The surgical procedure to remove the uterus, which may also include the removal of the cervix, ovaries and/or the Fallopian tubes. Performed by a gynecologist, it is by far the most common gynecological surgical procedure. After the operation, a patient will no longer be able to have children. If you have not yet gone through the menopause, you will no longer have periods.
A hysterectomy is used to treat conditions that affect the female reproductive system, such as heavy periods (menorrhagia), chronic (long-term) pelvic pain, non-cancerous tumors (fibroids) and cancer of the ovaries, womb, cervix or fallopian tubes.
It is a major operation with long recovery time. It is usually only considered after alternative, less invasive treatments have been tried.
There are several circumstances when you may be recommended to have a hysterectomy. The most common reasons include heavy periods, pelvic inflammatory disease (PID), endometriosis, prolapse of the uterus, cancer
The procedure begins with sedating the patient using a general anesthetic. After this, it can either be performed in the traditional way, that is open surgery or by a minimally invasive technique. However, which method is used depends upon the condition of the patient.
With a traditional Open Hysterectomy, a 5 to 7-inch incision is made across the abdomen. It can either be up and down or side to side. The Uterus is removed from the incised area and stitches are put in place and bandages are applied over it.
Whereas with the Minimally Invasive Hysterectomy, it is performed by various methods, but the basics are the same; for the Vaginal Hysterectomy, an incision is made in the vagina and the uterus is removed through it. Stitches are applied within so no visible scarring is seen. For the Laparoscopic Hysterectomy, a laparoscope with small surgical tools is inserted through several small incisions in the abdomen and the uterus is removed accordingly with minimal scarring.
The surgeon may also opt to remove all parts or only a part of your uterus, depending on the reason for a hysterectomy and may also follow the removal of your cervix and/or ovaries
Removal of Cervix
Subtotal or Supracervical hysterectomy – only the upper part of the uterus is removed, keeping the cervix in place.
- Total hysterectomy – the whole uterus and cervix are removed.
- Radical hysterectomy – this type of hysterectomy is done when cancer is present. The whole uterus, tissue on the sides of the uterus, the cervix and the upper part of the vagina are removed.
Removal of Ovaries
- Salpingectomy – when the tubes are removed.
- Oophorectomy – removal of the ovaries.
- Salpingectomy-oophorectomy – the entire uterus, tubes, ovaries are removed.
Length of Stay in Destination
Open hysterectomy is a 1-2 hour procedure and after the operation, a 2-3 day stay at the hospital is advised. Your health conditions are regularly monitored during this period. If everything goes fine, you are allowed to leave. With Minimally invasive techniques, it can be an outpatient procedure and you are discharged on the same day. Still, you have to stay in this country for at least 14 days post-op. During this time, you will go back to the hospital for a few follow-up check-ups. Pain killers are prescribed to help with the discomfort. Your stitches are removed after 7-10 days, at which point you can continue your recovery before traveling home 2 weeks after the procedure.
An average of 4-6 weeks is required to recover from an open hysterectomy. While minimally invasive techniques for hysterectomy take only 3-4 weeks, hence why these methods are more commonplace these days, given the lack of scarring too. You should allow at least 6 weeks before returning to work and longer if your job requires physical labor.
You will need to rest as much as possible and a follow-up appointment should be arranged 6-12 weeks after your surgery to check your recovery progress. This can be arranged with any specialist in your home country.
Also, consider the following points when recovering:
- Abstain from sexual activity for at least 6 weeks after the surgery.
- Do not lift heavy objects or children for 5 to 6 weeks.
- Do not drive until you’re fully recovered.
- Keep yourself active after surgery. Start walking a little in the early days, but don’t overdo it.
- Take your time climbing the stairs.
- Change your bandages regularly as a dirty bandage can also cause infection.
- Give yourself the proper time to heal and ensure you get plenty of rest.
Hysterectomy has a success rate of 80% and can cure several medical conditions as mentioned above. As for some women, it is the answer to several years of suffering from uterine problems. For others, it is the last resort to treat a life-threatening condition such as cancer.
Since this is major surgery, possible risks and side effects could include chronic pain, vaginal prolapse, vaginal fistula, urinary incontinence, wound infections, blood clots, or a hemorrhage. There are also long term risks associated with having a hysterectomy which should also be considered, such as an increase in the risk of heart attack and stroke, urinary problems, sexual function problems, depression, hormone deficiency, or a decrease in blood supply to the ovaries.
Alternatives to Hysterectomy
There are a few alternatives to having a hysterectomy:
- Uterine artery embolism: this is an alternative treatment to uterine fibroids. Small particles are released into the uterine artery through a catheter. Blood supply to the uterus is discontinued. This causes the shrinkage and ultimately end of the fibroids.
- Loop electrosurgical excisional procedure (LEEP): this is an alternative treatment option to cancer. This technique works by removing pre-cancerous cells before cancer spreads.
- Endometrial ablation: excessive endometrial lining can be removed through ablation using this technique. Electrical energy or heat is used for the thinning of the uterine lining.
Vaginal pessary: this is an alternative for the treatment of uterine prolapse. An object is inserted from the vagina which keeps the uterus at a fixed place.
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