Hysterectomy

What is a Hysterectomy

A Hysterectomy involves the removal of the uterus or womb. A Hysterectomy may be recommended as a treatment for:

• Heavy Bleeding,
• Irregular Bleeding,
• Fibroids,
• Prolapse, and
• Painful Periods (endometriosis, adenomyosis).

Hysterectomy is also performed in the treatment of various gynaecological cancers.

Types Of Hysterectomy Surgery

There are three types of hysterectomy

• Laparoscopic Hysterectomy
• Vaginal Hysterectomy, and
• Abdominal Hysterectomy

Laparoscopic Hysterectomy

Dr Turner has particular expertise in the procedure called a Total Laparoscopic Hysterectomy.

What Is a Laparoscopic Hysterectomy?

Total Laparoscopic Hysterectomy is a surgical procedure for removing the uterus and cervix. In this technique, the uterus is separated from its attachments to the pelvis and removed through the vagina.

The ovaries and fallopian tubes can also be removed at the same time. Dr Turner will discuss these options with you.

Why Is a Laparoscopic Hysterectomy Performed?

Total Laparoscopic Hysterectomy is done to treat conditions such as

• Painful Periods, endometriosis, adenomyosis
• Heavy Menstrual Periods,
• Pelvic Pain,
• Fibroids, or
• As a Part of Cancer Treatment.

How Is A Laparoscopic Hysterectomy Performed?

The procedure is done under general anaesthesia in the operating room.

A small incision is made just below your umbilicus. The abdomen is inflated with gas, and a fibre-optic instrument called a laparoscope is inserted to view the internal organs.

Further, small incisions may be made on your abdomen through which tiny surgical instruments are passed. Then, the uterus and cervix are removed along with or without ovaries and tubes through the vagina. The current recommendation is to concurrently remove both fallopian tubes, which is associated with a lower incidence of ovarian cancer. The total operating time is about 90 minutes.

Ask For A Second Opinion

Your surgeon performs 80% of hysterectomies as a Total Laparoscopic Hysterectomy procedure. Dr Turner will discuss with you the best way to do your hysterectomy, which depends on the indication for surgery, any previous surgery, the size of the uterus and the amount of prolapse present. This is often done as a laparoscopic or vaginal procedure and less frequently as an open operation.

Laparoscopic hysterectomy has benefits such as:

• Shorter Recovery Time,
• Faster Return to Usual Activities,
• Reduced Post Op Pain,
• Minimal Scarring, and
• Less Post-op Adhesion Risk

Alternatives To A Total Laparoscopic Hysterectomy

Other conservative interventions may be appropriate for your particular condition. Dr Turner will discuss the other options to help you make a well-informed decision regarding what best suited for you. Depending on your condition Dr Turner will discuss with you the role of removal of the ovaries.

Removal of the ovaries is recommended for women over the age of 50 years. If the ovaries are not removed, you will not experience menopausal symptoms, including hot flushes and night sweats, until you reach natural menopause.

If your ovaries are removed before natural menopause, estrogen replacement therapy is usually recommended until 50 years of age. This relieves menopausal symptoms and prevents the early onset of osteoporosis and cardiovascular disease.

What Precautions Should Be Taken Before A Laparoscopic Hysterectomy?

You can continue taking your regular medications unless Dr Turner advises otherwise. If you take non-steroidal anti-inflammatory medication, Dr Turner will recommend that you discontinue this one week before surgery.

You will be admitted to the hospital on the day of your operation. You will meet the anaesthetist just prior to surgery to discuss the anaesthetic and any concerns you may have.

What Can Be Expected During The Recovery Period?

You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours. You may have shoulder or back pain because of the gas used in the procedure. It resolves within a day or two. You will start eating and drinking normally within a short period.

You may have some discomfort or feel tired for a few days after the procedure. Constipation is very common. You will be in the hospital for two days following the procedure. Dr Turner will ensure that your stay in the hospital is as comfortable as possible.

Contact Dr Turner if pain and nausea do not settle or are becoming worse. You should avoid strenuous activities or exercise until you recover completely. Most women will take two weeks off work and return to work at the start of the third week. your surgeon will review you again one week after your discharge from the hospital.

You may have some vaginal discharge (old blood) for several days after the procedure. You can return to light activity after two weeks, but complete recovery may take longer. After the procedure, you will no longer be menstruating and unable to conceive. Avoid intercourse for six weeks - to allow the top of the vagina adequate time to heal.

Many women are concerned with a possible change in their sex life after a hysterectomy. However, many women feel liberated now, free of troublesome bleeding, pain with periods, discomfort from prolapse and no further need for contraception. Libido can be improved with an improvement in well-being. A hysterectomy does not affect the ability to orgasm.

Possible Risks Of A Laparoscopic Hysterectomy?

As with any surgical procedure, there are associated risks and complications, which include:

• Problems due to the anaesthesia
• Injury to the internal organs - 1/1000 risk of inadvertent damage to bladder, bowel or ureter
• Bleeding/Blood transfusion
• Infection
• Blood clots

Any specific risks and complications will be discussed before the procedure. Prophylactic antibiotics and measures to prevent blood clots are given.

Vaginal Hysterectomy

What Is Vaginal Hysterectomy?

A vaginal hysterectomy is an alternative surgical procedure to an abdominal hysterectomy. In this procedure, the uterus is removed through the vagina rather than through the incision in the abdomen.

What are the advantages of vaginal hysterectomy over abdominal hysterectomy?

Recovery following vaginal hysterectomy is much faster than abdominal hysterectomy. You may be discharged from the hospital in a day or two, and you can return to your daily activities within a few weeks after the surgery. However, no heavy lifting or straining should be done for 6-8 weeks.

Who Are The Good Candidates For Vaginal Hysterectomy?

Individuals with the following conditions and those who don’t have an enlarged uterus are considered eligible candidates for vaginal hysterectomy,

Uterine Prolapse: It is the protrusion of the uterus from the pelvic cavity into the vaginal canal due to the weakening of the muscles and connective tissues that hold the uterus in place. It is often seen in women who had one or more vaginal births.

How Is Vaginal Hysterectomy Performed?

You may be given general or regional anaesthesia. An incision is made in the vagina, and the uterus is removed. The incision in the vagina is then closed with absorbable stitches.

What Are The Risks Of The Vaginal Hysterectomy?

Vaginal hysterectomy is generally safe. Complications may include infection, blood loss, a blood clot, usually in the leg vein or damage to the nearby organs in the abdomen and pelvic regions such as the urinary bladder, ureter or bowel.

Obesity, diabetes, and high blood pressure increase the chances of complications due to surgery.

What To Expect After The Vaginal Hysterectomy?

Recovery after vaginal hysterectomy is fast. Medicines are prescribed for pain and to prevent infection.

Bleeding from the vagina is normal and will last a few weeks after the surgery. Using sanitary pads should be preferred as tampons increase the risk of infection. You will not have periods and cannot conceive after the vaginal hysterectomy.

If ovaries and fallopian tubes are removed along with the uterus in vaginal hysterectomy, you may have vaginal dryness or hot flushes, the symptoms of menopause.

These may be treated with medicines if required. You will be able to do normal activities in around two weeks after the surgery but should not lift heavy objects or have vaginal intercourse until the sixth week postoperatively after your review with Dr Turner.

Abdominal Hysterectomy

A 10 cm incision is made in the lower abdomen. This is performed if numerous fibroids significantly enlarge the uterus or if there is gross pelvic pathology, including adhesions. It is also performed in cases of cancer. Sometimes this incision has to be vertical [up and down the middle of the abdomen] rather than transverse [horizontally across just above the pubic hair].

What Are The Advantages Of Abdominal Hysterectomy

The main advantage is to the surgeon, who has greater access to the pelvis. The procedure lasts about 60-90 minutes.

The main candidates are people with

• Endometriosis: It is an abnormal growth of the endometrium, the membrane lining the uterus, on surfaces of other organs in the pelvis such as ovaries, fallopian tubes, and the outer surface of the uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum.
• Cervical Dysplasia: It is the premalignant condition of the cells lining the cervix.
• Uterine Fibroids: They are the non-cancerous growths in the uterus. If the fibroids are large, an abdominal hysterectomy is required.
• Large ovarian cysts
• Gynaecological cancers.

What Can I Expect From An Abdominal Hysterectomy

You will be in the hospital for about 3 -5 days. It will be about four weeks to recover at home. Most women will return to work by the start of the (6th) week.

What If I Come Across Any Problem During The Recovery Period?

You should seek immediate medical attention if you experience any of the below-mentioned conditions:

• Fever
• Offensive vaginal discharge or heavy bleeding
• Severe nausea or vomiting
• Inability to empty your bladder or bowels
• Severe pain
• Chest pain/shortness of breath.