Hysterectomy

About the Procedure

A Hysterectomy is a procedure to remove a woman's uterus and possibly other nearby reproductive organs. Reasons for removing the uterus include malignant or benign tumors, fibroids, excessive bleeding, vaginal or uterine prolapse, endometriosis, severe complications of childbirth, and sterilization. Hysterectomy is the most common gynecological surgery in the United States with a high percentage for benign circumstances. Doctors encourage alternative treatment of disease whenever possible, especially in pre-menopausal women for whom the hormonal adjustments have significant effects. In a Radical Hysterectomy, primarily used in the treatment of cancer, all reproductive organs with the exception of the lower end of the vagina are removed. A Total Hysterectomy includes removing the uterus and the cervix, and a Partial Hysterectomy removes the uterus but not the cervix. Historically, the ovaries were removed during this surgery as a preventive measure against ovarian cancer but recent studies indicate a negative impact on long-term survival with removal of the ovaries. Because of the serious adverse effects of a hysterectomy, advancements in the treatment of reproductive diseases in women are particularly welcomed.

A gynecologist or general surgeon performs hysterectomies in a hospital commonly with general anesthesia but, in less invasive procedures, epidural or spinal anesthesia is available. The traditional, open abdomen hysterectomy is rarely used today; reserved for complicated situations and when there's a need to explore the abdominal cavity. The procedure takes two to four hours and requires one to three days in a hospital. A laparectomy is the more common surgical option, offering the benefit of easy access to the organs with a smaller incision and less recovery time. An incision is made in the abdomen immediately above the pubic bone and the procedure is accomplished using a laparascope by removing the uterus through the incision. Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) is becoming increasingly popular because there are no scars other than the tiny holes where the laparoscopes are inserted. Not all patients are eligible for the vaginal procedures and there are hysterectomies which require a more extensive technique.

What to Know Before the Procedure

Each technique has its benefits and disadvantages. In the search for smaller incisions, less pain, shorter hospital stay and recovery period, and decreased risk of infection, techniques such as LAVH increase anesthesia risks because it takes longer to perform. In addition to complications involving injury to surrounding organs, there are surgery-related problems which may not show up immediately, such as bowel blockage from scars in the intestines, or clots developing in the wound. When the surgery is made difficult because of large fibroids, extensive endometriosis, or cancer, there is an increased risk for damaging nearby structures and vessels. The most significant complication of a hysterectomy is a sudden, early menopause. The body adjusts to a slow reduction in estrogen but if the ovaries are removed during the hysterectomy, the woman immediately experiences the uncomfortable physical symptoms of menopause, as well as an earlier risk of osteoporosis, heart disease, and stroke. The physical symptoms of a surgical menopause have been found to be more severe, more frequent, and continue longer than those involved in a natural menopause.

What to Know After the Procedure

Following the procedure, the patient may be sleepy and in pain. Even with the latest invasive techniques, many women are not discharged until the day after surgery while others remain for up to five days. Depending on the procedure, the incision will require attention or will be covered with a small bandage. The larger the incision and extent of the surgery, the more pain will be experienced. Recovery may be as long as six weeks although normal activities are usually resumed in one to three weeks. It's important to rest and increase activity over a period of time. Showers are recommended until the incision(s) has healed. Vaginal bleeding and discharge is common for several days to weeks. Do not use tampons or douches; sanitary pads are recommended. Sexual activity can not be resumed until eight weeks post-surgery unless otherwise advised by the surgeon.

If you Need to Travel Outside of your Local Hospital

Due to the nature of the procedure, ongoing research, and the development of new treatment methods, it’s advised that a woman spend time looking into all of her options. Speak to multiple doctors about their methods, risks of complication, success rates, and typical recover times. Speak with doctors about new advancements in the procedure as well as risks and benefits associated with them. The information gathered about the procedure may play a large role in the decision on where to have it performed. Keep in mind that there is the possibility of a long recovery time that may inhibit travel depending on the method used for the procedure.