A hysterectomy is a common gynaecological procedure that involves the removal of the uterus. Hysterectomy may be complete (removal of the uterus body and cervix) or partial (removal of the uterus body, leaving the cervix intact). If the hysterectomy is performed via abdomen, it is called Abdominal Hysterectomy.
Hysterectomy is commonly performed gynaecological procedure that involves the surgical removal of the uterus. Hysterectomy may be complete (removal of the uterus body and cervix) or partial (removal of the uterus body, leaving the cervix intact).
Depending on the method to perform the procedure, hysterectomy can be categorized as
Large, symptomatic fibroids in the walls of the uterus (noncancerous tumours) are the most common conditions that necessitate hysterectomy.
Endometriosis, gynaecological cancer, persistent or heavy vaginal bleeding, chronic pelvic pain or uterine prolapses are other reasons for a hysterectomy.
The procedure may also lead to removal of one or both of the ovaries and fallopian tubes, depending on the patient’s condition.
Before scheduling a hysterectomy procedure, the surgeon will refer the patient to a general practitioner to ascertain current medical status, and identify any condition that may interfere with the surgical procedure and recovery thereafter.
A detailed physical examination that includes medical history will ensure the patient’s readiness towards the surgery.
In some cases, the surgeon recommends tests like pap smear, endometrial biopsy or ultrasound of pelvic region for checking cancer.
Generally the procedure is of 1 to 2 hours and is performed under general anestheisa. During the procedure, the surgeon generally follows these steps
Urinary bladder will be emptied by passing a catheter through the urethra. Then abdomen and vagina will be cleaned using a sterile solution.
For open hysterectomy, the surgeon will either make a verticle incision from below navel to pubic bone or make a horizontal incision above pubic bone. The type of incision will depend on the uterus size and main reason for the procedure. Uterus will be removed and incision will be sutured.
A laparoscopic hysterectomy is a minimally invasive surgical procedure that removes the uterus through a small incision in the abdomen. A tiny camera is inserted through it and the entire surgery is performed by watching images captured by the camera on to a screen. Two or three separate incisions in the lower abdomen allow specialized instruments to be inserted the pelvic region to facilitate the removal of uterus.
Removal of ovaries during hysterectomy might be recommended if the patient’s family has a history of ovarian cancer or the doctor identifies abnormal growth in the ovaries.
If open hysterectomy is performed, the patient has to stay in hospital for 1 to 2 days. While in case of laparoscopic procedure, the patient may be allowed to go home on the same day.
The patient has vaginal bleeding for a few days after the surgery. Generally, it is not as heave as in menstual period. For most women it take 4 to 6 weeks to get back to normal routine.
Patients will have two to four scars in different parts of the abdomen from the incisions during surgery. Some stitches and glue will dissolve by themselves, while other stitches, staples and clips will require removal at the hospital about a week after the operation.
There will certain permanent changes in life, as mentioned below
The patient will not have any menstrual periods
The patient cannot get pregnant
If the ovaries are removed, then the patient reaches menopause earlier than expected.
In case the cervix was not removed during the laparoscopic surgery, the patient will be required to routinely undergo screening (smears), while removal of ovaries might necessitate hormone replacement therapy (HRT). Discussions with the gynaecologist can chart the best way forward.
Risk and Complications
Although hysterectomy is a safe procedure, there are certain risks involved.
Clotting of blood in legs
Adverse effects on surrounding organs
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