Hysterectomy: Description, Complications, Risks and Prognosis

By | 28/02/2018
hysterectomy anatomy

A hysterectomy is the surgical removal of the womb (uterus).

It is usually required to treat cancer of the womb and is often necessary to treat other tumors, such as ovarian cancer, which may spread to the uterus.

Other conditions, such as fibroids, adenomyosis, endometriosis, and prolapse of the uterus, may be treated with a hysterectomy if other treatments have failed.

A hysterectomy may sometimes be needed after a woman delivers a baby if the placenta has grown into the walls of the womb (Placenta accreta).

It is surgery to remove the uterus (womb) of a woman. The uterus is a hollow muscular organ that feeds the fetus during pregnancy.

Description

There are several types of hysterectomy

A total hysterectomy involves the removal of the womb (uterus) and cervix (neck of the womb). A subtotal hysterectomy requires removal of the uterus, but the cervix remains untouched.

There will still be a risk of cervical cancer, so the patient must continue having a cervical screening in the future.

Total hysterectomy with bilateral salpingo-oophorectomy involves removal of the ovaries, fallopian tubes, womb, and cervix.

Sometimes, medical experts resort to this procedure in cancer treatment.

Radical hysterectomy is used to treat cancer. Here the ovaries, fallopian tubes, womb, cervix, the upper part of the vagina, nearby lymph glands, and adjacent fatty tissue are all removed.

There are some ways surgeons can remove the uterus. Vaginal removal typically does the least damage and has the shortest recovery time. Doctors remove the uterus through the vagina, but they cannot remove the ovaries in this manner.

Conventional abdominal surgery may be needed when large fibroids or tumors are present, or the ovaries and fallopian tubes need to get removed too.

Doctors make an incision in the lower abdomen. This operation has the most prolonged recovery time. A patient can expect to be off work for several weeks, and should not lift anything heavy (including shopping) while recovering.

The doctors can also use Keyhole surgery (laparoscopic surgery). The ovaries and fallopian tubes can be removed using keyhole techniques as well.

Recovery time is usually somewhat less than with conventional surgery. Doctors typically carry out hysterectomies using total anesthesia, but sometimes they use local anesthesia for vaginal removal.

During a hysterectomy, you may have the entire uterus, or part of it removed. Medical experts can also remove the fallopian tubes and the ovaries.

There are many different ways to have a hysterectomy. It can be done through:

  • A surgical incision in the abdomen (open or abdominal call).
  • Three to four small surgical incisions in the belly and then using a laparoscope.
  • A surgical incision in the vagina and using a laparoscope.
  • Three to four small surgical incisions in the belly, to perform robotic surgery.

You and the doctor will decide the type of procedure. The choice will depend on your medical history and the reason for the surgery.

Complications and Side-Effects

Modern surgical techniques mean that severe complications from surgery are rare. Infections may occur, but doctors can treat them with antibiotics.

Some damage to other organs, such as the bladder or bowel may occur, but in most cases, they can get repaired.

If doctors remove the ovaries, early menopause may come as a result. Even if doctors were to leave ovaries in their place, they might still cease to function eventually, since they receive part of their blood supply from the uterus.

There is an increased risk of urinary incontinence and vaginal prolapse in women who have had a hysterectomy, although these may not occur until many years later.

Early menopause increases the risk of osteoporosis and cardiovascular disease. Hormone replacement therapy can be given but carries its risks.

Having a hysterectomy for a non-cancerous condition at the age of less than 65 means that your life is likely to be somewhat shorter than it would otherwise have been.

It is not an operation that people should undergo hastily. If you don’t have cancer, it’s a good idea to discuss other treatment options with a knowledgeable specialist before having the operation.

In recent years the number of hysterectomies has started to decrease in the USA, having been previously on the rise for many decades, reaching a peak in 2002.

Why people choose the procedure

There are many reasons why a woman may need a hysterectomy, such as the following:

  • Adenomyosis, a condition that causes abundant and painful periods
  • Cancer of the uterus, most often endometrial cancer
  • Cervical cancer or changes in the cervix called cervical dysplasia that can lead to developing tumors
  • Ovarian cancer
  • Chronic (prolonged) pelvic pain
  • Severe endometriosis that does not improve with other treatments
  • Severe and prolonged vaginal bleeding that people cannot control with other medical procedures
  • Slipping of the uterus into the vagina (uterine prolapse)
  • Tumors in the womb, such as uterine fibroids
  • Uncontrollable bleeding during labor

Hysterectomy is major surgery. Some people can get their conditions treated with less invasive procedures such as:

  • Embolization of the uterine arteries
  • Excision of the endometrium
  • Using Birth Control Pills
  • Use of analgesics
  • Use of an IUD (intrauterine device) that secretes the progestogen hormone
  • Pelvic Laparoscopy

Before the procedure

Before deciding to undergo a hysterectomy, ask your healthcare provider what to expect after the procedure.

Many women notice changes in their body and in the way they perceive themselves. Talk to the provider, your family, and your friends about these possible changes before undergoing this surgery.

Risks

The risks of any surgery are:

  • Allergic reactions to medications.
  • Respiratory problems.
  • Blood clots, which can cause death if they travel to the lungs.
  • Bleeding.
  • Infection.
  • Damage to nearby body areas.
  • The risks of a hysterectomy are:
  • Injury to the bladder or ureters.
  • Pain during sexual intercourse.
  • Early menopause if the ovaries got removed.
  • Decreased libido.
  • Increased risk of heart disease if the ovaries got removed before menopause.

Expectations (prognosis)

The length of your recovery depends on the type of hysterectomy. The average recovery times are:

  • Abdominal hysterectomy: 4 to 6 weeks.
  • Vaginal hysterectomy: 3 to 4 weeks.
  • Total or robot-assisted laparoscopic hysterectomy: 2 to 4 weeks.

A hysterectomy would trigger menopause if your ovaries got removed during the procedure. Excision of the ovaries can also lead to decreased libido.

The doctor may recommend restorative estrogen therapy. Discuss the risks and benefits of this therapy with your provider.

If doctors did a hysterectomy because of cancer, you might need additional treatment.