Hysterectomy is a surgery performed to remove a woman’s uterus. The procedure is carried out to eliminate the problems linked with pelvic pain, menstruation, tumors, etc. The operation type and also the need to remove the ovaries, fallopian tubes, and cervix along with the uterus is determined based on the problem in hand. Once a hysterectomy is done, a woman can no longer have periods or get pregnant.
As the stakes are high, hysterectomy is often the last resort. Doctors look into other medical options and alternatives to evade a hysterectomy as much as possible. Women may take the option to bear the pain and not opt for surgery. However, specific conditions present no alternatives. Those include uterine fibroids, endometriosis, uterine prolapse, pelvic pain, endometrial cancer, and abnormal uterine bleeding. Just to be sure, it’s advised to take another medical opinion when a hysterectomy is recommended for non-cancerous problems.
As aforementioned, the type of hysterectomy surgery needed can vary with specific problems and requirements. The following are the types:
A complete or total hysterectomy is the most common hysterectomy type, in which the uterus along with the cervix is removed. However, contradicting the procedure’s name, all the related organs such as the fallopian tubes and ovaries are not removed.
Also called subtotal hysterectomy, a partial hysterectomy only gets rid of the uterus’ upper portion and leaves other organs such as the cervix untouched.
In this procedure, the uterus, upper portion of the vagina, cervix, pelvic lymph nodes, and supporting tissues are removed. The surgery is considered in case of endometrial cancer.
Generally, during a hysterectomy procedure, the fallopian tubes and ovaries are not removed unless they are plagued with issues.
The surgery technique used may vary based on patient requirements and her overall health, and surgeon skills and experience. Some women may not be the right candidates for specific techniques.
Also called open surgery hysterectomy, abdominal hysterectomy is a common approach, which accounts for close to 65 percent of all hysterectomy surgeries. The open approach means access to the innards. The procedure is performed in cases wherein the woman has fibroids, endometriosis, enlarged uterus, cancer, obesity or never birthed kids.
For surgery, the surgeon makes an incision of 5 to 7 inches, either horizontally around the bikini line or vertically, across the abdomen to remove the uterus. The bikini line method is preferred due to less-obvious post-operation scars. The patient must stay in the hospital for at least two to three days after surgery.
An abdominal hysterectomy’s major advantages are little to zero blood vessels and urinary tract damage. The increased pain involved is the main disadvantage.
In a vaginal hysterectomy, a surgical incision is made in the vagina’s upper portion to remove the uterus via the vagina. The procedure is ideal only for medical conditions such as endometrial hyperplasia, uterine prolapse, or cervical dysplasia. The method is less painful, with almost no visible scar and a brief length of stay (LOS). In fact, a vaginal hysterectomy is preferred over an abdominal hysterectomy whenever possible. However, if the patient has a smaller vaginal canal, an extremely large uterus, needs complete abdomen examination, or cannot raise her legs for prolonged time periods, an abdominal hysterectomy is performed.
This hysterectomy entails a few small abdominal incisions, and a part of the surgery is done as laparoscopy. The laparoscope instrument lets the surgeon view the abdomen interior through the small incisions on a computer screen. The other incisions are used to insert surgical instruments.
The main advantages of laparoscopic hysterectomies are shorter hospitalization and recovery periods. The drawbacks include a lengthier surgery duration, highest costs, and increased urinary tract infection risks. Moreover, there’s special skill needed to perform the procedure, something not all surgeons possess. And if the patient has had abnormal scarring courtesy prior surgeries or has an excessively large uterus, a laparoscopic hysterectomy may not be ideal.
Preparing for the Surgery
Prior surgery, medical tests such as urine tests, blood tests, ultrasounds, pelvic exam, Pap smear, X-rays, and an electrocardiogram are done. Some exploratory procedures may be performed to confirm there are no other causes relating to the pain. Endometrial sampling is done to rule out cancer. Non-hormonal treatments, along with the above mentioned tests, are carried out to confirm the patient’s hysterectomy candidacy.
Hysterectomy is generally a safe procedure, but there are risks involved or complications post-surgery.
- Anesthesia-related problems
- Blood clots in veins
- Vaginal bleeding, infection and/or fever
- Damage to internal organs such as the bladder, urinary tract or bowel
- Ovarian function loss
- Vaginal vault prolapse, or the vagina top dropping due to the lack of support structures
Hospital stay for a few days is usually the norm with a hysterectomy – the actual number of days may vary with the procedure type. Complete recovery should typically take a month or two. Generally, the abdominal technique may require a much longer healing period (six to eight weeks) than vaginal or laparoscopic surgery (three to four weeks).
Routine activities can be resumed, but in moderation or with decreased intensity levels. Anything that involves excessive physical exertion is a strict no. This is until the post-operation pain, bleeding and abdominal pressure stop. Around the six-week mark, sexual activity and bathing can be resumed. However, gyms or exercising should wait for another two months.
After the procedure, the patient would enter menopause if her ovaries were removed too. If not, she may enter menopause much earlier than normal. There could be alterations in sexual feelings. For instance, some women may not have much interest in sex, especially if the surgery involved removal of ovaries. However, there are also many women who’ve reported increased interest in or a much enhanced sexual life post hysterectomy, thanks to the pain relief or absence of heavy vaginal bleeding. However, the resulting infertility may lead to some women getting depressed or feeling intense grief.