HYSTERECTOMY

Hysterectomy is the surgical removal of a woman's uterus. It may also involve the removal of the fallopian tubes and ovaries. Once a hysterectomy is performed, a woman can no longer have children or menstrual periods. Hysterectomy is used to treat a number of conditions, such as excessive menstrual bleeding and cancer.
Operation procedure

The operation is done under general anaesthetic, which means you will be asleep during the operation. You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. Alternatively you may be given an epidural. This completely blocks feeling from the waist down and you will stay awake during the operation. If you have an epidural, you're likely to be given sedation - this relieves anxiety and helps you to relax. The operation may be performed via a lower abdominal incision or through the vagina.

ABDOMINAL HYSTERECTOMY

For an abdominal hysterectomy, a cut is usually made horizontally along your pubic hairline. For most women, this results in a small scar. Some patients may need a vertical incision in the lower abdomen.

VAGINAL HYSTERECTOMY

A vaginal hysterectomy is performed through an incision (cut) at the top of the vagina. This may or may not involve the use of a laparoscope. A laparoscope is a slender instrument used in 'keyhole' surgery. During a laparoscopic assisted vaginal hysterectomy, surgery is performed via three or four small incisions in the abdomen. It is completed through the vagina. Vaginal hysterectomy is a preferred option for many women as it avoids the need for a long abdominal cut. An abdominal procedure is generally recommended when large fibroids or cancer is present.

TYPES OF HYSTERECTOMY

• Total Hysterectomy
  • The entire uterus and cervix is removed, but the ovaries are retained.
• Subtotal (Partial) Hysterectomy
  • The uterus is removed, but the cervix may be retained. While removal of the cervix is generally advised because it is a potential cancer site in the body, some women consider that it serves a purpose during penetrative sex. If the cervix is kept, regular Pap smears are necessary.
• Hysterectomy And Bilateral Salpingo-Oopherectomy
  • The uterus, fallopian tubes and ovaries are removed. This operation is performed if cancer of the ovaries or the uterus has been diagnosed. It may also be performed for severe infection or endometriosis.
• Radical Hysterectomy
  • The most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes. This may be performed if cancer of the cervix, ovaries or uterus is present.

Immediately after the operation

After the operation, you can expect some soreness around the operation site - your doctor will prescribe pain-killing medication for you. You may experience 'wind' pain for a few days. Depending on the procedure and your condition, the intravenous tube in your arm will be removed sometime during the first few days. The catheter (drainage tube) in your bladder is usually removed within 24 hours of surgery, unless the bladder was traumatised during the procedure. As soon as possible, you will be encouraged to get out of bed and go for short walks around the ward.

How long do I have to be hospitalized?

Depending on the type of surgery, you can expect a hospital stay of between two and seven days. Recovery is generally faster after vaginal surgery than abdominal surgery.
Following surgery, it is important to start pelvic floor and abdominal exercises as soon as possible. These exercises strengthen the muscles in the pelvis and help maintain normal bladder function and vaginal muscle tone. Your doctor or physiotherapist will let you know how soon you can start these particular exercises.

Recovery and Recuperation

You will need to take it easy for a few days. Continue with the exercises as given by physiotherapist at the hospital. You can lift light items but don't lift anything heavy.
It's normal to have some blood-stained vaginal discharge for about six weeks after surgery. Use sanitary towels rather than tampons to help reduce the risk of infection. If you have any concerns or you have a vaginal discharge that is bright red, heavy or smells unpleasant, contact your GP as you may have an infection.
You will need to wait at least six weeks before having sexual intercourse so that the stitches placed at the top of your vagina when the cervix is removed aren't disturbed. It's natural to worry that a hysterectomy might affect your sex life. This isn't necessarily the case and depends on a number of factors, including the exact type of operation you have - ask your surgeon for more advice. A full recovery can take up to 12 weeks, but you may recover faster than this.

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