Hysterectomy

What is it?
Hysterectomy is the surgical removal of the uterus. The uterus is a pear-shaped organ located at the top of the vagina. A hysterectomy can involve other reproductive organs in addition to the uterus, depending upon the reason for the surgery. A woman who has had a hysterectomy will no longer have a menstrual period each month and will no longer be able to have children.
Who needs this procedure?
A hysterectomy is the usual treatment for women with uterine, ovarian, or cervical cancer; severe endometriosis; fibroid tumors that are causing bleeding and other complications; or heavy, uncontrollable vaginal bleeding. It may be necessary as treatment for prolapsed uterus, in which the uterus protrudes through the vagina; pelvic inflammatory disease; and endometrial hyperplasia, which is a potentially precancerous condition. It has also been used as a permanent sterilization procedure to prevent pregnancy. Hysterectomy is the second most common operation performed in the United States.
How do I prepare for this procedure?
If you and your doctor decide a hysterectomy is the best treatment for you, you will need to sign a release form showing you understand the procedure and giving the doctor permission to perform the operation. Your doctor will order blood and urine tests before the surgery. You’ll meet with the anesthesiologist to talk about the type of anesthesia you will have for the surgery. With a local anesthetic, you will remain awake and only the part of your body where the incision is made will be made numb so you don’t feel any pain. A general anesthetic makes you feel as if you are in a deep sleep so you don’t feel any pain. Follow all instructions provided by your doctor concerning food and drink before your surgery. Generally, you should not eat or drink anything after midnight. If you normally take medications, check with your doctor about how to take them the morning of your surgery. You may need to use a laxative or enema before the surgery to empty your bowels. The day of your surgery, you’ll receive an intravenous (IV) line in your arm for fluids and medications. You may also have a catheter to drain urine from your bladder until you are able to urinate on your own. Both the IV and catheter will be remove within a day or two of your surgery.
How is this procedure performed?
The type of hysterectomy you need depends upon the reason you need the surgery. In a total hysterectomy, the uterus and the cervix are removed. This is the most common kind of hysterectomy, usually performed for uterine and cervical cancer. When the fallopian tubes and ovaries are removed along with the uterus, it is called hysterectomy with bilateral salpingo-oophorectomy. This procedure may be performed to reduce the risk of ovarian cancer. A subtotal, or partial, hysterectomy removes only the uterus and is used to treat fibroids, abnormal bleeding, or pelvic pain. A radical hysterectomy removes the uterus, cervix, ovaries, oviducts, fallopian tubes, top part of the vagina, lymph nodes, and lymph channels. It is performed when cervical or endometrial cancer has spread to the cervix, and has the longest recovery period. Hysterectomies can be performed abdominally or vaginally. The choice depends upon your doctor and the type of hysterectomy you need. With an abdominal hysterectomy, the surgeon makes a cut in the abdomen, similar to a cesarean section, through which he or she removes the uterus and other reproductive organs, if necessary. An abdominal hysterectomy accounts for most of the hysterectomies performed in the United States. It gives the surgeon a good view of the uterus and other reproductive organs, allows the surgeon to remove even large fibroids, and gives the surgeon room to work around and see any adhesions (scarring) from previous surgeries. However, abdominal hysterectomy does leave a scar, has some discomfort associated with the recovery period, and has a longer recovery period than the vaginal hysterectomy. With a vaginal hysterectomy, the incision is made near the top of the vagina. Through this incision, the surgeon can cut and tie off the ligaments, blood vessels, and fallopian tubes. The uterus is then cut free and removed through the vagina. The surgery and hospital stay are shorter than the abdominal hysterectomy and women usually return to normal activities after around four weeks. The vaginal hysterectomy is less painful than the abdominal procedure and leaves no exterior scar. However, if you have large fibroids or need more than just the uterus removed, the vaginal hysterectomy is not possible. Because it is difficult for the surgeon to actually see the uterus and surrounding tissue during the vaginal procedure, he or she may use a laparoscope. This is a slender tube equipped with a tiny camera and is inserted through a small incision below the belly button. The surgeon can then see the uterus on a television monitor. He or she uses small instruments inserted through two other tiny incisions in the abdomen to cut and tie off the blood vessels, fallopian tubes, and ligaments. The uterus is then removed though a small incision at the top of the vagina. The hospital stay is very short, and women generally recover within two weeks. However, only very skilled surgeons are able to perform the laparoscopic-assisted vaginal hysterectomy.
What can I expect after the procedure?
The time you must stay in the hospital and your recovery period depend upon the reason for your surgery, the type of surgery you need, and how the surgery is performed. Your doctor can provide you with these details.
Self-care tips
Follow your doctor’s instructions carefully during your recovery period. Avoid heavy lifting, get plenty of rest, and have regular checkups after the surgery. Always contact your doctor if you experience heavy bleeding, fever, nausea or vomiting, dizziness, pain during urination, a leaking or open incision, or leg pain, swelling, or redness. If you have both ovaries removed, you will benefit from estrogen replacement therapy to reduce the risk of heart disease and osteoporosis (brittle bone disease). Some women experience changes in sex drive and some weight gain after a hysterectomy. Seek support and advice from your doctor on these issues