Diagnostics

Hysterectomy

What is a hysterectomy?

A hysterectomy is a surgical procedure involving the removal of the uterus and, in many cases, the cervix. Depending on the specific medical reasons for the surgery, surrounding organs and tissues like the fallopian tubes and ovaries may also be removed. The uterus is the organ where a fetus grows during pregnancy, and its lining is what causes periods. After a hysterectomy, pregnancy will no longer be possible, and the patient will no longer experience menstrual periods.

Who performs hysterectomy?

Gynecologists perform hysterectomy surgery which is usually performed in hospitals with gynecology departments equipped with advanced surgical facilities.

What are the reasons for undergoing a hysterectomy?

Hysterectomies are performed to address various female reproductive disease conditions, including:

  • Abnormal or heavy vaginal bleeding that does not respond to other treatment methods.
  • Severe menstrual pain that is not relieved by other treatment methods.
  • Leiomyomas, or uterine fibroids, are noncancerous tumors.
  • Long-term pelvic pain.
  • Uterine prolapse, where the uterus “drops” into the vaginal canal due to weakened support muscles, leads to difficulties with urinary incontinence or bowel movement.
  • Gynecologic cancers include uterus, ovary, cervix, or endometrium cancer.
  • Conditions affecting the uterus lining include endometrial hyperplasia (endometrial lining of the uterus becomes thick), recurrent uterine polyps, or adenomyosis (endometrial tissue that lines the uterus grows into the muscle of the uterus).

What are the different types of hysterectomy?

The main types of hysterectomy are:

  • Total hysterectomy: The womb and cervix (neck of the womb) are removed. This is the most commonly performed procedure.
  • Subtotal hysterectomy: The main body of the womb is removed, leaving the cervix in place.
  • Total hysterectomy with bilateral salpingo-oophorectomy: The womb, cervix, fallopian tubes, and ovaries are removed. If ovaries are removed before experiencing menopause, it will trigger menopausal symptoms, such as hot flashes, vaginal dryness, or insomnia (difficulty falling asleep), etc
  • Radical hysterectomy: The womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands, and fatty tissue.

How is the hysterectomy procedure performed?

Before surgery

Preparing for a hysterectomy involves discussing the procedure in detail with the doctor, including potential complications and side effects. Before undergoing a hysterectomy, the doctor may order several tests to assess overall health and evaluate any specific conditions that may influence the surgical approach. Some common tests done include blood tests, urine tests, imaging tests like ultrasound, CT, or MRI if needed, and preoperative consultation with an anesthetist.  Informed consent is obtained from the patient or their relatives before performing surgery.

During surgery

During the hysterectomy, the doctor will determine the appropriate type of hysterectomy and surgical method. The patient will be asked to change into a hospital gown and be connected to monitors for heart rate monitoring.

An intravenous (IV) line will be placed in the arm to administer medications and fluids.

The patient will receive either general anesthesia, which renders the patient unconscious during the procedure, or regional anesthesia (epidural or spinal anesthesia), which numbs the lower back area while maintaining wakefulness.

There are several surgical approaches for a hysterectomy:

  • Vaginal hysterectomy: The uterus is removed through an incision at the top of the vagina without any external incisions. Dissolvable stitches are placed inside the vagina. This approach is commonly used for uterine prolapse and nonmalignant conditions, with fewer complications and faster recovery (up to four weeks).
  • Laparoscopic hysterectomy: A laparoscope is inserted through a small incision in the belly button. Surgical tools are inserted through other small incisions, and the uterus can be removed in small pieces through the abdomen or vagina. Recovery is shorter and less painful compared to an abdominal hysterectomy, and some patients may go home the same day or after one night in the hospital.
  • Abdominal hysterectomy: The uterus is removed through a six- to eight-inch-long incision in the abdomen. The incision is made either from the belly button to the pubic bone or across the top of the pubic hairline. The surgeon will use stitches or staples to close the incision. This approach is most commonly used for cancer, or when the uterus is enlarged, or the disease has spread to other pelvic areas. Compared to other methods, abdominal hysterectomy generally requires a more extended hospital stay of two or three days and a longer recovery time.


After surgery

The duration of the hospital stay after a hysterectomy depends on the type of surgery the patient underwent. The doctor will carefully monitor the patient to ensure there are no signs of complications, such as blood clots or bleeding.

To prevent blood clots in the legs, the patient will be encouraged to start walking around as soon as possible after the surgery. This early mobility helps improve blood circulation and reduces the risk of developing blood clots.

Recovery period

The recovery period can vary based on the type of hysterectomy.

After a hysterectomy, here are some common instructions to follow:

  • Expect light vaginal bleeding for one to six weeks. Use only a light panty liner or sanitary pad to manage the discharge.
  • Avoid lifting heavy objects (over 10 pounds) for at least four to six weeks.
  • Avoid inserting anything into the vagina for four to six weeks or as per the doctor’s advice.
  • Abstain from sexual activity for six weeks after surgery.
  • The patient may take a shower and wash the incision with soap and water. Stitches will dissolve in about six weeks. Surgical strips may fall off within a week, and the doctor should remove staples.
  • Resume the exercise routine in four to six weeks, depending on how one feels.
  • The patient can go back to work in three to six weeks, depending on the nature of an individual’s work.

When patient should get in touch with the doctor?

If a hysterectomy has been performed, it is important to contact the doctor if experiencing any of the following:

  • Bright red vaginal bleeding.
  • A fever over 100 degrees Fahrenheit (37.77 degrees Celsius).
  • Severe nausea or vomiting.
  • Difficulty urinating, a burning feeling when urinating, or frequent urination.
  • Increasing amounts of pain.
  • Increasing redness, swelling, or drainage from incision.

References

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