Abdominal hysterectomy

Definition

Abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen. Your uterus — or womb — is where a baby grows if you're pregnant. Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes. Hysterectomy is one of the most common surgical procedures among women.

Hysterectomy can also be performed through an incision in the vagina (vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses laparoscopic instruments passed through small abdominal incisions. Abdominal hysterectomy may be recommended over other surgical approaches if you have a large uterus or if your doctor wants to check other pelvic organs for signs of disease.

Types of hysterectomy surgery

Types of hysterectomy surgery

A partial hysterectomy (top left) removes just the uterus, and a total hysterectomy (bottom left) removes the uterus and cervix. A total hysterectomy can also include removal of the uterus, cervix, ...

Why it's done

Hysterectomy may be needed if you have one of the following conditions:

• Gynecologic cancer. If you have a gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
• Fibroids. Hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
• Endometriosis. In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, you might need a hysterectomy along with removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
• Uterine prolapse. Descent of the uterus into your vagina can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Hysterectomy may be necessary to achieve satisfactory repair of these conditions.
• Persistent vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.
• Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy creates new problems. Seek careful evaluation before proceeding with such major surgery.

Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, hysterectomy might be the only option. But other conditions — including fibroids, endometriosis and uterine prolapse — have alternative treatments that you can try first.

During hysterectomy surgery, your surgeon might also perform a related procedure that removes your ovaries and fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor will discuss ahead of time whether you should have this procedure done.

Female reproductive system

Female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina make up the female reproductive system. ...

Risks

Hysterectomy is generally very safe, but with any major surgery comes the risk of complications.

Risks associated with abdominal hysterectomy include:

• Blood clots
• Infection
• Excessive bleeding
• Adverse reaction to anesthesia
• Damage to your urinary tract, bladder, rectum or other pelvic structures during surgery, which may require further surgical repair
• Early onset of menopause
• Rarely, death

How you prepare

Hysterectomy is an inpatient procedure — meaning you're admitted to the hospital to have it done. How long you'll be in the hospital depends on what type of hysterectomy you have and what your doctor recommends. Generally, abdominal hysterectomy requires a hospital stay of at least one to two days.

Plan for an extended recovery time once you get home. Full recovery could take several weeks. Your doctor may recommend restricting your activities during your recovery, such as avoiding driving or lifting heavy objects. Arrange for help at home if you think you'll need it.

What you can expect

During an abdominal hysterectomy, your surgeon detaches your uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The lower part of your uterus (cervix) is usually removed (total hysterectomy) but may sometimes be left in place (partial, or supracervical, hysterectomy). At the time of the hysterectomy, additional pelvic organs and tissue, such as your ovaries and fallopian tubes, may be removed.

Before the hysterectomy
Before surgery, you may undergo testing to make sure you don't have any hidden gynecologic cancer, which could change your surgeon's approach to your surgery. Tests may include:

• Pap test, which detects the presence of abnormal cervical cells or cervical cancer.
• Endometrial biopsy, which detects abnormal cells in the uterine lining or endometrial cancer.
• Pelvic ultrasound, which may show the size of uterine fibroids, endometrial polyps or ovarian cysts.

The day before your surgery, you may be instructed to take a medication or drink a solution to empty your digestive tract in preparation for surgery. A preoperative cleansing of your vagina (vaginal douche) may be done to reduce your risk of infection. Immediately before surgery, you'll also be given an intravenous antibiotic medication to minimize your risk of developing an infection after the procedure.

During the hysterectomy
A hysterectomy typically is performed under general anesthesia, so you won't be awake during the surgery. The procedure itself lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.

To begin the procedure, a member of your surgical team passes a urinary catheter through your urethra to empty your bladder. The catheter remains in place during surgery and for a short time afterward. Your abdomen and vagina are cleaned with a sterile solution prior to surgery. Any hair at the incision site is shaved.

To perform the hysterectomy, your surgeon cuts through skin and connective tissue in your lower abdomen to reach your uterus. The surgeon uses one of two types of abdominal incisions for the hysterectomy. A vertical incision starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. A horizontal bikini-line incision lies about an inch above your pubic bone. Which incision type your surgeon chooses depends on many factors, including the reason for your hysterectomy, the need to explore the upper abdomen, the size of your uterus and the presence of any scars from prior abdominal surgeries. For instance, hysterectomies performed for endometriosis, large fibroids and gynecologic cancers are done mainly through a vertical incision.

After the hysterectomy
After surgery, you'll remain in the recovery room for a few hours. You'll be monitored for signs of pain. You'll be given medicine for pain and to prevent infection. You'll probably be up and walking around by the following day. Abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be up to four days.

You'll need to use sanitary pads for vaginal bleeding and discharge. It's normal to have bloody vaginal drainage for several days after a hysterectomy. However, let your surgeon know if you experience heavy vaginal bleeding — such bleeding that's as heavy as a menstrual period.

The abdominal incision will gradually heal, but a visible scar on your abdomen will remain.

Recovering from a hysterectomy
It takes time to get back to your usual self after an abdominal hysterectomy — about six to eight weeks for most women. During that time:

• Get plenty of rest.
• Don't lift anything heavy for a full six weeks after the operation.
• Wait about six weeks to resume sexual activity.
• Follow your doctor's recommendations about returning to your other normal activities.

Life after a hysterectomy
A hysterectomy permanently changes some aspects of your life. For instance:

• You'll no longer have menstrual periods.
• Most of the time, you'll get relief from the symptoms that made your surgery necessary.
• You won't be able to become pregnant.
• If you're premenopausal, having your ovaries removed along with hysterectomy initiates menopause.
• If you have a hysterectomy before menopause and you keep your ovaries, you may experience menopause at a younger than average age.
• If you have a partial hysterectomy, your cervix remains in place so you're still at risk of cervical cancer. You need regular Pap tests to screen for cervical cancer.

Other parts of your life will return to normal or perhaps improve once you've recovered from your hysterectomy. For example:

• If you had a good sex life before hysterectomy, you'll maintain it afterward. Some women even experience an increase in sexual pleasure. This may be due to relief from the chronic pain or heavy bleeding that was caused by a uterine problem.
• The relief of symptoms may greatly enhance your quality of life. You may have an improved sense of well-being and a chance to get on with your life.

On the other hand, because the uterus is strongly associated with femininity, you may feel a sense of loss after hysterectomy. Premenopausal women who must undergo hysterectomy to treat gynecological cancer may experience grief and possibly depression over the loss of fertility.

Vertical and horizontal incisions

Vertical and horizontal incisions

A vertical incision gives your surgeon greater access to the pelvis. A horizontal incision follows your skin's natural lines, usually leaving a thinner scar. ...