Hysterectomy

Hysterectomy is a surgical procedure conducted to remove the uterus, also known as the womb. It is an organ that holds and protects the fetus during pregnancy. The hysterectomy surgery also involves removal of the other parts of the reproductive system such as ovaries (where eggs are produced), fallopian tubes (which carry the eggs to the uterus), and the cervix (neck of the uterus).

The hysterectomy surgery can be performed through the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy), with or without the use of laparoscopy. After having a hysterectomy, the woman is not able to conceive.

Vaginal hysterectomy is the surgical procedure to remove the uterus (womb) through the vagina. Depending on the patient’s condition, the doctor will choose which part is to be removed by hysterectomy surgery.

In which conditions would the doctor suggest hysterectomy procedure?

There are many reasons why a doctor recommends this type of surgery. The general condition where hysterectomy is recommended are:

• Cancer of ovaries
• Cancer of the uterus or cervix
• Uterine prolapse – when the uterus slips from its normal position into the vagina
• Abnormal tissue growth
• In some cases, irregular or heavy menstrual flow and discomfort may make hysterectomy an important treatment option.

You should know that removal of the uterus and other reproductive organs is a serious condition and there may be several hysterectomy side effects, and it can make significant changes in your life. A vaginal hysterectomy may be contraindicated in patients with uterine cancer, big size of the uterus, and narrow vagina.

Vaginal Hysterectomy

The surgery may last for an hour.

• You will be given sedative and anaesthesia (general or epidural) so that you do not feel pain during the surgery. Then you will be provided with a breathing tube to help you breathe during the operation. A catheter will be placed into the bladder to collect urine. The total hysterectomy surgical area will be cleaned with a sterile solution before the surgery.
• During the total hysterectomy, the doctor inserts a speculum into the vagina to hold it and stretch it open. Then the doctor will make an incision around the cervix, cutting ligaments and tissues that hold the uterus in place and then slides the uterus out the vagina.
• During a partial hysterectomy, only the uterus is removed and the rest of the part is left as is. A partial hysterectomy is a less complicated procedure as compared to total hysterectomy.
• In some instances, the doctor may also cut enlarged uterus into small pieces and remove it in sections. This is called as morcellation.

Abdominal Hysterectomy

The duration of the surgery may be approximately an hour.

• The doctor will provide you a sedative before you are transferred to the surgical unit. Then the anesthesiologist will give general anesthesia. The surgical area will be cleaned with antiseptic solution.
• Then your doctor will decide whether to make a horizontal or a vertical incision. An incision is made, about 10 cm long, across the lower abdomen, cutting through the skin and muscle of the abdomen. Next, the doctor will inspect the abdominal organs.
• Once the ovaries are exposed, the uterus is separated from the bladder. Then the Fallopian tubes are tied off and cut. Now the uterus will be pulled upwards. This stretches the vagina and allows the surgeon to cut the uterus freely at the cervix.

The surgeon then closes the top of the vagina with stitches, staples, or glue and provides additional support for attaching the ligaments that once held the uterus in place. The incision is then closed and the drainage tube may be left inserted at the site. Finally, a sterile bandage is applied. The bandage is removed after 24 hours but if you have stitches, they will be removed after 5 to 10 days.

You may feel pain and discomfort in the groin and lower abdominal area after the surgery. Most of the times, the pain gets settled within a week or two, but sometimes hysterectomy recovery time may last a few weeks in some patients. You will be provided with pain relievers for that. You should not lift heavy objects and avoid doing strenuous work for few days after the surgery because it puts pressure on the surgical repair.

Daily activities such as heavy lifting, gardening, and lifting washing baskets or utensils should be avoided during hysterectomy recovery time. Stop smoking as it delays the wound repair and increases the risk of wound infection.

You may not have bowel movements for few days after the surgery during the hysterectomy recovery time. Therefore, you should have a proper diet to resolve the bowel. You should avoid heavy exercises for few months because it takes time to fully recover from the surgery.

You may have a vaginal discharge which is brownish or pinkish in color, but it is a normal condition. Inform the doctor immediately if the discharge is foul-smelling, bright red, and unpleasant. Be alert in using sanitary napkins or pads, because it may increase the risk of infection. Contact the doctor in case of any other hysterectomy side effects.