisions to create images of the area operated upon.
Laparoscopically assisted vaginal hysterectomy (LAVH) or robotic hysterectomies are other versions of vaginal hysterectomy that allow surgeons to remove the uterus vaginally while they view the pelvic organs through the laparoscope.
What are the known complications of the surgery?
Hysterectomy is a low-risk surgery that does not cause serious complications in most women who undergo the procedure. However, like any surgery, some cases may result in few complications, which may include:
- Urinary incontinence
- Vaginal prolapse (part of vagina coming out of the body)
- Formation of fistula (abnormal connection between bladder and vagina)
- Chronic pain
- Infection, blood clots, haemorrhage, injury to surrounding organs
What precautions or steps are necessary to stay healthy and happy before and after hysterectomy?
Recovery from hysterectomy depends on the type of surgery, though most women find the surgery improves their main problem (like pain or heavy periods). Average recovery times are:
- Abdominal hysterectomy – Four to six weeks
- Vaginal hysterectomy – Three to four weeks
- Total laparoscopic or robot-assisted hysterectomy – Two to four weeks
Hysterectomy is a major operation and patients can have to stay in the hospital for up to five days following surgery. Doctors advise women from lifting heavy objects and abstain from sex for six weeks after the surgery. Adequate rest is needed for abdominal muscles and tissues to heal. In case the surgery involved removal of ovaries, the patient would go into surgical menopause immediately, regardless of her age, and would be offered hormone replace therapy (HRT) to manage the abrupt changes in hormone levels that would otherwise follow.
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“Hysterectomy,” NHS.uk, http://www.nhs.uk/conditions/Hysterectomy/Pages/Introduction.aspx
“Hysterectomy,” MedlinePlus, NLM, NIH, http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm
“Hysterectomy,” WebMD.com, http://www.webmd.com/women/guide/hysterectomy
“Vaginal hysterectomy,” MayoClinic.com, Mayo Clinic Staff, http://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/basics/what-you-can-expect/prc-20020565