A simple abdominal hysterectomy is a surgical procedure done to remove the entire uterus and in some cases the cervix.
Uterus is the womb where the baby grows when a female is pregnant, and cervix is the narrowed down part of the uterus, which acts as a birth canal during delivery or labour.
According to the Centres for Disease Control and Prevention (CDC), around 11.7 percent of women had a hysterectomy surgery in the US between the ages of 40-44.
Reasons for Hysterectomy
In case of following situations, the doctors may suggest hysterectomy.
- Uterine fibroid is the commonest cause. Fibroids are noncancerous growths in the uterus. Though they are not cancerous they are quite notorious to cause heavy menstrual bleeding and pain or pressure in the pelvis.
- Menstrual disorders (heavy bleeding or bleeding in between cycles) - Of unknown cause.
- Cervical dysplasia ? Precancerous state of the cervix.
- Uterine prolapse ? The uterus sags into the vagina.
- Endometriosis ? Increased growth of the inner lining of the uterus leading to heavy menstrual bleeding.
- Cancer of the uterus (E.g: endometrial cancer)
In stage 1 and low-grade cancer and in younger women the removal of the uterus and cervix without removal of ovaries might be done rarely.
This procedure is also done in very rare precancerous conditions of the uterus (carcinoma in situ).
- Rupture of uterus during labour
Not all cases call for hysterectomy, but in cases where rupture site is of poor prognosis or there is extensive damage.
Before surgery, following steps are important:
- Complete pelvic examination by the doctor.
- Pap smear ? A swab is brushed through the vagina over the cervix, the cells obtained are sent to lab for study.
- Ultrasonography of the pelvis.
- Complete blood count.
Types of Hysterectomy procedures:
This is the commonest type.
A vertical or more preferred horizontal incision on the abdomen is taken and the uterus is removed.
Here the uterus removal is done through the vagina.
Conditions such as uterine prolapse call for this type of procedure.
Here a laparoscope, which is a thin tube to view the inner structures, is used.
There are two types:
- Laparoscopy assisted vaginal hysterectomy (LVAH): This procedure is similar to vaginal hysterectomy but patients with prior surgery or large abdominal mass do not fit for such procedure.
- Abdominal laparoscopic hysterectomy: Here 2 to 3 small cuts are made over the abdomen and the uterus is freed of its attachments and removed.
Apart from the above mentioned techniques depending on the parts removed we have ?
Supracervical hysterectomy ? Where the cervix is not removed.
Total abdominal or laparoscopic hysterectomy ? The cervix along with the uterus is removed.
Radical hysterectomy ? The uterus, cervix and the surrounding structures are removed.
Apart from the complications of anaesthesia there are other problems, which may arise, such as:
- Damage to other organs such as the bladder. Blockage of intestines (bowels) may occur. Vaginal shortening in radical hysterectomy.
- Infection, bleeding and clot formation.
- Pelvic pain.
- Alteration in sex drive ? Improvement seen in majority of cases, but in some painful intercourse problems appear.
- A woman can never bear a child.
Hospital Stay and Postoperative Care
- For abdominal routes, the stay is for 3-5 days.
- The patients are encouraged to walk on the second day itself.
- Returning to work will take around eight weeks.
- Heavy physical activity is not advised for about 6 weeks.
- Avoid vaginal douching and sex for about 5-6 weeks.
About 71% of patients do feel a lot better of their complaints, feel better mentally and physically, The pros and cons should be discussed with the doctor before going ahead with the procedure. In addition, the alternatives have to be discussed such as endometrial ablation (removal of the inner lining of the uterus), myomectomy (removal of the muscular lining of the uterus) and a few others.