- It is one of the most done gynecological operations. - lt involves the removal of the uterus, cervix and in some cases the
ovaries and fallopian tubes.
Indications:
1) fibroids.
2) Endometriosis 3) uterine prolapse. 4) Uterine, cervical, ovarian cancer
5) Chronic pelvic inflammatory disease. 6) Abnormal uterine bleeding unresponsive to therapy.
7) Postpartum -life threatening- bleeding.
Types of hysterectomy:- 1- Total abdominal hysterectomy: which involves the removal of the uterus and cervix through an abdominal incision. 2-Subtotal hysterectomy: this involves the removal of the uterine corpus without the removal of the cervix through an abdominal incision. 3-Radical hysterectomy: in addition to the removal of the uterus,cervix, ovaries and tubes, it involves the removal of lymph nodes and the upper vagina. 4- Vaginal Hysterectomy. 5- Laparoscopic assisted vaginal hysterectomy.
Why a female needs her uterus? 1- She needs it for menstruation.
2- She needs it for pregnancy and delivery.
Contraindications:- 1- unfit for anesthesia. 2-in cases of vaginal hysterectomy: Contraindications are: - large uterus. - Pelvic adhesion
- advanced cancer.
Workup you need to do before hysterectomy:
- Complete blood count.
- Blood group and cross match (possible need to prepare blood before the operation
- Pap smear.
- Endometrial sample.
- Pelvic ultrasound.
- Some cases may need MRI ,CT scan, Cystoscopy.
Complications:
-Wound infection - Bleeding. - Bladder, ureteric injury. - Bowel injury. - Nerve damage. - Ileus. - Deep venous thrombosis, pulmonary embolism.
How to be prepared for the operation? - You need to have a warm bath. -Shave your mons hair
- You will be evaluated by the anesthesiologist. - The operation can be done under general anesthesia or under spinal anesthesia. - The abdomen and the vagina are sterilized with iodine, Foley catheter is inserted to clear the urine.
- Then you will be covered by sterile drapes. - Incision is done either abdominally: (vertical in the midline) or (just below the abdominal crease) or vaginally according to what you decided prior to the operation.
- Surgery will take 1-2 hours. - You will stay in the recovery room for 30 minutes to one hour in order to monitor your blood pressure, pulse, breathing, bleeding
- Foley is removed 6 hours post operatively unless there is complication, and you will be advised to ambulate in order to decrease the risk of thrombosis.
- You may need to stay in the hospital for a couple of days unless you have complications then you may need a longer admission time.
- When you go home you can do your daily activity one week after the operation but avoid: 1- Intercourse. 2- Lifting heavy objects. 3- Doing strenuous exercise for at least 6 weeks postoperatively.
Does hysterectomy affect your life? 1- You may notice absence of bleeding. 2- You may noticed absence of pain you previously suffered from. 3- You may complain of premenopausal symptoms as hot flushes, dryness especially if you underwent removal of the of the ovaries. In this case you may need hormone replacement therapy. 4- You May suffer from incontinence which may need medications. 5- Sexual life differs from one female to another some report better sexual life because they get rid of pain and bleeding. Others miss the feeling of uterine contractions which happen during intercourse, so in these cases it is better to preserve the cervix if possible.