Hysterectomy

Overview

A hysterectomy involves the surgical removal of the uterus, and depending on the specific circumstances, adjacent organs like the ovaries and fallopian tubes may also be removed. This procedure eliminates the possibility of pregnancy and menstruation for the patient.

Throughout pregnancy, the uterus serves as the space where a fetus develops, while the menstrual cycle involves the shedding of the uterine lining. By undergoing a hysterectomy, individuals can no longer conceive and will no longer experience menstrual periods.

Conditions such as cancer, fibroids, uterine prolapse, and abnormal bleeding may necessitate hysterectomy as a treatment option. Recovery typically takes four to six weeks, varying based on the type of surgery performed.

Types

The type of hysterectomy required will be discussed by the healthcare provider based on the patient’s condition. This will establish if they require the removal of their ovaries and/or fallopian tubes.

• Total hysterectomy: Preserving the ovaries while removing the uterus and cervix.
• Supracervical hysterectomy: Removing the uterus just in the upper portion, leaving the cervix intact.
• Total hysterectomy with bilateral salpingo-oophorectomy: Removing the ovaries (oophorectomy), fallopian tubes (salpingectomy), uterus, and cervix. Menopausal symptoms will begin if the ovaries are removed if they have not yet gone through menopause.
• Radical hysterectomy with bilateral salpingo-oophorectomy: the removal of the ovaries, fallopian tubes, uterus, parts of the surrounding tissue, and lymph nodes, as well as the upper portion of the vagina. When cancer is involved, this kind of hysterectomy is carried out.

Reasons for undergoing the procedure

Patient could require a hysterectomy for the following reasons:

• Cancer: A hysterectomy could be the best course of action for a patient who has cancer of the cervix or uterus. Other treatment options may include chemotherapy or radiation, depending on the particular cancer and its stage.
• Fibroids: Fibroids can only be permanently treated through a hysterectomy. Growths within the uterus are called fibroids. They may result in anemia, severe bleeding, pelvic discomfort, and pressure on the bladder.
• Chronic pelvic pain: If they experience persistent pelvic discomfort that originates in the uterus, surgery can be required as a last option. But some types of pelvic discomfort cannot be resolved by a hysterectomy. Getting an unnecessary hysterectomy might lead to more issues.
• Endometriosis: Endometriosis is a disorder in which tissue that resembles the lining of the uterus develops outside. On the fallopian tubes, ovaries, and other surrounding organs, the tissue may develop. In cases of severe endometriosis, a hysterectomy may be required in order to remove the uterus, ovaries, and fallopian tubes.
• Uterine prolapse: There might not be enough support to hold the uterus in place if the pelvic floor muscles and ligaments stretch and weaken. Uterine prolapse is the term used when the uterus moves into the vagina and becomes displaced. Urine leaks, pelvic pressure, and constipation issues might result from this disorder. Treatment for this medical condition occasionally involves a hysterectomy.
• Heavy and irregular vaginal bleeding: A hysterectomy could provide relief if the periods are heavy, irregular, or last several days per cycle. Surgery to stop the bleeding is reserved for cases where no other treatment is possible.
• Gender-confirmation surgery: In order to better match their bodies to their gender identities, some persons choose to have the uterus and cervix removed during hysterectomies. Ovarian and fallopian tube removals are possible side effects of this type of surgery.

The patient can no longer become pregnant after the hysterectomy. Consult their healthcare provider about alternate possibilities for treatment if there’s a chance they might wish to get pregnant in the future. If they have cancer, the only option available may be a hysterectomy. There could be alternative treatments available for diseases including fibroids, endometriosis, and uterine prolapse.

The patient may have a similar operation to remove the fallopian tubes and ovaries during hysterectomy surgery. Surgical menopause results from the removal of both ovaries if the woman is still menstruating.

Symptoms of menopause resulting from surgical intervention can begin immediately after the procedure. Short-term hormone therapy can be prescribed to alleviate discomfort and manage symptoms effectively.

Risk

Although a hysterectomy is usually safe, complications can occur with any major operation. Among the risks of a hysterectomy include the following:

• Infection.
• Severe bleeding.
• Blood clots.
• Injuries sustained during surgery that may require further procedures to correct, such as damage to the bladder, rectum, or other pelvic tissues.
• An adverse reaction to anesthesia.
• Early onset of menopause, even in cases when ovaries are left in place.
• Urinary tract infection.

Before the procedure

The operation will be thoroughly explained by a healthcare provider, who will also go over any potential risks. Discuss any worries the patient may have with them.

Tests may be required for the patient to rule out cancer and other diseases. The healthcare provider’s strategy for the procedure could change in response to test results. Tests might consist of:

• Pap test: Commonly known as cervical cytology, it detects abnormal cervix cells or cancer.
• Blood tests: Should rule out any medical conditions that might interfere with surgery.
• Endometrial biopsy: Which extracts a sample of uterine lining tissue. This test may detect endometrial cancer or abnormal cells in the uterine lining.
• Pelvic ultrasound: This is a diagnostic procedure that can reveal the size of ovarian cysts, endometrial polyps, and uterine fibroids.
• Pelvic MRI: This is a scan that produces images of the body’s organs and tissues using a magnetic field.
• CT of the abdomen and pelvis: It displays cross-sectional images of the uterus and other pelvic tissues using X-rays obtained of the body from various angles.

The patient will take a bath or take a shower with specific soap the day before and the morning of the procedure. This may assist in lowering the chance of infection. Their medical staff could also advise patients to use an enema to clear their rectum and a vaginal douche to clean their vagina.

During the procedure

Their healthcare provider will decide which type of hysterectomy is necessary and the most effective surgical technique to carry out the operation. They’ll change into a hospital gown and have their heart rate monitored by monitors. To administer medicines and fluids, an intravenous (IV) line is inserted into a vein in their arm.

Anesthesiologist will administer either general anesthesia (the patient will be put into sleep during the procedure), or regional anesthesia also known as epidural or spinal anesthesia (medicines are injected close to lower back nerves to “block” pain while the patient is conscious).

The healthcare provider can perform a hysterectomy using one of numerous surgical techniques:

• Vaginal hysterectomy
  • An incision is made at the top of the vagina to remove the uterus. No external incision is present.
  • The vagina is stitched up with dissolvable sutures.
  • Typically used to treat nonmalignant (or noncancerous) problems such as uterine prolapse.
  • Patients usually go home the same day after surgery.
  • Requires fewer complications and recovers faster—up to four weeks—making it the recommended method.
• Abdominal hysterectomy
  • An abdominal incision measuring six to eight inches is used to remove the uterus.
  • The incision is made across the top of the public hairline or from the belly button to the pubic bone. The wound will be closed by the surgeon using staples or stitches.
  • Mostly utilized in cases of cancer, enlarged uteruses, or disease spreading to other pelvic regions.
  • It usually necessitates a lengthier recovery period and a two- or three-day hospital stay.
• Laparoscopic hysterectomy
  • A little incision made in the belly button allows for the insertion of a laparoscope, a thin tube with a video camera on the end, into the lower abdomen.
  • Multiple smaller incisions are used to introduce surgical instruments.
  • The vagina or abdominal incisions can be used to remove the uterus in tiny parts.
  • Patient may need to spend one night in the hospital, while some patients return home on the same day after the procedure.
  • Recovery takes less time and causes less discomfort than an abdominal hysterectomy.
• Robotic-assisted laparoscopic hysterectomy
  • A robotic machine assists the surgeon during the entire procedure.
  • A laparoscope is placed into the abdomen to observe the pelvic region.
  • Three to five incisions are made around the belly button to implant small, thin surgical equipment. Surgeons operate robotic arms and equipment with control.
  • The recovery period follows that of a laparoscopic hysterectomy.

After the procedure

The patient is taken from the operating room to the recovery area and finally to their hospital room. The healthcare team will:

• Look for indication of discomfort.
• Give them medication to manage their discomfort.
• As soon as possible following surgery, encourage them to get up and walk around.
• Suggest that they consume little meals and stay hydrated.
• Instruct them to observe for any surgical complications.

The patient may require hospitalization for one to two days, although it could extend longer depending on individual circumstances. Management of vaginal bleeding and discharge can be achieved through the use of sanitary pads. Following a hysterectomy, patients may experience bloody vaginal discharge for several days to weeks. If they encounter continuous or heavy bleeding comparable to menstrual flow, it’s important to inform their healthcare provider promptly. While the incision will heal over time, it will leave a noticeable scar on the abdomen.

Outcome

A hysterectomy can make a patient’s life more pleasurable, particularly if they are experiencing heavy and irregular bleeding or persistent pelvic discomfort. A hysterectomy might potentially save their lives if they have a higher chance of developing uterine cancer.

After a hysterectomy, most patients recover in four to six weeks. The type of hysterectomy they underwent and the technique of the procedure will determine how well they recover. Recovery after a laparoscopic and vaginal hysterectomy is quicker than that of an abdominal hysterectomy.

The patient should progressively raise their level of physical activity while monitoring their symptoms. They should cease if something hurts them. Discuss specific instructions, such as what medications to take, while recovering at home with their healthcare provider.

A hysterectomy will cause the periods to stop. Occasionally, they could have sensations similar to those of menstruation and feel bloated. For four to six weeks following surgery, mild vaginal bleeding or a dark brown discharge are typical.

Any redness, bruising, or swelling will go away in four to six weeks, although the patient may experience discomfort at the location of the incision for around four weeks. It is typical to experience burning or itching around the incision. In addition, they could feel numb all the way down their leg and surrounding the incision. If it occurs, this is typical and normally goes away within two months. Both internal and exterior scarring are common. Compared to abdominal hysterectomies, laparoscopic operations will result in smaller, less noticeable scars.

If the patient’s ovaries are still intact, they should not experience hormonal effects. However, women who have had their ovaries removed along with their uterus before menopause may encounter common menopausal symptoms such as hot flashes. Hormone replacement therapy could be recommended by the healthcare provider to alleviate these symptoms.

After a subtotal hysterectomy, patients might have mild periods for up to a year. This can happen due to the presence of small remnants of the endometrial lining in the cervix. While some individuals may initially experience feelings of loss, these emotions are often transient. For many, a hysterectomy can be a life-saving procedure that improves their overall health and well-being. It’s important for patients to discuss any emotional concerns they may have with their healthcare provider.
Other areas of their lives will probably either improve or go back to how they were before the operation. For instance:

• It’s likely that they will maintain a satisfying sexual life following surgery if they enjoyed fulfilling relationships prior to the hysterectomy. After a hysterectomy, they could even experience increased sexual gratification. This might be the result of severe bleeding from a uterine issue or alleviation from persistent discomfort.
• Their quality of life may increase if their symptoms are relieved. They could have a general feeling of wellbeing.

The patient may need to contact their healthcare provider if they experience any of the following:

• Fever.
• Bright red vaginal bleeding.
• Having problem urinating, or having burning sensation.
• Constant pain.
• Redness, swelling, or drainage at the incision site.
• Severe nausea and vomiting.