ABDOMINAL HYSTERECTOMY

Abdominal hysterectomy involves a surgical procedure to remove the uterus through incision at the lower abdomen.

There are basically three types of hysterectomy :

• Partial hysterectomy – Removal of uterus

• Total hysterectomy – Removal of uterus & cervix

• Radical Hysterectomy – Removal of uterus, ovaries, fallopian tubes, and upper vagina & any of the connective tissue or blood vessels that support it. It is done for uterine or cervical cancer.

Hysterectomy is not indicated unless the bleeding recurrent, severe and unresponsive to hormonal therapy and D&C on several occaasions.

Some of the conditions which may lead to abdominal hysterectomy include :

1. Fibroids is the noncancerous growth of uterus during the days of child bearing years. Uterine Fibroids are the most common reason for hysterectomy, accounting for approximately 30% of indication for this procedure.

2. DUB – Heavy menstrual bleeding. Approximately 20% to 30% of hysterectomies are performed with DUB as the primary indication.

3. Endometriosis and or Adenomyosis or Bulky uterus or Swelling on the uterus is the condition where the patient suffers from a pelvic pain due to the appearance of endometrial tissue outside the womb.

4. Chronic pelvic pain not relieved with medications.

5. Gynecologic cancer includes the uncontrolled spread & growth of abnormal cells in the female organs which include cervix, ovaries, uterus, fallopian tubes, vagina & vulva.

Patient may feel anxious and the following are some of the tips which the patient can keep in mind.

• Gathering information can help the patient gain confidence about her condition.

• Following instruction about medication is another important phenomenon which is required

• It is always better to enquire of what type of anaesthesia you will be provided before the surgery.

Should I stop OC pills before abdominal hysterectomy

• Practice of stopping OC pills 2-4 weeks prior to surgery have been discontinued as it is not supported by current prospective controlled studies and places the patient at risk for unwanted pregnancy as well as menstrual irregularities.

Recent Update regarding what parts to be removed

• Prophylactic bilateral salpingectomy to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy.

• When hysterectomy is required for non-cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed.

• It has been suggested that not removing the cervix (subtotal hysterectomy) would reduce the chances of sexual difficulties or problems with passing urine or stools.

• Surgery is faster with subtotal hysterectomy and there is less blood loss during or just after surgery, although these benefits are not large.

• With subtotal hysterectomy, women are less likely to experience fever during or just after surgery but are more likely to have long term ongoing menstrual bleeding when compared with total hysterectomy.

"Authored By Dr.Niraj Mahajan"