Hysterectomy

Hysterectomy is the surgical removal of the uterus. Different portions of the uterus, as well as other organs, may be removed at the same time.

Reasons for performing a hysterectomy include, but are not limited to, the following:

• Symptomatic uterine fibroids: They often cause bleeding, pressure and pain.
• Endometriosis: This is a condition in which endometrial cells grow outside the uterus, causing scar tissue of the pelvic lining and between other organs in the pelvic cavity. It leads to chronic pelvic pain, painful intercourse during sex or bowel movements and prolonged or heavy bleeding.
• Adenomyosis: This is the condition in which endometrial cells grow into the muscle of the uterus causing, most commonly, painful menses and heavy bleeding.
• Abnormal uterine bleeding: This may be due to endometrial hyperplasia, an over-thickening of the uterine lining that can develop into cancer over time.
• Cancer: Cervical, ovarian or endometrial cancer is the diagnosis in approximately ten percent of hysterectomies.
• Blockage of the bladder, ureters or intestines by the uterus or a growth.

Hysterectomy may also be performed when uterine prolapse (the uterus drops down into the vagina) occurs, or in the presence of chronic pelvic conditions, such as pelvic pain or pelvic inflammatory disease that do not respond to other treatments.

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

• Hemorrhage.
• Blood transfusion.
• Injury to the ureters (tubes that carry urine from the kidneys to the bladder) and urinary bladder.
• Infection.
• Injury to the bowel or other intestinal organs.
• Difficulty with urination or urinary incontinence.

Women who have not reached menopause prior to a hysterectomy may experience menopausal symptoms such as hot flashes, mood swings and vaginal dryness after the procedure if the ovaries are removed at the time of hysterectomy.

Mood swings, depression and feelings of loss of sexual identity may also occur after hysterectomy.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

The type of hysterectomy performed and the technique used to perform the procedure will be determined by your physician, based upon your particular situation.

For women who have not yet reached menopause, having a hysterectomy means that menstruation will no longer occur, nor will pregnancy be possible.

Before the Procedure

• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• You will be asked to fast for eight hours before the procedure, generally after midnight.
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• You will be given instructions on how to cleanse your bowels before the operation. if applicable.
• You may be told to avoid using a douche and tampons on the day of the procedure.
• You will be sedated before being taken to the operating room and you will be asleep for the procedure.
• The area around the surgical site may be shaved.
• You may be given an antibiotic to take the day before the procedure.
• Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Hysterectomy may or may not require a stay in the hospital. Procedures may vary depending on your condition and your physician's practices. Often, minimally invasive hysterectomy patients go home the same day.

The procedure will vary depending on the type of procedure and surgical technique used.

Generally, a hysterectomy follows this process:

• An intravenous (IV) line will be inserted in your arm or hand.
• You will be positioned on the operating table lying on your back. For a vaginal procedure, your feet will be placed in stirrups.
• The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level during the procedure.
• A catheter (thin, narrow tube) will be inserted into your bladder to drain urine.

During an abdominal hysterectomy:

• The incision will be made vertically from the navel to the pubic bone or horizontally across the lower abdomen. The surgeon will discuss which incision is preferable in your particular situation prior to the procedure.
• The tissues connecting the uterus to blood vessels and other structures in the pelvis will be carefully cut away.
• The uterus will be removed, along with any other structures such as the ovaries, fallopian tube, and cervix, as required by your situation.
• The incision will be closed with surgical stitches that are dissolvable or staples that get removed a few days after surgery by your surgeon or his or her designee.

During a vaginal hysterectomy:

• A speculum will be inserted into your vagina to spread the walls of the vagina apart to expose the cervix.
• An incision will be made inside the vagina, near the cervix.
• The tissues connecting the uterus to blood vessels and other structures in the pelvis will be carefully cut away.
• The uterus will be removed through the vagina. If required, excess vaginal tissue and/or other tissue or structures may be removed.
• The opening into the perineal cavity created by the removal of the uterus will be closed with stitches. The vagina will be packed with antiseptic-soaked gauze.

During a laparoscope-assisted vaginal hysterectomy:

• A small incision will be made in the abdomen near the navel. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the uterus and surrounding organs can be more easily visualized. Depending on the type of laparoscope used, additional incisions may be made in the abdomen to accommodate other surgical instruments.
• The operating table will be tilted so that your head is lower than your feet. This helps to move the other abdominal organs and structures out of the surgical field and make room for the laparoscopic surgical instruments.
• The laparoscope will be inserted through the incision and the abdominal cavity will be examined. The tissues surrounding the uterus will be removed.
• Once it is detached from the surrounding tissues, the uterus will be removed through the vagina or through the laparoscope. Other organs or structures, such as the ovaries and/or fallopian tubes, may be removed, depending on your particular situation.
• When the procedure is completed, the laparoscope will be removed. The vagina will be packed with antiseptic-soaked gauze.

After the Procedure

After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of procedure performed and the type of anesthesia that is given. Once your blood pressure, pulse and breathing are stable and you are alert, you will be taken to your hospital room.

Abdominal cramping may occur after the surgery. You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.

If your procedure was an abdominal hysterectomy, you may have a thin, plastic tube inserted through your nose into your stomach to remove air that you swallow. The tube will be removed when your bowels resume normal function. You will not be able to eat or drink until the tube is removed.

You may have small to moderate amounts of vaginal drainage for several days. The nurse will check the sanitary pads periodically to monitor the amount of drainage.

You will be encouraged to get out of bed within a few hours after a vaginal procedure or by the next day after an abdominal procedure. In addition, you should perform coughing and deep breathing exercises as instructed by your nurse.

Depending on your situation, you may be given liquids to drink a few hours after surgery. Your diet may be gradually advanced to more solid foods as tolerated.

Arrangements will be made for a follow-up visit with your physician, usually several weeks after the procedure.

Once you are home, it is important to keep the incision clean and dry. Your physician will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit, if they were not removed prior to your discharge from the hospital. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The incision and the abdominal muscles may ache, especially after long periods of standing. If a laparoscope was used, you may experience shoulder pain from the carbon dioxide in your abdomen. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Walking and limited movement are generally encouraged, but strenuous activity should be avoided. Your physician will instruct you about when you can return to work and resume normal activities.

Avoid becoming constipated by including fiber and plenty of liquids in your diet. Your physician may recommend a mild laxative.

If a laparoscopic procedure was performed, you should avoid drinking carbonated beverages for one to two days after the procedure. This will help minimize the discomfort associated with the carbon dioxide gas. In addition, drinking carbonated beverages may cause nausea.

You should not use a douche, tampons, engage in sexual intercourse or return to work until your physician advises you to do so.

Notify your physician to report any of the following:

• Fever and/or chills.
• Redness, swelling or bleeding or other drainage from the incision site(s).
• Increased pain around the incision site(s).
• Abdominal pain, cramping or swelling.
• Increased vaginal bleeding or other drainage.
• Leg pain.