Patient Education

Hysterectomy

A hysterectomy can be a solution for problems of the uterus that have not responded to other treatments. Usually, it is the last resort after other attempts of improving the condition were not effective. This can be an emergency procedure that needs to be done for the safety of the patient. Since a hysterectomy is a major surgery, it is important to know the facts about what the procedure entails and what to expect.

WHAT IS A HYSTERECTOMY?

A hysterectomy is a surgical procedure that removes part or all of a woman’s uterus. It is a major surgery. There are several different kinds of hysterectomies:

  • Total Hysterectomy: This procedure removes the entire uterus, cervix, and surrounding support structures. It is usually performed to treat certain kinds of cancer and uterine problems. 
  • Supracervical Hysterectomy: A procedure where the upper part of the uterus is removed, but the cervix is left in place. 
  • Hysterectomy with Removal of Ovaries and Fallopian Tubes: A hysterectomy does not include the removal of ovaries and fallopian tubes. However, sometimes they are removed at the same time the uterus is removed. 

WHY ARE HYSTERECTOMIES PERFORMED?

The uterus may be removed to treat certain conditions that affect it, such as: 

  • Uterine fibroids 
  • Endometriosis 
  • Abnormal uterine bleeding 
  • Cancer 
  • Chronic pelvic pain 

Since hysterectomies are a major surgeries, it is important that they are only performed as a last resort due to the risks surgeries present. 

HOW ARE HYSTERECTOMIES PERFORMED?

The way your doctor chooses to perform your hysteroscopy will depend on what condition is affecting your uterus and your general physical health. There are three different ways to perform a hysteroscopy: 

  • Vaginal Hysteroscopy: During this procedure, the uterus is removed through the vagina. Vaginal hysterectomy only makes an incision in the vagina, meaning that the healing time is much faster than that of those performed through the abdomen. They also cause fewer complications and allow for shorter hospital stays. However, they cannot be performed on women with larger uteruses or adhesions (scars) from past surgeries. 
  • Abdominal Hysterectomy: This procedure is used oftentimes on women with tumors or types of cancer. Abdominal hysterectomies are performed by making an incision either horizontally or vertically in the lower abdomen to reach the uterus. Abdominal hysterectomies are a very good way for your doctor to get a clear view of your uterus, but they may have a longer healing time and hospital stay. 
  • Laparoscopic Hysterectomy: A laparoscopic hysterectomy uses a thin, telescope-like device with a camera on the end called a laparoscope that is inserted into the abdomen to guide the surgery. The camera is connected to a screen, which gives the doctor a large picture of your uterus to see. Separate small incisions may also be made for tools to be inserted. Laparoscopic surgery has many benefits over abdominal surgery, such as the incisions are smaller so there is less pain, shorter hospital stay and home recovery time, and the risk of infection is lower. However, the surgery may take a longer time, which can cause complications the longer the patient is under general anesthesia. There are three different types of this procedure:
    • Total laparoscopic hysterectomy- The laparoscope is inserted below the navel, and other small tools are inserted in other various places below it. The uterus is then detached from the wall and removed from the body in pieces that are passed out through the vagina. The cervix may be left in place. 
    • Laparoscopically assisted vaginal hysterectomy- The uterus and cervix are removed through the vagina, and the ovaries and fallopian tubes may be removed with a laparoscopy and then also passed out through the vagina. 
    • Robot-Assisted laparoscopic hysterectomy- sometimes, a robot can be attached to the laparoscope to assist with the surgery along with the surgeons. This technology is still relatively new, and more research is needed as to whether or not robotic surgery has certain benefits.  

WHAT ARE THE RISKS TO HAVING A HYSTERECTOMY?

 Although hysterectomies are one of the safest surgeries that can be performed, there are risks, as with any surgery. Infection, bleeding, damage to other organs, vein or lung blood clots, anesthesia-related complications, and death may all occur, but very rarely. Hysterectomies are safe and complications are rare. Also, your body’s healing process could cause complications that arise years later, such as scarring against certain organs.

WHAT SHOULD I EXPECT IF I AM HAVING A HYSTERECTOMY?

Before your surgery, you will have tests, and a physical to assess your current health. Your doctor may run tests on you or order chest x-rays. A few days before, your doctor might tell you to take a bowel prep and to eat very lightly. On the day of your surgery when you arrive at the hospital: 

  • You will be hooked up to an intravenous needle (IV) which will be placed on your arm, wrist, or hand, which will be hooked up to a bag that will supply you with fluids or medicine. 
  • You will be given an antibiotic to prevent infection. 
  • You may be given special stockings, devices, or medication to prevent a blood clot from forming in the legs, called a deep vein thrombosis. This is a risk with any surgery. 
  • You will be asked to state your name, type of surgery you are to receive, and other information. This is to make certain that you are the correct patient receiving the scheduled surgery. 
  • You will be given regional anesthesia (numbs part of your body) or general anesthesia (puts you to sleep). 
  • Your pubic hair may be clipped. 
  • A tube called a catheter will be inserted into your bladder, which will drain out urine during the procedure. 

After you wake up from your surgery, you will have to stay at the hospital for a variable duration to recover. You will have to walk around shortly after you wake up to prevent blood clots from forming. It is normal to have some pain afterwards, especially if you had an abdominal hysterectomy. 

It is normal to experience slight bleeding and discharge from the vagina for several weeks afterward, for which you should use a sanitary pad, NOT a tampon. Follow your doctor’s instructions very carefully while you are recovering. Do not put anything inside your vagina for the following six weeks, including tampons, having sex, and douching. You should be able to slowly return to normal activities as you heal.

WILL HAVING A HYSTERECTOMY AFFECT ME PHYSICALLY OR EMOTIONALLY IN ANY WAY?

Hysterectomies can cause both short term and long term physical and mental effects. This will depend on your age, and whether or not your ovaries are removed. 

  • Physical effects: if your ovaries are not removed and you have not gone through menopause yet, they will still continue to produce estrogen. However, if they were removed and you have not yet reached menopause, you might need hormone replacement therapy to make up for the lost estrogen. 
  • Emotional effects: some women experience emotional pain after receiving a hysterectomy because it means that they can no longer have children. However, if your depression lasts more than several weeks, you should call your doctor. 
  • Sexual effects: Some women notice that their sexual response changes when they receive a hysterectomy, because the uterine contractions that accompany orgasm are no longer present.   

IN CONCLUSION

A hysterectomy is a serious surgery that is only used as treatment for disease after all other options are tried. Although it is an extremely safe surgery, complications can still arise. Talk to your doctor about hysterectomy and whether or not this treatment would be an option for you.