Hysterectomy

What Is It?

A hysterectomy is the surgical removal of the uterus. Depending on the type of hysterectomy, other pelvic organs or tissues also may be removed. The types of hysterectomy include:

• Subtotal, supracervical or partial hysterectomy — The uterus is removed, but not the cervix.
• Total or complete hysterectomy — Both the uterus and the cervix are removed. About 50 % of all hysterectomies are total hysterectomies, and this procedure is the most common form of hysterectomy done in women older than age 45.
• Total hysterectomy plus unilateral salpingo-oophorectomy — This procedure removes the uterus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in place. After surgery, the remaining ovary should produce enough female hormones if the woman has not reached menopause.
• Total hysterectomy plus bilateral salpingo-oophorectomy — This is the removal of the uterus, cervix, and both fallopian tubes and ovaries. Removing both ovaries will cause a "surgical menopause" in a woman who has not reached menopause because the production of female hormone stops when the ovaries are removed.
• Radical hysterectomy — This procedure removes the uterus, cervix, both ovaries, both fallopian tubes and nearby lymph nodes in the pelvis. This procedure is only done in some women who have gynecological cancer. Since both ovaries are removed, levels of female hormones drop to menopause levels after surgery, and hormone supplements may be needed.

Hysterectomies can be done with different types of surgical incisions (surgical cuts). About 75% of all hysterectomies are abdominal hysterectomies, in which the uterus is removed through a horizontal or vertical incision in the lower abdomen. The rest are vaginal hysterectomies, in which the uterus is removed through an incision in the vagina.

In one form of vaginal hysterectomy, called a laparoscopically assisted vaginal hysterectomy (LAVH), the uterus is removed through the vagina, but the surgeon also makes several small incisions in the abdomen. These incisions allow the surgeon to insert a laparoscope, a telescopelike instrument with a camera for viewing inside the abdomen. Through the laparoscope, the surgeon can inspect the pelvic organs and insert small instruments to help remove the uterus.

Hysterectomy is a very common surgical procedure in the United States, especially in middle-aged women between 40 and 50. About one out of every three women in the United States eventually have a hysterectomy.

What It's Used For

About one-third of all hysterectomies are done because the uterus is enlarged with fibroids, which are benign (noncancerous) growths of uterine muscle fibers in the uterus. About one out of 10 hysterectomies are done to treat uterine cancer, and about one out of 20 of the surgeries are done because of severe menstrual bleeding problems. Hysterectomies also are used to treat a prolapsed uterus, endometrial hyperplasia (abnormal growth of the uterine lining which may lead to cancer) or endometriosis.

Preparation

Because a hysterectomy removes the uterus, this surgery will prevent you from ever becoming pregnant. If you wish to remain fertile, you should ask your doctor if there is any other treatment for your gynecological problem. If there is any chance that you might be pregnant, you should be carefully tested by your doctor before surgery.

You may have preliminary blood tests, a urinalysis, an electrocardiogram (EKG) and a chest X-ray to make sure there are no undiagnosed medical problems that could complicate your surgery. A pelvic ultrasound may be done to evaluate the uterus and ovaries, depending on your medical history and physical exam. Beginning at least eight hours before surgery, you must not eat or drink anything. This reduces the risk of vomiting during surgery. Most women are asked not to eat or drink anything after midnight before surgery to allow the stomach to be as empty as possible. Antacids commonly are given just before surgery to counteract any remaining stomach acids and to further reduce the risk of vomiting.

How It's Done

A hysterectomy takes about one to two hours. You will be under general anesthesia during the surgery. Before the procedure, an intravenous (IV) catheter will be inserted into one of your veins to deliver fluids and medications. What happens next depends on the type of hysterectomy:

• Abdominal hysterectomy — The surgeon will make a 5-inch to 7-inch incision in your lower abdomen. The incision can be vertical (from the belly button to just above the pubic bone) or transverse (horizontal at the pubic-hair line, often called a "bikini incision"). The uterus is freed from its attachments to blood vessels and supportive tissues, and then is removed through the incision. Then the layers of the abdomen will be closed with sutures (stitches) and the incision may be closed with sutures or titanium (metal) staples. Staples or non-dissolving skin sutures usually are removed about one week after the surgery.
• Vaginal hysterectomy — An incision will be made in the wall of the upper portion of your vagina. Through this incision, the surgeon will use sterile instruments to detach your uterus and to tie off nearby blood vessels. Your uterus will be removed through your vagina, and then the incision will be stitched closed. Once the vagina has healed, the length of the vagina should be adequate for comfortable sexual intercourse.
• Laparoscopically assisted vaginal hysterectomy (LAVH) — As in vaginal hysterectomy, an LAVH allows the uterus to be removed through your vagina. However, three or four small incisions also are made in the wall of the abdomen to allow the surgeon to insert a laparoscope and additional surgical instruments. These instruments are used to help free the main body of the uterus and to remove the ovaries, if necessary. At the end of the procedure, the upper portion of the vagina is stitched closed and the small abdominal incisions are closed with sutures or surgical tape.

After your surgery, you will be taken to a recovery room. There, your vital signs (blood pressure, heart rate, breathing rate and temperature) will be monitored closely, and you will be given pain medication if needed. After a few hours, you will be taken to your hospital room to rest and to begin healing. Your IV line will be removed, and you will be allowed to eat as soon as your digestive system is ready to handle liquids and solid food. You may remain in the hospital for three to five days. During the first few days after your hysterectomy, you may have slight vaginal bleeding and discharge.

Follow-Up

Before you leave the hospital, your doctor will tell you when to schedule a follow-up office visit. At this visit, your doctor will check the healing of your incisions and remove any sutures or staples. If you have had an abdominal hysterectomy, the soreness at your incision site should ease gradually over a period of about six weeks. In most cases, you can resume sexual intercourse in three to four weeks. Talk with your doctor for guidance about resuming sexual intercourse and other activities (exercising, driving, sports, lifting).

Risks

While not common, possible complications from a hysterectomy include but are not limited to:

• Excessive bleeding
• Infection
• An injury to the bowel or bladder
• An injury to nerves that regulate the bladder, causing either incontinence or overfilling of the bladder
• Ablood clot in the veins of the legs (called “deep venous thrombosis”). If such a clot floats out of the leg and lodges in the lungs, it is a more dangerous complication called a pulmonary embolism.

When To Call A Professional

Once you return home, call your doctor immediately if you develop any of the following problems:

• Fever
• Excessive bleeding from your vagina
• Bleeding, discharge, swelling or extreme tenderness at your incision site
• Nausea, vomiting or abdominal pain
• Trouble urinating
• Feelings of excessive sadness
• Difficulties or discomfort during sexual intercourse (once the gynecologist says it's OK to resume sex)

Additional Info

American College of Obstetricians and Gynecologists

P.O. Box 96920

Washington, DC 20090-6920

Phone: (202) 638-5577

http://www.acog.org/