Hysterectomy

By , 8 March 2014

Hysterectomy
 

What is a hysterectomy?

Hysterectomy is the surgical removal of the uterus (the "womb").  

There are several types of hysterectomy, depending on the precise structures of the pelvis that are surgically removed.  These include:

  • Subtotal hysterectomy: removal of the upper part of the uterus only.  The cervix remains.
  • Total hysterectomy: complete removal of the uterus and cervix, with or without the uterine (Fallopian) tubes.  The ovaries are not removed unless specifically required.  This is the most common type of hysterectomy performed. 
  • Radical hysterectomy: removal of the uterus, cervix, tubes, ovaries, and a small part of the upper vagina.  This procedure is only required for the management of some forms of gynaecological cancer.

 

Why would a hysterectomy be needed?

A hysterectomy made be required to treat bothersome symptoms where conservative or medical (that is, non-surgical) treatments have failed or are inappropriate, such as:

Alternatively, a hysterectomy may be require to prevent or treat more serious conditions such as:

  • Pre-cancerous lesions of the cervix or uterus
  • Cancer of the cervix, uterus, tubes or ovaries

A hysterectomy is a major operation, and the decision to proceed with this form of treatment requires a careful evaluation and discussion.  If my opinion is that your condition will be best treated by undergoing a hysterectomy, I will explain this fully with you so that you feel informed, involved, and supported in your treatment decisions.
 

What alternatives are there to having a hysterectomy?

The suitability of other treatment options depend on you particular medical condition, your needs for fertility, and your personal wishes.  In general, unless cancer is suspected, a hysterectomy is only recommended after other, simpler and safer, options have failed.  Other treatment options include:

  • For heavy menstrual bleeding:
    • Medications, hormonal or non-hormonal
    • Insertion of an intrauterine device (IUD) that hormonally thins the lining of the womb
    • Surgical removal or destruction of the lining of the womb only (endometrial resection or ablation)
  • Pelvic organ prolapse:
    • Pelvic floor physiotherapy
    • Insertion of a vaginal pessary
    • Surgical prolapse repair without removing the uterus
  • Endometriosis or adenomyosis
    • Hormonal medications
    • Insertion of an IUD
  • Fibroids
    • Surgery to remove the fibroid(s) only (myomectomy)
    • Medications to shrink the fibroids (temporary only)
    • Occlusion of the blood vessels supplying the fibroids, to cause shrinkage (embolisation)
    • Specialised MRI-guided focussed ultrasound energy to destroy fibroids without surgery (*not available in many areas)
       

How is a hysterectomy performed?

There are several ways a hysterectomy may be performed, depending on the indication for the hysterectomy, whether other procedures are required at the same time (e.g. removal of ovaries, prolapse repair), the size of the uterus, and any history of previous surgery (including caesarean sections).  Methods of hysterectomy include:

  • Vaginal hysterectomy: 
    • No external/visible scars - the hysterectomy is performed through an incision at the top of the vagina
    • Most commonly if there is some degree of uterine prolapse, the uterus is not too large, and the ovaries are not being removed
    • This approach is associated with less pain post-operatively and a faster return to normal activity, compared with open hysterectomy
  • Total laparoscopic (keyhole) hysterectomy:
    • A surgical telescope ("laparoscope") is inserted through a small incision in the navel
    • Three further small (5mm) "keyhole" incisions are made in the lower abdomen through which other surgical instruments can be used
    • The uterus (and tubes/ovaries if required) are removed through the vagina after surgical dissection, and the top of the vagina is stitched closed with dissolvable stitches
    • This approach is associated with less pain post-operatively and a faster return to normal activity, compared with open hysterectomy, and is achievable in most cases by skilled gynaecological endoscopic surgeons
  • Laparoscopically-assisted vaginal hysterectomy:
    • Involves using laparoscopic ("keyhole") instruments to remove the ovaries and/or tubes, before proceeding with a vaginal hysterectomy
    • This approach has similar indications as for vaginal hysterectomy, but where removal of the ovaries is also required
  • Abdominal (open) hysterectomy:
    • This involves a horizontal (sometimes vertical) cut along the lower abdomen
    • This approach is sometimes needed for very large wombs (e.g. fibroids) or complex previous surgery
       

What happens after a hysterectomy?

Generally, after the operation:

  • You may feel some discomfort around the operation site (in most cases, pain relief in the form of tablets is all that is required)
  • There will be a catheter (drainage tube) in your bladder, that is usually removed the owning following surgery
  • Wind pain is not uncommon, and is helped by short walks around the hospital ward as soon as you are comfortable to do so
  • The length of stay in hospital depends on the type of hysterectomy, but most women are able to go home the day after surgery.  After an abdominal hysterectomy, or if other procedures were performed at the same time, your stay might be for 3 or 4 days.
  • Pelvic floor and abdominal exercises are important to commence early after surgery, and you will be seen by a specially-trained physiotherapist before you go home
     

What are some of the possible complications of hysterectomy?

Complications are possible with any surgical procedure although, thankfully, they are uncommon.  During or after a hysterectomy, complications may include:

  • Heavy bleeding, rarely requiring blood transfusion
  • Conversion from the planned approach to hysterectomy (e.g. keyhole) to open surgery
  • Blood clots
  • Pain, nausea and vomiting
  • Infection at the wound site
  • Trouble emptying your bladder after the operation
  • Cosmetic considerations - scarring at incision sites
  • Adhesion formation (internal scar tissue)
  • Rarely - injury to bladder, bowel, or ureters (tubes that carry urine from the kidneys to the bladder
  • Rarely - a fistula, or abnormal hole connecting bowel or bladder with the vagina
  • If done for unexplained pelvic pain, symptoms may not improve after a hysterectomy
  • Feelings of sadness or loss
  • The risk of pelvic organ prolapse is increased after hysterectomy
     

More information

This information is a guide only.  You may prefer to clarify any questions with your General Practitioner or by making an appointment to discuss your concerns with me.

 

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Hysterectomy
 

About Dr David Moore

Hysterectomy

David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland.  He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery.  David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments.  He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.

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