Hysterectomy: Indications, Procedure, and Risks
What is hysterectomy?
Hysterectomy is a surgical procedure that involves removing the entire uterus or part of it.
This is about :
- total hysterectomy if removal of the body and cervix is ?? performed.
- subtotal hysterectomy, if the cervix remains in place.
- interfacial hysterectomy, if the ovaries and fallopian tubes remain in place.
What is this operation for?
The main indications for Hysterectomy are:
- Genital bleeding caused by uterine disease (fibroids, endometrial hyperplasia, adenomyosis …) and not subjected to elimination by medical treatment or alternative surgical methods of uterus preservation
- Prolapse of the genitals (prolapse of the genitals) along with the prolapse of the uterus
- Cancer of the uterus and ovaries
- Some precancerous diseases of the uterus
- In exceptional cases, pain in the uterus, which is not amenable to treatment with the medication method (endometriosis).
How the operation is performed
The intervention, as the case may be, may be performed under general anesthesia or local and regional anesthesia
Intervention can be done in three ways:
The essence of the operation with laparoscopic access lies in the fact that through small incisions or punctures in the abdominal cavity a laparoscope is inserted – an optical device that allows the surgeon to see the state of the internal organs on the monitor. The indications for hysterectomy laparoscopy are:
- large uterine fibroids that are accompanied by pain, continuous, debilitating bleeding
- endometriosis with pain syndrome
- endometrial precancerous processes
- bleeding of unknown etiology
- chronic pelvic pain
- cancer of the uterus, ovaries
Like any surgical procedure, laparoscopy requires a mandatory medical examination, which includes a list of standard clinical and laboratory studies. If necessary, the attending physician prescribes hormone therapy, antibiotic therapy is carried out to prevent infection during surgery.
It is believed that laparoscopic hysterectomy is the preferred and gentle method of removing the uterus, but it also has contraindications, namely:
- prolapse of the uterus
- too large uterus
- large cysts
- Grade 3–4 obesity
- recent abdominal surgery
Laparoscopic operations are performed in a hospital, and, since the procedure lasts 2-3 hours, general anesthesia is chosen for the manipulation. Three to four incisions are made surgically on the abdomen. A laparoscope is inserted into the first incision, which allows you to visually monitor the operation process on the monitor screen. Through the second incision, carbon dioxide is injected, under the pressure of which the abdominal wall is raised, thereby increasing the operative field. Laparoscopic miniature instruments are introduced through the remaining incisions, with the help of which the hysterectomy takes place. At the very beginning of the operation, an excision of the bladder and round ligaments is performed. Then the upper part of the ligamentous apparatus of the uterus and the blood vessels intersect, stopping the bleeding. On the ruptured area are stitched.
Although laparoscopy hysterectomy is famous for its many advantages (minimal bleeding, short recovery period, good cosmetic effect), it is a very painful procedure, after which narcotic painkillers are prescribed to the patient for two days. In addition, there is often a risk of complications after surgery, hysterectomy, laparoscopy, which significantly complicate the recovery period. The main problems are the patient’s reaction to anesthesia, as well as emphysema of the organs and tissues with the incorrect introduction of carbon dioxide. In addition to the operational risk and the risk associated with anesthesia, the postoperative period of the laparoscopic hysterectomy operation can be complicated:
- moderate bleeding that continues throughout the recovery period
- hematomas at the surgical site
- difficulty urinating
- the development of infection at the site of incisions in the vagina, bladder
Recovery after surgery is quite difficult. For five to six weeks, there is weakness and discomfort. While in the hospital, the patient is recommended to walk a lot, as this improves blood flow and reduces the risk of blood clots. It is strictly forbidden to lift weights for six months after laparoscopy hysterectomy, to prevent the vaginal fornix from descending. Of the medications prescribed a course of antibiotics. If the laparoscopic hysterectomy is performed with large blood loss, a blood transfusion is performed.
Removal of maca does not affect the hormonal background of the woman, but if during the operation the ovaries are removed, then the production of estrogen stops in the body, a grandiose hormonal failure occurs and menopause occurs. Therefore, immediately after the laparoscopic hysterectomy procedure, the patient is prescribed hormone replacement therapy to alleviate the symptoms of menopause. The mental state of the patient is also greatly affected. After all, a woman perceives laparoscopic hysterectomy or removal of the uterus as a loss of youth and femininity, and at the same time an opportunity to have a baby. A woman becomes irritable, nervous, there are mood swings, a feeling of inferiority arises, and as a result – depression.
At present, counseling by qualified psychologists is recommended for psychological support, since laparoscopy may be an annoying medical mistake. The lack of professionalism of doctors can permanently deprive a woman of the most important dream of life – to give birth to a child. Such amateurish actions on the part of medical personnel should not go with impunity.
Vaginal hysterectomy (or through the natural path)
Vaginal hysterectomy is a surgical operation to remove the uterus.
The body of the uterus is removed from the vagina, so this method is suitable for women who have given birth, or women who have a physiologically small uterus. This procedure is performed for patients diagnosed with cancer in the early stages.
Surgery to remove the uterus are the most radical ways to treat gynecological diseases. Depending on the diagnosis, the method of surgical intervention is chosen. Vaginal hysterectomy is performed for women:
- with small myomas
- with endometriosis
- with prolapse or prolapse of the uterus
- with endometrial bleeding
- with benign ovarian neoplasms
- with adenomyosis
- with cervical dysplasia
- with cancers of the reproductive sphere in the early stages
Before the operation, the doctor compulsorily collects an anamnesis about the patient’s state of health. At the same time, the presence of any chronic diseases such as hypertension, diabetes, congenital heart defects, and bronchial asthma is specified in detail. A standard test package is assigned.
Despite the fact that vaginal hysterectomy is a standard gynecological surgery, it still has contraindications, namely:
- history of cesarean section, adhesions
- the large size of the uterus
- big myoma
- diseases with inflammation in the body
- malignant neoplasms of the uterus, cervix, appendages
Since vaginal hysterectomy is a surgical procedure, it is performed under general anesthesia. And here the presence of a qualified specialist is important. Anesthesia is selected general or spinal anesthesia.
The surgical procedure of vaginal hysterectomy is performed by a gynecological surgeon. To remove the uterus, a semicircular vaginal incision is made. Through such access, the uterus body and cervix are separated, ligaments that hold the uterus and blood vessels intersect, and the fallopian tubes are ligated. At the next stage of the operation, the uterus and cervix are removed through the vagina, and interrupted sutures are placed on the incision. Finally, the pop-up wall of the vagina is removed. By the time the procedure lasts one to two hours. The operation is carried out exclusively in the hospital. Often, the removal of the uterus by this method takes place with complications. If the procedure is not accurate enough and correct, the procedure may cause bleeding and hematomas, and when crossing the ligaments and vessels of the uterus there is a risk of damage to the bladder.
Auxiliary vaginal hysterectomy is the same vaginal hysterectomy, only in the course of the surgical process, a laparoscope is used. Diagnostic laparoscopy allows you to carefully examine the abdominal cavity and assess the condition of nearby organs. This method of surgery is used when it is planned to remove the ovaries in addition to the uterus, as well as during the initial stages of endometrial cancer. If we compare the usual vaginal hysterectomy and operation using a laparoscope, then the second takes place with great complications, and the period of recovery and hospital stay is longer. Contraindications to surgery are:
- large uterus size
- large cysts
- endometrial dysplasia
- endometrial hyperplasia
- cancer of the uterus and ovaries
Removal of the uterus is a serious enough injury for the female body, and in order to decide on this step, indisputable evidence is required to carry it out. In addition, there is a risk of postoperative complications. The most common problems in this period are fever and bleeding, which usually occur in violation of the technique of the operation, insufficiently correct and detailed suturing, errors in measures to stop the blood. As a result of the operation, vaginal hysterectomy may cause peritonitis, the formation of adhesions, infection of the suture, pulling pain in the lower back, urinary disturbance up to incontinence, and inflammation of the lower extremity veins. In order for the rehabilitation period to proceed without undesirable consequences, infusion therapy is certainly carried out to restore blood loss, water-salt balance. In order to prevent purulent complications after vaginal hysterectomy, a course of antibiotics is prescribed. To prevent the formation of adhesions, therapeutic gymnastics and physiotherapeutic procedures are recommended. The prescription of hormonal drugs will depend on histological analysis.
In order to return to normal everyday life, a woman will need a lot of strength. After all, surgery to remove the uterus is a great stress for the female psyche, especially if the surgery was an unacceptable medical mistake. Most women are not psychologically prepared for vaginal hysterectomy and for the changes that will occur in the body. A woman has a feeling of inferiority and inability to bear and give birth to a child, physical activity decreases, signs of depression appear.
Abdominal hysterectomy (or through laparotomy)
In this case, the intervention is usually carried out through a horizontal incision of the abdomen (as with cesarean section), but in some cases, it can be performed through the vertical, between the pubis and navel. Potent painkillers (morphine derivatives) are often necessary for the first 24 hours. An installed probe for removing urine can be left in the bladder for 24-48 hours. Exit from the clinic is usually possible, starting from the 5th day after the operation.
What happens after hysterectomy?
The patient will be prescribed a suspension of the conduct of professional life for 2-4 weeks. After leaving the clinic, you will be able to gradually return to daily activities.
From sexual relations and bathing should refrain for about 4 weeks for the normal process of internal scarring.
Depending on the nature of the intervention, a postoperative visit is planned 2-4 weeks after it.
If you were not in the menopause period before the intervention:
- The main manifestation after hysterectomy will be the absence of menstruation and the inability to get pregnant, which does not mean that you are entering a menopause.
- If the ovaries remain in place, their functionality will continue until the natural menopause period begins. You will not have any hot flashes or other manifestations of menopause after the intervention.
- Removal of the ovaries entails the onset of menopause, as a result, you may begin to experience its manifestations, such as hot flashes. You can discuss with your doctor the possibility of substitution medication.
If you were in the menopause period before the intervention:
- After it, no special changes are noted.
In all cases, hysterectomy affects neither the possibility nor the quality of the sexual relationship. There are no reasons for the occurrence of undesirable manifestations, such as weight gain or depression, prescribed by hysterectomy.
Are there risks or undesirable effects?
Hysterectomy is a common and well-managed intervention; in most cases, the progress of its implementation is quite simple.
During the operation, taking into account the revealed circumstances, a decision may be made to change the method of its implementation. So, in some cases, it may be necessary to perform the opening of the abdominal cavity, whereas initially it was planned to carry out the intervention through the natural way or by the laparoscopic method. The probability of damage to organs adjacent to the uterus may be noted in exceptional cases: damage to the intestines, urinary tract or blood vessels requires special surgical intervention. In case of severe bleeding, a blood transfusion may be required.