HYSTERECTOMY

A hysterectomy is a surgical removal of the uterus. Based on the type and reasons of hysterectomy performed, associated organs such as the fallopian tubes, ovaries and cervix may also be removed at the same time. It is essential for a woman to be aware that a hysterectomy is a major surgery and should not necessarily be considered the primary solution for heavy menstrual bleeding. A hysterectomy should be undertaken only by women for whom more conservative treatment options have not worked, who have a complete family and who understand the risk involved with this type of major procedure.

Uterine leiomyomata or fibroid are the most common reason for hysterectomy, accounting for approximately 30% of indication for this procedure. Approximately 20% to 30% of hysterectomies are performed with DUB as the primary indication. Hysterectomy is not indicated unless the bleeding recurrent, severe and unresponsive to hormonal therapy and D&C on several occaasions.

Advantages

• Eliminates the risk of Ovarian Cancer
• Good option for women with a family who wish to have sex without any chance of pregnancy

Length

• The procedure may last for between one to two hours

Causes

Hysterectomies are generally performed to treat

• Uterine fibroids
• Heavy bleeding
• Endometriosis
• Adenomyosis
• Uterine prolapse
• Uterine cancer

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. This review has found no evidence of a difference between these two different operations for these outcomes. 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.

Preparation

Certain medications are to be specifically avoided pre surgery:

• Pre operative antibiotics.
• Avoid wearing any jewelry.
• Void the bladder regularly.
• Avoid post operative prophylactic antibiotics.

Procedure

The three methods of performing hysterectomy are:

• Laparoscopic Hysterectomy
• Vaginal Hysterectomy
• Abdominal Hysterectomy

In Laparoscopic hysterectomy, small keyhole incisions are made in the abdomen and/or navel for introducing the Laparoscope into the body. The laparoscope is a long, flexible tube that has miniature surgical instruments attached to its head, along with a camera and light source. The images are transmitted to the screen, via which the surgeon can perform the procedure. The recovery period is minimal for this procedure, and the patient might even get a discharge the very next day.

Vaginal hysterectomy is a surgical procedure in which the uterus is removed through the vagina. During a vaginal hysterectomy, the uterus is surgically disconnected from the ovaries, fallopian tubes and upper vagina, and also from the blood vessels and connective tissue with which it is supported. The uterus is then removed through the vagina. In some cases, vaginal hysterectomy is also done with the help of a laparoscope. After surgery, the patient is kept under medical observation for a longer period.

Abdominal Hysterectomy is a surgical procedure in which the uterus is removed through an incision in the lower abdomen. One or both ovaries and fallopian tubes may also be removed during the procedure

All surgeries are performed under General Anesthesia or Spinal Anaesthesia

Follow up

Patients are required to follow up with their physician for up to 4-6 weeks post surgery. In the following cases, consult your physician immediately:

• Abnormal vaginal bleeding
• Chest pain, coughing, difficulty in breathing
• Painful urination

"Authored By Dr.Niraj Mahajan"