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OPERATION HYSTERECTOMY, October, 2004.

Hysterectomy --- having the operation.
You and your doctor have decided that hysterectomy is the best treatment for you. You must discuss with your doctor about the procedure, how it is performed, how much of the reproductive organs are removed, recovery after the surgery .

Types of hysterectomy:
The type of hysterectomy depends on the reason you need the hysterectomy.

Depending on the amount of the reproductive organs removed hysterectomy is classified as:

Total hysterectomy: This is the most common type of hysterectomy & in this procedure both the uterus & the cervix are removed. When the tubes & the ovaries are also removed the procedure is called total hysterectomy with bilateral salpingo oophorectomy. Whether the ovaries are to be removed or not must be discussed with the surgeon before surgery. Ovaries are removed because it can be the site of future disease like cancer. Cancer of the ovary is difficult to identify in the earlier stages & therefore difficult to treat. The disadvantage is that if removed before menopause an acute menopause follows. Generally whenever a hysterectomy is done after 45 yrs ovaries are removed.

Subtotal hysterectomy: Also called as partial hysterectomy removes only the uterus leaving behind the cervix, the neck of the womb. This type of hysterectomy is less commonly done & is indicated only for benign conditions like fibroids, abnormal bleeding or pelvic pain. The procedure is mainly done when due to surgical difficulties there is a possibility of injuring the adjacent structure i.e. ureter. Some believe that leaving behind the cervix can reduce sex related consequences of hysterectomy. However if the cervix is left behind it is necessary to continue in the cervical smear-screening programme.

Radical hysterectomy: A radial hysterectomy removes the uterus, cervix, and upper part of the vagina, ovaries, tubes, lymph nodes & lymphatic channels. This type of surgery is done for cancer.

The uterus can be removed through the abdomen or through the vagina. The choice depends on your doctor, the type of hysterectomy you need & the reason you need a hysterectomy. Accordingly a hysterectomy is classified as:

Abdominal hysterectomy: A cut is made on the abdominal wall & through this the uterus & other reproductive organs are removed. This is the most common type. The cut is usually a bikini cut, a horizontal cut above the pubic bones. If the uterus is too large because of a large fibroid or the ovary has a large swelling a vertical cut from belly button down to the pubic bone will be made. An abdominal approach gives the surgeon a good view of the uterus & the other pelvic organs, and also gives enough room to work around. So it is the preferred route if there are adhesions (scarring from previous surgeries). The abdominal hysterectomy however leaves a scar & will require a longer recovery period.

Vaginal hysterectomy: Vaginal hysterectomy involves removal of the uterus through an incision made near the top of the vagina. There is no cut on the abdomen. Because of this there is less pain & postoperative recovery is faster. It is the preferred surgery when the uterus sags down in the vagina. When the uterus is large & when more than just the removal of the uterus is required vaginal hysterectomy is not possible.

Laparoscopically assited vaginal hysterectomy: This procedure combines laparoscopy & hysterectomy. Laparoscope is a slender tube equipped with a tiny camera& is inserted through a small incision in the belly button. The uterus & the other pelvic organs can then be seen on a television monitor. Using the laparoscopic tools the uterus is detached from its attachments & blood supply. If the ovaries are to be removed they are also detached from attachments & blood supply. The uterus is then delivered out through an incision in the vagina. The postoperative pain is less & recovery if faster in this procedure. However only very skilled surgeons can perform the operation. The surgery may also take longer time to complete.

Postoperative recovery:

  • No matter how the uterus is removed there will be some pain & you will have to stay in the hospital for 3-5 days. Pain killers will be given to get some relief.
  • You will be encouraged to get out of your bed as soon as possible. Moving around can be painful but helps to improve your circulation & avoid the risk of blood clots.
  • You will be allowed to drink & eat regular food gradually in the first 1-2 days.
  • A tube will be placed in your bladder to empty the urine & this will be left behind for a day or two.
  • Once you are fit you will be discharged. You will be sent home to rest. It takes about 6 weeks for the abdominal wound & the tissues to heal. So strenuous activities are to be avoided in that period.
  • You can resume normal activities & join back to work in 6-8 weeks time.
  • You will be able to have intercourse 6 weeks after surgery. Sex life is not affected by hysterectomy. In fact women
  • who had pain during intercourse or had prolonged bleeding see an improvement in their sex life.
  • If you are premenopausal & the ovaries have been removed you may have acute menopausal symptoms. Hormones replacement will be beneficial for you.
  • Generally most women feel better after the surgery as they are relieved of the nagging problems: bleeding & pain. Some may feel depressed. If you are feeling depressed talk to your doctor.

Risks: A hysterectomy is a major operation that most women undergo without experiencing any complications. However no operation is free of risks. Some complications can occur time & again & these include:

  • heavy bleeding at the time of surgery. This may require blood transfusion. Sometimes bleeding can occur in postoperative period & rarely requires re operation.
  • infection involving the bladder or the wound. This problem can be adequately dealt with antibiotics.
  • retention of urine. The bladder may take some time to recover. This problem is more common with extensive repair of the anterior vaginal wall done during correction of prolapse. The problem is solved by leaving behind an indwelling catheter in the bladder.
  • Surgical damage to the bladder or to the ureters. This complication is relatively rare.
  • Venous thrombosis: an uncommon but potentially serious problem. A blood clot can develop in the veins of the legs.

Finally, remember, hysterectomy is to be performed only when there is specific indications. These are mentioned in our last newsletter on this subject.

Be well informed; be happy and be healthy!

Dr R Sukhada Rao, MB, M,D (Ob. & Gynaec.),
Consultant Obstetrician & Gynaecologist and Laparoscopic Surgeon,
Dr. U Mohan Rau Memorial Hospital, Chennai.




 

  

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