WHAT IS HYSTERECTOMY?

Hysterectomy is a surgical procedure in which women’s uterus (womb) is removed. Uterus is the organ in which the baby grows during pregnancy. After this procedure, a female will no longer have her menstrual periods and cannot become pregnant.
 

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QUICK GLANCE ON FEMALE REPRODUCTIVE SYSTEM:

Female reproductive system provides several functions. The internal reproductive organs include

• Vagina: It is a canal that joins the cervix (the lower part of uterus) to the outside of the body. Also known as the birth canal.

• Uterus (womb): It is a hollow, pear-shaped organ where the fetus develops. Uterus is divided into two parts:

               Cervix: It is the lower part that opens into the vagina, and the main body of the uterus, called the

                Corpus: It is the main body of the uterus & it expands to hold the developing baby.

• Ovaries: These are small, oval-shaped glands that are located on either side of the uterus. They produce eggs and hormones.

• Fallopian tubes: These are narrow tubes that are attached to the uterus and they serve as a pathway for the ova (egg cells) to travel from the ovaries to the uterus. Characteristically, the fertilization of an egg by a sperm occurs in the fallopian tubes. This fertilized egg then moves to the uterus, where it implants in the uterine lining.

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WHEN IS A HYSTERECTOMY REQUIRED?

A hysterectomy is required during the following conditions:

• Uterine Fibroids causing severe pain & bleeding.

• Long term pelvic pain

• Uterine prolapse that is sliding of the uterus from its normal position into the vaginal canal.

• Endometriosis (A disorder in which tissue that normally lines the uterus grows outside the uterus).

• Abnormal vaginal bleeding

• Cancer of the uterus, cervix ,ovaries or fallopian tubes

• Adenomyosis or thickening of the uterus

TYPES OF HYSTERECTOMY

On the basis of how much of the uterus has to be removed, there are three types of hysterectomy which are mentioned below: .

• Partial or supracervical hysterectomy: upper part of the uterus is only removed, keeping the cervix intact.

• Complete or total hysterectomy: In this the whole uterus & cervix are removed. This is most commonly performed.

• Radical hysterectomy: It is an extensive procedure in which the uterus, cervix, ovaries, fallopian tubes, upper vagina, some surrounding tissues & lymph nodes are removed. It is mostly done when a patient is suffering from cancer.

• Hysterectomy with bilateral salpingo-oophorectomy: in the uterus, cervix, fallopian tubes, and ovaries are removed.

TYPES OF HYSTERECTOMY PROCEDURES

They are three main types of hysterectomy procedures:

ABDOMINAL HYSTERECTOMY (AH):

In this procedure (AH) an incision is made on the abdominal wall (tummy), which is approximately 5 inches long, cutting through the skin & connective tissue to the uterus. The cut can either be made horizontally along the bikini line, or vertically from the belly button to the bikini line (Known as a bikini-line incision).

Vertical incision is mostly made if there are large fibroids (non-cancerous growths) in the womb, or for some types of cancer. Once the womb has been removed, the incision is stitched up.

The procedure takes about an hour to complete and is performed under general anesthesia.

Recommended:

• When the womb is enlarged by fibroids or pelvic tumors and it's not possible to remove it through your vagina.

• If the ovaries need to be removed.

Advantages:

• There is a complete, unobstructed look at the uterus and surrounding area during the surgery.

Disadvantages

• Longer recovery time & intensity of pain is more severe as compared to the other procedures.

• It gives a large scar.

VAGINAL HYSTERECTOMY (VH):

This is considered as the standard procedure for removing uterus. In this procedure, a small incision is made at the top of the vagina. With this incision, uterus (and cervix, if necessary) is separated from its connecting tissue and blood supply and removed through the vagina. If the cervix is not to be removed, then the incision is made around the cervix, which is then reattached when the surgery is finished.

Recommended:

• Uterine prolapse

Advantage:

• Healing is faster

• Less pain

• No external scarring

Disadvantage:

• Less operating area, because of which there is limited access to other organs in the pelvic region.

LAPAROSCOPIC HYSTERECTOMY (LH):

Also known as key-hole surgery, is the preferred method for removing the organs & the surrounding tissues. In this procedure special surgical tools are used to operate through small incisions made in the abdomen and vagina.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera is inserted through a small incision into the abdomen. This will provide a clear access to the internal organs. Instruments are then inserted through the other small incision that were made in the abdomen or vagina to remove the womb, cervix and any other parts of the reproductive system.        

Recommended:                                                                             

• Endometriosis

• Large uterus

Advantages

• Less pain

• Faster recovery

• Shorter stay in the hospital

• Fewer surgical complications

• Minimum scarrin

GETTING PREPARED FOR THE SURGERY

For getting ready for the procedure, it is very important for the patient to be fit & healthy. Following steps should be taken before going for the procedure:

• Exercise regularly

• Quit smoking

• Have a healthy and balanced diet

• Lose weight, if the patient is overweight

ONCE IN THE HOSPITAL:

Before the procedure, following things will be done:

• Blood and urine sample will be taken for testing

• Patient may receive an enema

• Abdominal and pelvic areas may be shaved (or partly shaved)

• Antibiotics will be given

• A urinary catheter will be placed in the bladder

HYSTERECTOMY RECOVERY

After the procedure, patient will wake up tired & have pain. They will be prescribed pain medications to give them relief from pain. They will also feel the need to empty the bowl frequently.

PATIENT WILL HAVE:

• Dressings placed over the wound

• Drainage tube in the abdomen (if the patient has an abdominal hysterectomy) to take away any blood from beneath the wound – these tubes usually stay in place for one to two days

• A gauze pack inserted into the vagina (if the patient has vaginal hysterectomy) to minimize the risk of bleeding, this usually stays in place for 24 hours

HYSTERECTOMY RECOVERY TIME

Duration of stay in the hospital will depend on the patient’s age & health. After a VH, patient is discharged after 3-4 days. Whereas those who have gone for an AH, will be discharged after 4-6 days.

PATIENT WILL BE ADVISED:

• To walk

• Not to put anything in the vagina, for a minimum of 6 weeks after the procedure.

• For the initial 6-8 weeks, patient is advised not to pick up any heavy thing or do any physically straining household work.

• Patient is advised to rest as much as possible for the initial 6 weeks.

HYSTERECTOMY RISKS 

Hysterectomy procedure is considered to be a safe procedure but it can cause major and minor complications:

• Painful wind: This will gradually get better.

• Brownish – red vaginal discharge: This is a normal discharge which will be present till 4 weeks.

• Body weight : Lot of women gain weight after hysterectomy

• Emotional & psychological effects: Lot of women feel stressed out & depressed after the surgery.

• Menopausal symptoms: Females who have got their ovaries removed will experience menopausal symptoms for about 3- 4 days.

• Decline in memory & cognitive skills

• Other effects :

  • Infection

  • Bleeding - possibly during or after surgery

  • Bowel blockage

  • Urinary tract injury

  • Anesthesia problems

  • Blood clots in the lungs or veins

MYTHS & FACTS

• Myth: If someone had a hysterectomy, they will need to take at least 6 weeks off from work to recover.

• Fact: These days minimally invasive surgery (laparoscopic surgery) is performed so that a patient can return to normal activity as their body permits. Patient feels better within two weeks after this surgery.

• Myth: Hysterectomy can cause menopause.

• Fact: Hysterectomy removes only the uterus, and has nothing to do with the ovaries. It’s the ovaries and not the uterus, which provides estrogen. At times ovaries are removed at the time of hysterectomy, but that is not the part of the procedure.

• Myth: There will be a big empty space where the uterus was.

• Fact: If the uterus is removed, the bowel falls into the space formerly occupied by the uterus. Hence there will be no “empty space.”

• Myth: Hysterectomy is the only option.

• Fact: It is very important to understand that hysterectomy is never an option for a person who is uncertain, on whether their family is complete or not. Secondly, some patients may pose such an anesthetic risk that all options should be explored before resort to hysterectomy.

HEALTHY LIFESTYLE AFTER HYSTERECTOMY

It is very important to keep yourself fit after the procedure. By following these simple things after the procedure, patient can maintain their fitness & wellness:

• Increase fiber intake

• Drink plenty of water

• Opt for healthy protein & fat food

• Exercise regularly

• Enough of sleep & rest

REFERENCES

http://www.nhs.uk/conditions/hysterectomy/Pages/Introduction.aspx

http://www.webmd.com/women/guide/hysterectomy

http://www.healthcommunities.com/gynecologic-surgery/types-surgical-procedures-hysterectomy.html

http://www.medscape.com/viewarticle/712569_5

https://innovativegyn.com/hysterectomy-myths-and-facts-part-2-changes-to-my-body/