Hysterectomy
What
is it?
Hysterectomy is the surgical
removal of the uterus.
The uterus is a pear-shaped organ located
at the top of the vagina. A hysterectomy can
involve other reproductive organs in addition to
the uterus, depending upon the reason for the
surgery. A
woman who has had a hysterectomy will no longer
have a menstrual period each month and will no
longer be able to have children.
Who
needs this procedure?
A hysterectomy is the usual
treatment for women with uterine, ovarian, or
cervical cancer; severe endometriosis; fibroid
tumors that are causing bleeding and other
complications; or heavy, uncontrollable vaginal
bleeding. It
may be necessary as treatment for prolapsed
uterus, in which the uterus protrudes through the
vagina; pelvic inflammatory disease; and
endometrial hyperplasia, which is a potentially
precancerous condition.
It has also been used as a permanent
sterilization procedure to prevent pregnancy. Hysterectomy
is the second most common operation performed in
the United States.
How
do I prepare for this procedure?
If you and your doctor decide
a hysterectomy is the best treatment for you, you
will need to sign a release form showing you
understand the procedure and giving the doctor
permission to perform the operation.
Your doctor will order blood and urine
tests before the surgery. You’ll
meet with the anesthesiologist to talk about the
type of anesthesia you will have for the surgery. With
a local anesthetic, you will remain awake and only
the part of your body where the incision is made
will be made numb so you don’t feel any pain.
A general
anesthetic makes you feel as if you are in a deep
sleep so you don’t feel any pain.
Follow all instructions provided by your
doctor concerning food and drink before your
surgery. Generally,
you should not eat or drink anything after
midnight. If
you normally take medications, check with your
doctor about how to take them the morning of your
surgery. You
may need to use a laxative or enema before the
surgery to empty your bowels.
The day of your surgery, you’ll receive
an intravenous (IV) line in your arm for fluids
and medications.
You may also have a catheter to drain urine
from your bladder until you are able to urinate on
your own. Both
the IV and catheter will be remove within a day or
two of your surgery.
How
is this procedure performed?
The type of hysterectomy you
need depends upon the reason you need the surgery.
In a total hysterectomy, the uterus and the
cervix are removed. This is the most common kind
of hysterectomy, usually performed for uterine and
cervical cancer.
When the fallopian tubes and ovaries are
removed along with the uterus, it is called
hysterectomy with bilateral salpingo-oophorectomy.
This
procedure may be performed to reduce the risk of
ovarian cancer.
A subtotal, or partial, hysterectomy
removes only the uterus and is used to treat
fibroids, abnormal bleeding, or pelvic pain.
A radical hysterectomy
removes the uterus, cervix, ovaries,
oviducts, fallopian tubes, top part of the vagina,
lymph nodes, and lymph channels. It
is performed when cervical or endometrial cancer
has spread to the cervix, and has the longest
recovery period.
Hysterectomies can be performed abdominally
or vaginally.
The choice depends upon your doctor and the
type of hysterectomy you need.
With an abdominal hysterectomy, the surgeon
makes a cut in the abdomen, similar to a cesarean
section, through which he or she removes the
uterus and other reproductive organs, if
necessary. An
abdominal hysterectomy accounts for most of the
hysterectomies performed in the United States.
It gives the surgeon a good view of the uterus and other
reproductive organs, allows the surgeon to remove
even large fibroids, and gives the surgeon room to
work around and see any adhesions (scarring) from
previous surgeries.
However, abdominal hysterectomy does leave
a scar, has some discomfort associated with the
recovery period, and has a longer recovery period
than the vaginal hysterectomy.
With a vaginal hysterectomy, the incision
is made near the top of the vagina. Through
this incision, the surgeon can cut and tie off the
ligaments, blood vessels, and fallopian tubes. The
uterus is then cut free and removed through the
vagina. The
surgery and hospital stay are shorter than the
abdominal hysterectomy and women usually return to
normal activities after around four weeks.
The vaginal hysterectomy is less painful
than the abdominal procedure and leaves no
exterior scar.
However, if you have large fibroids or need
more than just the uterus removed, the vaginal
hysterectomy is not possible.
Because it is difficult for the surgeon to
actually see the uterus and surrounding tissue
during the vaginal procedure, he or she may use a
laparoscope.
This is a slender tube equipped with a tiny
camera and is inserted through a small incision
below the belly button.
The surgeon can then see the uterus on a
television monitor.
He or she uses small instruments inserted
through two other tiny incisions in the abdomen to
cut and tie off the blood vessels, fallopian
tubes, and ligaments.
The uterus is then removed though a small
incision at the top of the vagina.
The hospital stay is very short, and women
generally recover within two weeks.
However, only very skilled surgeons are
able to perform the laparoscopic-assisted vaginal
hysterectomy.
What
can I expect after the procedure?
The time you must stay in the
hospital and your recovery period depend upon the
reason for your surgery, the type of surgery you
need, and how the surgery is performed.
Your doctor can provide you with these
details.
Self-care
tips
Follow your doctor’s
instructions carefully during your recovery
period. Avoid
heavy lifting, get plenty of rest, and have
regular checkups after the surgery.
Always contact your doctor if you
experience heavy bleeding, fever, nausea or
vomiting, dizziness, pain during urination, a
leaking or open incision, or leg pain, swelling,
or redness. If
you have both ovaries removed, you will benefit
from estrogen replacement therapy to reduce the
risk of heart disease and osteoporosis (brittle
bone disease).
Some women experience changes in sex drive
and some weight gain after a hysterectomy.
Seek support and advice from your doctor on
these issues.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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