Your doctor has recommended a hysterectomy to treat your condition. A hysterectomy is an operation which involves the removal of the uterus. After a hysterectomy you will no longer have periods and you will be unable to become pregnant.
Total Hysterectomy - The surgeon will remove the whole of the uterus, including the cervix.
Subtotal Hysterectomy - The surgeon will remove the top part of the uterus, leaving the cervix behind.
Radical Hysterectomy This is a more extensive hysterectomy performed for cancer of the uterus or cervix.
With any type of hysterectomy, the ovaries and fallopian tubes may be removed as well (Salpingo-oophorectomy). This is more commonly done in women over the age of 45. Please feel free to discuss your preferences with your doctor.
Abdominal Hysterectomy - The operation is performed through a 15-20cm incision in the abdomen. The incision may be horizontal and quite low (Bikini line) or vertical from the umbilicus down to the pubic bone. This is the traditional way of performing a hysterectomy and is still required in some difficult cases. It usually requires a longer hospital stay and longer recovery period than the other methods of performing a hysterectomy.
Vaginal Hysterectomy - The uterus is removed via incisions in the vagina. This is the safest way to perform a hysterectomy. Its main disadvantages are that it may not be technically possible to perform (eg large uterus), and that the surgeon may not be able to see or treat other problems inside the abdomen.
Laparoscopic Hysterectomy - Through 4 small incisions in the abdomen, and by using "keyhole surgery" techniques, the uterus and/or ovaries can be cut free and removed via the vagina. This is the newest form of hysterectomy. It is only performed by a small number of surgeons. Initially there was a slightly higher incidence of complications as surgeons were learning the procedure. It is now felt that the risks are comparable to abdominal hysterectomy, but the recovery time is shorter.
Laparoscopically Assisted Vaginal Hysterectomy "Keyhole surgery" is used to help the surgeon perform a vaginal hysterectomy in situations where the only other option would be abdominal hysterectomy. Performed by many gynaecologists, it is useful for removing the ovaries or when other pathology is present, such as fibroids or endometriosis.
All surgery involves risks. The risk of a particular complication may vary depending on the complexity of the surgery or the severity of your condition. These risks can be divided into general risks associated with any surgery and risks specific to hysterectomy.
These include risk of:
These include
The above list is not exhaustive and does not include all possible risks. If you have any further concerns please feel free to ask your specialist.
Post operative pain - Within a day of laparoscopic hysterectomy most patients require only oral pain medication.
Mobility - Showering and walking short distances within 24 hours.
Return to work - Patients often return to non-strenuous employment 4 weeks after surgery. Light duties can be started within 3 weeks.
Post operative pain - Patients usually require 48 hours of injections (i.e pethidine, morphine) given either intravenously, subcutaneously or intramuscularly for pain relief.
Mobility - Showering and walking short distances within 24-36 hours.
Return to work - Patients can return to non-strenuous employment within 5-6 weeks of surgery. Light duties can be started within 4 weeks
Vaginal Bleeding and Discharge - A small amount of vaginal bleeding is common after this surgery and it may persist for 6 weeks. Have some ultrathin sanitary pads on hand - best to avoid tampons. Please report any discharge that is offensive or becomes heavier than a period.
Return to normal activity
Pelvic floor exercises - These should be recommenced when they can be done comfortably, usually within a week or two of surgery. Role of hormone replacement therapy If your ovaries have been removed your oestrogen levels will fall significantly within a few days of surgery. This may cause problems such as hot flushes, sleep disturbances and loss of libido. You may wish to consider hormone therapy. This will be discussed at one of your consultations.
Pap Smears - If you had regular 2 yearly pap smears in the past and they were normal, providing your cervix has been removed, you will no longer require pap smears. It is recommended however, that your GP continue to review you 2 yearly for a pelvic examination and breast check .
Mood swings - It is normal for you to experience "the blues" following a hysterectomy as the operation brings to a close significant symbols of femininity (periods and fertility). Please discuss these important feelings and issues with your family, friends and doctor.