What is a Hysterectomy?

A hysterectomy is a surgical procedure to remove all or part of your uterus.

Surgical removal of your ovaries is called oopherectomy. Surgical removal of your fallopian tubes is called salpingectomy. If your uterus, ovaries and tubes were removed, then you had a hysterectomy with bilateral salpingo-oopherectomy.

Total hysterectomy implies removal of your entire uterus.

Partial hysterectomy (or supracervical) implies preservation of your cervix (the lower part of your uterus).

How is a hysterectomy done?

1. The surgeon makes 3 to 5 tiny incisions on your abdomen.
2. Your abdomen is inflated with gas.
3. A camera and light are introduced through one of the incisions so the surgeon can see inside.
4. Long, narrow instruments will be inserted through the incisions to detach the uterus, fallopian tubes, and ovaries.
5. All tissues are removed through the incision in your vagina where the cervix was.
6. The top of the vagina, as well as the skin incisions on your abdomen, is closed with stitches that will dissolve over time.
7. The gas is released.

How long will my hospital stay be?

You will likely be sent home the next day after your surgery.

What medications will I be prescribed after surgery?

Before surgery, you will receive antibiotics in the hospital to lower your risk of infection. Make sure to tell your surgeon about any medication allergies you have. You will be sent home on painkillers, usually over-the-counter ibuprofen (up to 800 mg by mouth every 8 hours) and acetaminophen (up to 1000 mg by mouth every 6 hours). Make sure to call your surgeon’s office if the pain is not well controlled at home.

What should I expect during the healing process?

• Discomfort in your belly
• Numbing or tingling or pulling or pain sensation around incisions
• Pain in your upper chest and shoulder area, due to the gas used to inflate your abdomen
• Pink, brown or yellowish brown discharge from your vagina for 4 to 6 weeks – passing stitches is also likely
• Incisions will be covered with a light dressing to be removed next day and steri-strips that would fall with shower within a week. You can peel off stubborn ones after a week. You might be able to feel some stitches that will fall with time.
• Incisions on your abdomen may be red with some bruising. This will slowly go away. Dark discolouration will lighten with time (roughly a year).

What check-ups or follow-up will be needed after my surgery?

You will need to follow up with your surgeon in 4 to 6 weeks after your surgery date to ensure you are recovering and healing as expected. Please contact your surgeon or primary care provider earlier if you have any concerns. During the follow up visit, your surgeon will check your abdomen’s incisions. A vaginal exam might be needed if you are still having bleeding or pink discharge.

What symptoms should be of concern?

• Feverishness (Please measure and record it for your surgeon) especially if associated with chills and ‘not feeling well’
• Severe abdominal pain not responding to the above over-the-counter medications
• Heavy vaginal bleeding or a lot of watery discharge

How long will it take for me to get back to work or my usual activities?

Allow for 2 weeks of rest with light activity. Most will be able to return to work within 2 weeks, some require a longer period to recover full activity. If you feel you need more time off work, you should contact your surgeon for evaluation.

You need to be on pelvic rest for 6 weeks. This means avoiding any vaginal penetration: tampon, toys, fingers, penis, etc…. Avoid heavy lifting or strenuous exercise for at least 6 weeks. Report any constipation or persistent cough, anything that increases your abdominal pressure could have a negative impact on the vaginal incision.

Peggy Turbett/The Plain Dealer: Dr. Amanda Nickles Fader, left, and Dr. Hasan Abdessamad assist Dr. Vivian von Gruenigen (not shown) with a hysterectomy at University Hospitals Case Medical Center. Von Gruenigen performed the surgery with <…> minimally invasive approach.

What are the complications associated with hysterectomy with bilateral salpingo oophorectomy?

Just like any other surgical procedure, there could be a risk of infection, bleeding, requiring a blood transfusion, injury to other vital organs like the bladder, bowels, large vessels and ureter (tube connecting kidney to bladder). There is also the risk of general anaesthesia and risk of developing blood clots (thrombosis) in lower extremities.

There is always a risk of converting to an open or traditional surgery (also called abdominal hysterectomy performed through a large incision on your abdomen called laparotomy). Laparotomy might be needed to fix complications or to complete a difficult surgery.

It is recommended to remove the tubes with the uterus as this will lower the risk of cancer of the ovaries.

If the ovaries are also removed (before menopause) you might experience symptoms of hot flashes, sweating, mood swings, and vaginal dryness among other symptoms of sudden menopause. Some patient might need hormone replacement therapy to control these symptoms.

Make sure to discuss all the above with your surgeon in advance. The discussion might also change depending on other risk factors and medical problems you have. Make sure to inform your surgeons of all the medications and herbal alternative treatments you are on.

Dr. Abdessamad teaching laparoscopic suturing at annual LIGO course for Total Laparoscopic Hysterectomy, San Francisco

Categories: Gynecology, Health

Tags: hysterectomy, Laparoscopic Hysterectomy, laparoscopy, Minimally Invasive Surgery, patient info, surgery