Hysterectomy: Indications and Complications

Hysterectomy is a surgical procedure for removal of the uterus. It is the second most frequently performed surgery in women of reproductive age. Annually 600,000 American women undergo hysterectomy. By the age of 60, one third of the women have had a hysterectomy. There are multiple types of hysterectomy:

• Partial hysterectomy: the uterus is removed but the cervix is left in place
• Total hysterectomy: uterus and the cervix are removed
• Hysterectomy with bilateral salpingo-oopherectomy: uterus, cervix, fallopian tubes and ovaries are removed
• Radical hysterectomy: uterus, cervix, fallopian tube, upper part of vagina and lymphnodes surrounding the uterus are removed.

Procedure of hysterectomy

Hysterectomy can be performed as an inpatient or an outpatient procedure. There are multiple methods for performing hysterectomy:

• Vaginal hysterectomy: the surgery for removal of the uterus happens through the vagina. There is no incision made on the abdomen. It is generally the first option of choice. Vaginal hysterectomy cannot be a mode of surgery for women with bulky uterus or women who have had previous surgeries involving the uterus (which leads to scarring and fibrosis around the uterus).
• Abdominal hysterectomy: the surgeon puts an incision on your abdominal wall to the pelvic organs. This procedure provides better visualisation of the organs.
• Laparoscopic assisted vaginal hysterectomy: three small incisions are made in the lower abdomen and a camera and surgical instruments are introduced through them. The uterus is operated upon with the help of these instruments and removed from the body.
• Laparoscopic abdominal hysterectomy: one small incision is made for the insertion of camera and instruments through which the uterus is operated upon. The uterus is removed from the body through the same incision. This method can be used only for partial hysterectomy.
• Robot assisted laparoscopic hysterectomy: through the three small incisions in the abdomen the instruments or laparoscopy are introduced into the lower abdomen. The surgeon performs the surgery from a remote control area by giving commands to the robot arms handling the laparoscopic instruments.

Indications for Hysterectomy

Hysterectomy is used to treat multiple conditions like:

• Cervical cancer
• Uterine cancer
• Chronic pelvic pain
• Uterine prolapsed
• Abnormal uterine bleeding
• Uterine fibroids
• Endometriosis

Hysterectomy is also done in life threatening situations like rupture of uterus following childbirth.

Preparation for Hysterectomy

Your provider will record a history of your medical condition and perform a thorough physical examination. A few routine tests for pre clearance will be ordered by your anaesthesia team. Your provider would like to know about all the medications that you’ve been taking then; you may be asked to stop taking some of them in preparation for the surgery. Inform your doctor if you have a history of allergic reaction to any medication or anaesthetic agent. It is advisable to arrange for someone to drive you home after you are discharged from the hospital.

Complications of Hysterectomy

Hysterectomy is one of the safest surgical procedures. Complication rates are relatively low. The complications seen are:

• Bleeding during and after surgery
• Injury to surrounding organs, during surgery, like urinary bladder and ureter
• Blood clot formation in the leg. This clot may dislodge from the leg and travel to the lung and lodge in the arteries there with disastrous consequences
• Fever and infection

Abdominal hysterectomy has the greatest rate of complication amongst the different methods.

Recovery after Hysterectomy

Following the surgery you will be continuously monitored as the effect of anaesthesia wear off. Depending upon the method used during surgery you may either be allowed to go home on the same day or will have to stay in the hospital for a few days. You will be encouraged to start walking on your own as soon as you can after the surgery, this helps in reducing the risk of formation of blood clots in your legs. You might also be prescribed blood thinning medications to prevent the same. Pain after the surgery for a few days is a common symptom. Your provider will prescribe medications for the management of pain. You might also experience bleeding and discharge from your vagina for a few weeks after the surgery, use sanitary napkins after the surgery. It is advisable to not put anything in the vagina for 6 weeks after the surgery. A few women experience constipation and inability to urinate after the surgery, these symptoms generally improve with time on their own.

Sources

• Centers for Disease Control and Prevention Website, Key Statistics from the National Survey of Family Growth, Atlanta, GA: Centers for Disease Control and Prevention 2015
• Choosing the Route of Hysterectomy for Benign Disease: The American Congress of Obstetricians and Gynecologists 2009
• ACOG FAQ hysterectomy