HYSTERECTOMY – PURPOSE & PROCEDURE
Sometimes the uterus gets various disorders that might make it unviable and unhealthy for a female. At such a time it is prudent to remove it, in-order to save the life of the patient. Such a procedure involving removal of female uterus is called as Hysterectomy
Why do patients require a hysterectomy?
- Chronic pain in the pelvis
- Uncontrolled bleeding from the vagina
- Cancer of Cervix, Ovary, Uterus, Vagina
- Ruptured uterus
- Prolapse of the genitalia
- Fibroids, Adenomyosis, Endometriosis of the uterus
What is hysterectomy and what are the types?
Hysterectomy as discussed is a surgical procedure involving removal of the uterus. It may involve removal of the entire parts or retention of some parts of the reproductive system.
- Pan-Hysterectomy: Removal of the uterus, cervix, ovaries and the fallopian tubes.
- Total Hysterectomy:Uterus and Cervix is removed.
- Subtotal Hysterectomy :Cervix is retained.
Approach and Procedure of Hysterectomy
All appropriate patients are first counselled and educated regarding the procedure being done. Once a patient gets her hysterectomy she can no longer have periods or get pregnant again. A general or local anaesthesia is given to the patient. In General Anaesthesia the patient is put to sleep and will not be aware of anything during the time of surgery. A Spinal (local) anaesthesia will render the patient numb from below the abdomen, but the patient is awake throughout the duration of surgery. There are two ways to remove the uterus, viz. Vaginal, Abdominal.
- Vaginal Hysterectomy
This method involves removal of the uterus through the vagina. The cervix is pulled down and a cut is made around it and the uterus is removed. The roof is sutured neatly and the vagina is packed with antiseptic gauze to prevent infection and bleeding. This procedure can be done when the size of the uterus is small and is freely movable. Benefits of such an approach involves
- No scar
- Minimal blood loss.
- Early post-operative recovery time.
- Abdominal Hysterectomy
In this method there is a small incision put on the abdomen which involves a scar horizontal or vertical extending anywhere between 5-10cm, the uterus is gently taken out and the parts are cut and ligated using sutures and the uterus is extracted. After removal, the rest of the parts are replaced and the abdomen is neatly closed in layers. This procedure is done for patients who have a big sized uterus, a large fibroid, uterus that is fixed to the surrounding structures.
Disadvantages of abdominal hysterectomy involves:
- Significant blood loss
- Cosmetically bothering scar
- Prolonged recovery time
For patients who might require an abdominal approach, there is Laparoscopy Assisted Vaginal Hysterectomy. This procedure involves insertion of three long metal tubes which has a camera and surgical tools that aid the surgeon to cut and ligate the uterus and cut it into many parts to aid in easily removing it through the vagina. This procedure offers all the benefits of a vaginal hysterectomy even in a patient with large uterus.
What are the complications of Hysterectomy?
As in all surgical procedures there are certain complications associated with this procedure as well Bleeding Injury to surrounding structures such as bladder, intestines, blood vessels and nerves. Infection Dyspareunia – painful coitus.
Recovery Period after Hysterectomy
Minimum of 7 days of hospital stay is essential for a patient who is undergoing hysterectomy. Pain killers will be adequately provided for the patient to recover. The patient is encouraged to walk around the hospital as soon they can as it helps in early mobility. The gauze piece that might be put during a vaginal hysterectomy will be removed in 3 days. Brownish discharge from the vagina during the recovery period is quite normal and patient is advised to use pads for comfort.
For a period of 3-6 months the patients are advised not to lift heavy weights or push heavy objects.Do any form of physical exertion have sexual intercourse before asking your doctor.
The patient may resume her daily activities within a period of 4 weeks if she has had vaginal or laparoscopic assisted vaginal hysterectomy and slightly longer if she has had abdominal hysterectomy.