Hysterectomy

It is a surgery that involves removal of the uterus. This procedure is done when there is severe damage to the uterus and only if patient is not willing to become pregnant.

VAGINAL HYSTERECTOMY

Vaginal hysterectomy is an alternative surgical procedure to abdominal hysterectomy. In this procedure, the uterus is removed through the vagina rather than through the incision in the abdomen.

What are the advantages of the vaginal hysterectomy over abdominal hysterectomy?

Recovery in vaginal hysterectomy is much faster than abdominal hysterectomy. You may be discharged from the hospital in a day or two and you can return to your daily activities within a few weeks after the surgery.

Who are the good candidates for vaginal hysterectomy?

Individuals with the following conditions and those who don’t have enlarged uterus are considered as eligible candidates for vaginal hysterectomy,

  • Uterine prolapse: It is the protrusion of the uterus from the pelvic cavity into the vaginal canal due to weakening of the muscles and connective tissues that hold the uterus in place. It is often seen in women who had one or more vaginal births.

  • Endometriosis: It is abnormal growth of endometrium, the membrane lining the uterus, on surfaces of other organs in the pelvis such as ovaries, fallopian tubes, outer surface of the uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum.

  • Cervical dysplasia: It is the premalignant condition of the cells lining the cervix.

  • Uterine fibroids: They are the non-cancerous growths in the uterus. If the fibroids are large, abdominal hysterectomy is required.

How is vaginal hysterectomy performed?

You may be given general or regional anaesthesia. An incision is made in the vagina and the uterus is removed through it. The incision in the vagina is then closed with absorbable stitches.

What are the risks of the vaginal hysterectomy?

Vaginal hysterectomy is generally safe. Complications may include infection, blood loss, blood clot usually in the leg vein or damage to the nearby organs in the abdomen and pelvic region such as urinary bladder, ureter or bowel. Obesity, diabetes and high blood pressure increase the chances of complications due to surgery.

What to expect after the vaginal hysterectomy?

Recovery after vaginal hysterectomy is fast. Medicines are prescribed for pain and to prevent infection.

Bleeding from the vagina is normal and will last for a few weeks after the surgery. Use of sanitary pads should be preferred as tampons increase the risk of infection. You will not have periods and cannot conceive after the vaginal hysterectomy.

If ovaries and fallopian tubes are removed along with uterus in vaginal hysterectomy you may have vaginal dryness or hot flashes, the symptoms of menopause.

These may be treated with medicines, if required. You will be able to do normal activities in around two weeks after the surgery, but should not lift heavy objects or have vaginal intercourse until the sixth week or till the complete healing occurs.

What if I come across any problem during the recovery period?

You should seek immediate medical attention if you experience any of the below mentioned conditions:

  • Fever

  • Offensive vaginal discharge or heavy bleeding

  • Severe nausea or vomiting

  • Inability to empty your bladder or bowels

  • Severe pain

TOTAL LAPAROSCOPIC HYSTERECTOMY

Total laparoscopic hysterectomy is a surgical procedure for the removal of the uterus. In this technique, the uterus is separated from inside of the body and is removed in small pieces through small incisions or through the vagina. A hysterectomy is a major surgical procedure and has both psychological and physical consequences.

Why is it performed?

Total laparoscopic hysterectomy is done to treat conditions such as painful or heavy menstrual periods, pelvic pain, fibroids or may be performed as a part of cancer treatment. You should clearly understand the reason for this surgery.

Are there other alternatives to this treatment?

There are other conservative interventions which may be appropriate for your particular condition. Hysterectomy may be performed vaginally, abdominally or laparoscopically. Laparoscopic hysterectomy has benefits such as shorter recovery period, reduced postoperative pain, but it may be associated with a greater risk of complications, particularly urinary tract injury.

How is a laparoscopic hysterectomy performed?

The procedure is done under general anesthesia in the operating room. A small incision is made just below your umbilicus. The abdomen is inflated with gas and a fiber-optic instrument called laparoscope is inserted to view the internal organs.

Further, small incisions may be made on your abdomen through which tiny surgical instruments are passed. Then, the uterus and cervix are removed along with or without both ovaries and tubes.

What precautions should be taken before the procedure?

You can continue taking your regular medications, unless Dr Alexander advises otherwise. You may need to have a bowel preparation which will empty your bowel before the surgery. For this, you should be on a liquid diet (soups, jellies, juices or similar drinks) for 24 hours before the surgery. Avoid smoking and if you develop signs of illness prior to your surgery, please contact Dr Alexander immediately.

What can be expected during the recovery period?

You will be in the recovery room when you wake up from anesthesia. You may feel sleepy for the next few hours. You may have pain in the shoulder or back which is because of the gas used in the procedure. It resolves within a day or two. You may have some discomfort or feel tired for a few days after the procedure. Contact Dr Alexander if pain and nausea does not go away or is becoming worse. You should avoid strenuous activities or exercise until you recover completely.

You may have some vaginal discharge for several days after the procedure. You can return to normal activity in three months time, but complete recovery may take longer.  After the procedure, you will no longer be menstruating or be able to conceive.

You may experience bladder and bowel dysfunction and an increased risk of urogenital prolapse.

What are the possible risks and complications of this procedure?

As with any surgical procedure, there are associated risks and complications which include:

  • Problems due to the anesthesia

  • Injury to the internal organs

  • Bleeding and infection

Any specific risks and complications will be discussed prior to the procedure.

What if I come across any problem during the recovery period?

You should seek immediate medical attention if you experience any of these conditions:

  • Fever

  • Offensive vaginal discharge or heavy bleeding

  • Severe nausea or vomiting

  • Inability to empty your bladder or bowels

  • Severe pain