International Adhesions Society





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What Is It?

A hysterectomy is the surgical removal of the uterus. Depending on the type of hysterectomy, additional pelvic organs or tissues may be removed as well. The following variations are possible:

Subtotal, supracervical or partial hysterectomy - The uterus is removed, but not the cervix.
Total or complete hysterectomy - Both the uterus and the cervix are removed. Overall, about 50 percent of all hysterectomies are total hysterectomies, and this procedure is the most common form of hysterectomy performed in women older than age 45.
Total hysterectomy plus unilateral salpingo-oophorectomy - This procedure removes the uterus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in place. After surgery, the remaining ovary should produce adequate levels of female hormones, if the woman is premenopausal.

Radical hysterectomy - This procedure removes the uterus, cervix, both ovaries, both fallopian tubes and the regional lymph nodes in the pelvis. This procedure is reserved for some gynecologic cancer patients. Since both ovaries have been removed, levels of female hormones will drop dramatically after surgery, and hormone supplements (hormone replacement therapy) may be needed.

Hysterectomies also vary depending on the location of the surgical incision (surgical cut). For example, about 75 percent of all hysterectomies are abdominal hysterectomies, where the uterus is removed through a horizontal or vertical incision in the lower abdomen. The rest are vaginal hysterectomies, where the uterus is removed through a vaginal incision.

In one form of vaginal hysterectomy, called a laparoscopically assisted vaginal hysterectomy (LAVH), the uterus is removed vaginally, but the surgeon also makes several small incisions in the abdomen. These incisions allow the surgeon to insert and manipulate a laparoscope (a tube-like instrument with a camera for viewing inside the abdomen). Through the laparoscope, the surgeon can inspect the pelvic organs and insert small instruments to assist in removing the uterus.

Overall, hysterectomy is a very common surgical procedure in the United States, especially in middle-aged women between ages 40 and 50. However, partly because of a growing controversy about the large number of hysterectomies performed in this country, the popularity of the procedure has declined steadily since the late 1980s. Recently, more and more women have been opting for less extreme surgical procedures, when this is medically possible. Still, the fact remains that by age 60, about 25 percent of all American women have had a hysterectomy.

What It's Used For

About 33 percent of hysterectomies are done to remove a uterus that has symptomatic uterine fibroids; another 11 percent are done to treat uterine cancer; and about 5 percent are done for severe menstrual problems. The remaining 51 percent are used to treat a prolapsed uterus, endometrial hyperplasia (abnormal growth of the uterine lining) or endometriosis.


Because a hysterectomy is irreversible, it will permanently prevent you from becoming pregnant. So if you have any doubts about the procedure, or if you definitely wish to keep your fertility, you should ask your doctor about whether an alternate treatment is possible for your specific gynecologic problem.

Your doctor will review your medical and gynecologic history, and he or she will perform a thorough physical examination, including a pelvic exam. If you have not yet begun menopause, and there is any chance that you might be pregnant, you should inform your doctor about this before surgery.

You will have preliminary blood tests, a urinalysis, an electrocardiogram (ECG) and a chest X-ray to ensure that you have no undiagnosed medical problems that might complicate your surgery. A pelvic ultrasound may be performed to evaluate the uterus and ovaries, depending on their present condition. About one week before your hysterectomy, you will be told to stop taking aspirin and other blood-thinning medications. Beginning at eight hours before surgery, you must not eat or drink anything (this reduces the risk of vomiting during surgery).

How It's Done

A hysterectomy usually takes about two hours and is usually performed with the patient under general anesthesia. Before the procedure, an intravenous (IV) catheter will be inserted into one of your veins to deliver fluids and medications. What happens next depends on the type of hysterectomy:

Abdominal hysterectomy - The surgeon will make a 5- to 7-inch incision in your lower abdomen. Then, after closing off any attached blood vessels, he or she will remove your uterus through the incision. A drainage tube will be placed in the incision. Then the incision will be closed with sutures (stitches) and titanium staples, which will be removed about one week after the surgery.

Vaginal hysterectomy - An incision will be made in the wall of the upper portion of your vagina. Through this incision, the surgeon will use sterile instruments to detach your uterus and to tie off nearby blood vessels. Your uterus will be removed through your vagina, then the vaginal incision will be stitched closed. After surgery, the length of your healed vagina should be adequate for comfortable sexual intercourse.

LAVH - As in a simple vaginal hysterectomy, an LAVH allows the uterus to be removed through your vagina. However, three or four small incisions are also made in the wall of the abdomen to allow the surgeon to insert a laparoscope and thin surgical instruments. These instruments are used to help in freeing the upper portion of the uterus and in removing the ovaries (if necessary). At the end of the procedure, the upper portion of the vagina is stitched closed and the small abdominal incisions are closed with sutures or surgical tape.

After your surgery, you will be taken to the recovery room. There your vital signs will be closely monitored, and you will be given pain medication. After a few hours, you will be taken back to your hospital room. Your IV line will be removed, and you will be allowed to eat once your doctor has determined that your digestive system has recovered from the stress of surgery. You will remain in the hospital for three to five days. During the first few days after your hysterectomy, you will have slight vaginal bleeding and discharge.


Before you leave the hospital, your doctor will tell you when to schedule a follow-up office visit. At this visit, your doctor will check the healing of your incisions and remove any sutures or staples. If you have had an abdominal hysterectomy, the soreness at your incision site should gradually ease over a period of about six weeks. In most cases, you can resume sexual intercourse in three to four weeks. For guidance about resuming sexual intercourse and other activities (exercising, driving, sports, lifting), check with your doctor.


Possible complications from a hysterectomy include, but are not limited to:

  • Excessive bleeding
  • Infection
  • An injury to the bowel or bladder
  • An injury to nerves that regulate the bladder, causing bladder dysfunction
  • Pulmonary embolism (floating blood clot that lodges in the lungs)

When To Call A Professional

Once you return home, call your doctor immediately if you develop any of the following problems:

  • Fever
  • Excessive bleeding from your vagina
  • Bleeding, discharge, swelling or extreme tenderness at your incision site
  • Nausea, vomiting or abdominal pain
  • Trouble urinating
  • Feelings of excessive sadness
  • Difficulties or discomfort during sexual intercourse (once the gynecologist has allowed you to do so)

Source: - Sept 2000


- Hysterectomy from ACOG
- National Library of Medicine
- Hysterectomy – Dr. Stanley West
- Hysterectomy Information from NY Dept. of Health
- From National Women Health Resources
- Hysterectomy and Adhesions – Video clip

Research Articles

- Laparoscopic lysis of adhesions. “Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy”
- Adhesion prevention in gynecologic surgery. (authored by IAS advisor, Dr. Tulandi) Indeed, more than one half of patients with adhesion-related small-bowel obstruction had previous gynecologic operations, and a high percentage occurs after abdominal hysterectomy.
- Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. “The incidence of adhesion-related intestinal obstruction after gynecologic surgery for benign conditions without hysterectomy is approximately 0.3%, increasing to 2% to 3% among patients who undergo hysterectomy, and is as high as 5% if a radical hysterectomy is performed.”
- Adhesion-Related Bowel Obstruction After Hysterectomy

- The Pain-Less Hysterectomy by Dr. Glenn Bradley

Online Communities

- HysterSisters


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