Hysterectomy

What is Hysterectomy?

Hysterectomy is the surgical removal of the uterus, which provides relief from troublesome symptoms such as pelvic pain and heavy irregular periods. It is the second most common surgery among women after cesarean section delivery.

What are the type of HYSTERECTOMY?

Total hysterectomy is removal of the entire uterus and the cervix (most common)Partial or sub-total hysterectomy is a procedure done where the cervix of the uterus is left behind but the upper section of the uterus is removed.Radical hysterectomyis usually done for cancer of the uterus or cervix and it means removal of the uterus along with the cervix, the upper part of the vagina, and the surrounding tissues.In many cases, surgical removal of the ovaries (oophorectomy) is performed concurrent with a hysterectomy. The surgery is then called "Hysterectomy with Bilateral Salpingo-ophorectomy",or Pan-hysterectomy. A hysterectomy may be done through an abdominal incision (abdominalhysterectomy), a vaginal incision (vaginal hysterectomy), a laparoscopic procedure (laparoscopic hysterectomy) or laproscopically assisted vaginal hysterectomy.Depending on the medical history and the indication for surgery, the doctor will help the patient decide which type of hysterectomy is most appropriate.

What are the Indications of Hysterectomy?

  • Fibroid tumors growing in the muscle of the uterus, which can sometimes cause heavy bleeding and pain.
  • Endometriosis happens when the tissue lining the inside of the uterus grows outside the uterus on the ovaries, fallopian tubes or other pelvic or abdominal organs. When medication and surgery fails to cure endometriosis, a hysterectomy with the removal of ovaries is recommended if family is complete.
  • Persistent vaginal bleeding. If the periods are persistently heavy, irregular, orlast for many days and medication does not help, a hysterectomy may bring relief.
  • Moderate or severe prolapse of the uterus - when the uterus moves from its usual place down into the vagina. This can lead to urinary problems, pelvic pressure, or difficulty with bowel movements
  • Complications during childbirth (like uncontrollable bleeding)
  • Endometrial cancer(in the inner lining of the uterus)
  • Cancer of the ovary
  • Cancer of the cervix or severe cervical dysplasia - a precancerous condition of the cervix

What are preoperative work up?

  • A complete history and physical examination to rule out any co-morbid conditions such as diabetes mellitus, hypertension, cardiac disease or asthma etc.
  • PAP smear to rule out cervical cancer.
  • CBC count (complete blood count), blood type and cross match.
  • ECG and chest radiograph to assess the cardiac and respiratory systems.
  • Other investigations as per patient’s condition.
  • Biopsy of the endometrium, which is the inner lining of the uterus is essential to rule out cancer or pre-cancer of the uterus particularly in women over 40 years of age. This procedure is called endometrial sampling and done by hysteroscopy and D and C (Dilatation and Curettage).

What are the techniques of Hysterectomy?

There are two main techniques--Open technique and minimally invasive technique.

  • Open technique is a total abdominal hysterectomy (TAH)
  • Minimally invasive techniques are -
    • Vaginal Hysterectomy
    • Laparoscopic assisted Hysterectomy
  • The ideal surgical procedure for each woman depends on her particular medical condition, her previous history of surgeries and body frame and patients choice.

What is Abdominal Hysterectomy?

Abdominal hysterectomy can be performed under spinal anesthesia or general anesthesia. The patient remains awake during a spinal anesthesia, with only lower section of the body being numbed to prevent pain. When given a general anesthetic, the person is unconscious.

What is the advantage and disadvantage of Hysterectomy ?

Advantage of an open abdominal procedure is that the surgeon can see the uterus and other organs and has more room to operate than if the procedure is done vaginally.

Disadvantage -
  • Longer hospital stay.
  • Greater discomfort than following a vaginal procedure.
  • A visible scar on the abdomen.

What is Vaginal Hysterectomy ?

Uterus is removed through the vaginal route. Prior to surgery, the patient is given a spinal or a general anesthesia.

What are the advantage and disadvantage of Vaginal hysterectomy?

Advantage is that there is no visible scar in vaginal hysterectomy and healing is faster in comparison to abdominal hysterectomy.

The disadvantages are -
  • There is less room for the surgeon to visualize and operate.
  • Special surgical expertise is required to operate on larger uterus.

What is Laparoscopically assisted vaginal hysterectomy (LAVH)?

The procedure is performed under general anesthesia

What are the advantage and disadvantage of LAVH?

Advantage is shorter hospital stay (2-3 days) and no visible scar on abdomen.

Disadvantages
  • Compared to abdominal hysterectomy, LAVH takes longer to perform.
  • If a woman has a history of prior surgery to the abdomen, or if she has a large pelvic tumor, LAVH may not be feasible in some patients and a regular abdominal hysterectomy may need to be considered.

What are the Complications of Hysterectomy ?

  • Infection, excessive bleeding, blood clots or an adverse reaction to the anesthesia.
  • Damage to the urinary tract, bladder or bowel during surgery, which may require further surgical repair
  • Loss of ovarian function if both ovaries are removed simultaneously

Convalescence

  • Early mobilization will promote quick recovery after hysterectomy. The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 4 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy, and may include less pain.
  • Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine.

Tips to help you recover after hysterectomy –

  • A sanitary towel will need to be worn to absorb any vaginal bleeding, which is usually similar to a light period.
  • Moving about as soon as possible helps to avoid blood clots in the legs and other problems.
  • Walking to the bathroom as soon as possible is recommended.
  • Normal diet is encouraged as soon as possible after bowel function returns.
  • Avoid lifting heavy objects for a few weeks following surgery.
  • Sexual intercourse should be avoided for 6 to 8 weeks after a hysterectomy.
  • If the ovaries have been removed (oophorectomy) in premenopausal women, the patient experiences menopausal symptoms like hot flushes, vaginal dryness, and mood disturbances.