Hysterectomy is the surgical removal of the uterus. Uterus or womb is the organ where the baby grows during pregnancy. A partial hysterectomy removes the uterus, leaving the cervix intact. A total hysterectomy removes the uterus and the cervix. Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes, a procedure called a total hysterectomy with salpingo-oophorectomy.

Hysterectomy can be performed in two ways: An abdominal hysterectomy is procedure to remove the uterus through an incision in the lower abdomen. A vaginal hysterectomy is performed through an incision in the vagina or by a laparoscopic or robotic surgical approach, which uses long, thin instruments passed through small abdominal incisions. The type of hysterectomy done based on the patient’s condition e.g an abdominal hysterectomy may be recommended in case the uterus is large or doctor wants to check other pelvic organs for signs of disease.

 

Why is hysterectomy done? 

 

A hysterectomy may be done to treat the following disease conditions. 

Gynecologic cancer- In cases of cancer of the uterus or cervix, a hysterectomy may be the best treatment option. Depending on the specific type of cancer and how advanced it is, other options might include radiation or chemotherapy.

Fibroids- A hysterectomy is the only and permanent solution for fibroids, benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are possible.  

Endometriosis- In endometriosis, the tissue lining the inside of uterus (endometrium) grows outside the uterus, on the ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, patient might need a hysterectomy along with removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy).

Uterine prolapse- Descent of the uterus into your vagina can happen when supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy may be necessary to treat these conditions.

Abnormal vaginal bleeding- If the periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.

Chronic pelvic pain-  In some cases where pain chronic pelvic pain clearly arises in the uterus, hysterectomy may be recommended.  

 

What are the risks of Hysterectomy

Generally, hysterectomy is very safe, but there are risks of complications. Following risks are associated abdominal hysterectomy:

Infection

Blood clots and excessive bleeding

Adverse reaction to anesthesia

Damage to the urinary tract, bladder, rectum or other pelvic structures during surgery, which may require further surgical repair

Earlier onset of menopause even if the ovaries aren't removed

 

Before the procedure

Before surgery, the patient may have tests done to check for cancer, these may include:

Cervical Cytology (Pap test) to detect the presence of abnormal cervical cells or cervical cancer

Endometrial Biopsy- to detect abnormal cells in the uterine lining or endometrial cancer

Pelvic Ultrasound-  To see the size of uterine fibroids, endometrial polyps or ovarian cysts.

During the Hysterectomy

The procedure is done under general anesthesia and usually takes about 1-2 hours. 
To begin the procedure, the surgical team passes a urinary catheter through the urethra to empty the bladder. The catheter remains in place during surgery and for a short time afterward. Abdomen and vagina are cleaned with a sterile solution before surgery.To perform the hysterectomy, the surgeon makes a cut (incision) in the lower abdomen, using one of two approaches: a vertical incision, starting in the middle of the abdomen and extending from just below the navel to just above the pubic bone or a horizontal incision, an inch above the pubic bone. The type of incision depends on many factors, including the reason for hysterectomy, the need to explore the upper abdomen, the size of the uterus and the presence of any scars from prior abdominal surgeries. For example, hysterectomies performed for endometriosis, large fibroids and gynecologic cancers are done mainly through a vertical incision.

During abdominal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The lower part of the uterus (cervix) is usually removed (total hysterectomy) but sometimes it can be left in place (partial hysterectomy). If necessary, the surgeon may remove additional pelvic organs and tissue, such as the ovaries or fallopian tubes. 

 

After the procedure

After the surgery, the patient remains in the recovery room for a few hours for monitoring pain, medication to prevent infection and mobilise the patient soon after surgery.  

 

An abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. Patient needs to use sanitary pads for vaginal bleeding and discharge. It is normal to have bloody vaginal drainage for several days to weeks after a hysterectomy. The abdominal incision will gradually heal, but a visible scar on the abdomen will remain.

 

Important Information

A hysterectomy ends ability to become pregnant. If patient might want to become pregnant, ask doctor about alternatives to this surgery. While in the case of cancer, a hysterectomy might be the only option, but for other conditions such as fibroids, endometriosis, uterine prolapse etc less invasive treatments should be evaluated.

During hysterectomy, the surgeon might also perform a related procedure that removes both of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy). This results in a surgical menopause. Patient should discuss this option as symptoms of menopause begin suddenly after the procedure affecting the quality of life. This may require short term hormonal treatment.