  
|  |
|
| Hysterectomy - removal of the uterus |
|
|
Written by Dr Philip Owen, consultant obstetrician and gynaecologist
|
What is a hysterectomy?
Hysterectomy means the removal of the uterus (womb). A
hysterectomy may or may not be combined with the removal of the Fallopian tubes
and one or both ovaries. Removal of a tube and ovary is called
salpingo-oophorectomy, removal of both tubes and ovaries is called bi-lateral
salpingo-oophorectomies (BSO for short).
There are different types of hysterectomy, which are described
according to which organs are removed.
-
A total hysterectomy is the most common operation and this
means removal of the uterus and cervix (neck of the womb).
-
A sub-total hysterectomy means the removal of the body of the
uterus, leaving the cervix behind.
-
A radical hysterectomy involves the removal of the uterus,
cervix, a small portion of the upper part of the vagina and some soft tissue
from within the pelvis. A radical hysterectomy is only performed in cases of
cancer of the cervix by gynaecologists who have received special
training.
When is a hysterectomy necessary?
Up to one in five women will undergo a hysterectomy during their
lifetime so it is a relatively common operation. A hysterectomy is nearly
always necessary if a diagnosis of cancer of the cervix or
cancer of the uterus
is made and is usually recommended if there is
ovarian
cancer.
However, most hysterectomies are performed in women who do not
have cancer but where bleeding or pain from the uterus is causing them so much
difficulty that they wish to undergo surgery. In such cases, a hysterectomy is
only appropriate for a woman who does not wish to have children in the future.
A hysterectomy is usually an option for women with
fibroids,
endometriosis,
pelvic inflammatory
disease or
heavy periods with no
explanation. If a woman has a
prolapse of the
uterus, then a hysterectomy may be performed as part of the prolapse
repair operation.
How is a hysterectomy performed?
Hysterectomy is a major surgical procedure and is performed
under
general
anaesthesia.
In addition to the different types of hysterectomy, there are
different ways by which a gynaecologist might perform the operation. This will
be influenced by the reason for performing the hysterectomy in the first place,
the size of the uterus and the experience and preference of the individual
gynaecologist.
-
Abdominal hysterectomy is the most common method and is
performed through an approximately six inch scar made across the lower
abdomen.
-
A vaginal hysterectomy is performed through the vagina and will
leave no visible external signs that the woman has had an operation.
-
In a laparoscopically assisted vaginal hysterectomy (LAVH) the
gynaecologist uses keyhole surgery in combination with surgery through the
vagina in order to complete the operation
How will I feel after a hysterectomy?
Strong
painkillers are prescribed for the
first few days following surgery. A woman is encouraged to be mobile within 24
hours of surgery and can expect to be eating and drinking during this time
also. Most women stay in hospital for between three and five days following a
routine hysterectomy.
It is advisable to plan four to six weeks of convalescence
following a hysterectomy although the recovery time will vary from one woman to
the next. The recovery time is often shorter if a vaginal hysterectomy or LAVH
has been performed compared to an abdominal hysterectomy. The recovery time is
longest following a radical hysterectomy.
The emotional response after a hysterectomy will vary widely
from one woman to the next, often depending on the reason for the operation.
Occasionally, there will be a feeling of relief that the monthly
pain and inconvenience of periods is a thing of the past with the sensation
that she can now get on with her life in a more positive manner.
Women who have been diagnosed with cancer are frequently and
very understandably anxious that the surgery will have been successful and may
be concerned about the necessity of other forms of treatment aimed at
preventing a recurrence.
For some women there is a sensation of loss, that the place
where their children developed and were born from is now gone forever. Whatever
the emotional response, it is advisable that the woman talks it over with
someone in whom she can confide, whether it is a relative, her gynaecologist,
nurse or a friend.
What are the risks of having a hysterectomy?
No operation is free of risk. A hysterectomy is a major
operation that most women undergo without experiencing complications. If a
woman is
overweight, then
losing weight before
her hysterectomy will make the surgery easier and will reduce the likelihood of
post-operative complications.
Complications do occur from time to time and these
include:
-
heavy bleeding at the time of surgery.
-
following surgery, infection involving the wound or bladder
(cystitis) may require
antibiotic treatment.
-
surgical damage to the bladder or ureters (the narrow tubes
that carry urine from the kidneys to the bladder).
-
an uncommon but serious complication is the development of a
blood clot in the veins of the leg (venous thrombosis).
Will a hysterectomy affect my sex life?
Most women do not experience an adverse effect on their
enjoyment of sex. Often the reverse is true with an improvement in their sex
life especially if bleeding was prolonged and the uterus was causing pain
during intercourse.
Most women are able to have intercourse again six weeks after
their hysterectomy.
Will I need to start Hormone Replacement Therapy after a
hysterectomy?
If a woman has not gone through the change of life (menopause) and her
ovaries have been removed at the time of the hysterectomy, then
HRT will usually be recommended. If
the ovaries have not been removed, then they will continue to produce the
female hormone oestrogen and HRT is not necessary.
Will I need to have cervical smears performed (Pap smears) after a
hysterectomy?
If there was no cancer present before the hysterectomy and the
cervix has been removed, then there is no need for further smears to be
performed. If a sub-total hysterectomy has been performed then it is necessary
to continue in the cervical smear screening programme.
Are there alternatives to hysterectomy?
In the presence of certain cancers, there is seldom a realistic
alternative to hysterectomy. For non-cancerous conditions a hysterectomy is
usually offered when tablet treatment or other surgical procedures have been
tried and have not been successful.
For women with heavy periods with no explanation, surgical
techniques that aim to remove or destroy the lining of the womb (endometrial
ablation) can provide relief of symptoms without resorting to major
surgery.
It must be remembered that a hysterectomy or endometrial
ablation procedure is only suitable for a woman who does not wish to become
pregnant in the future.
|
|
|
Last updated 16.02.2005
|
 |
|
|
 |
| |      |
|
