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.
Preparation
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.
Follow-Up
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.
Risks
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: InteliHealth.com - Sept 2000
Overviews
-
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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