Abdominal hysterectomy

Definition

Abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen. Sometimes the procedure also includes removal of one or both ovaries and fallopian tubes. Hysterectomy ranks as one of the most common surgical procedures among women.

Your uterus is where a baby grows if you're pregnant. The ovaries produce eggs to be fertilized and hormones that regulate your reproductive cycles. The fallopian tubes carry eggs from the ovaries to the uterus. The cervix at the lower end of the uterus provides the opening through which sperm enter to fertilize an egg or through which a baby is delivered during childbirth.

Hysterectomy can also be performed through an incision in the vagina (vaginal hysterectomy). But abdominal hysterectomy is the preferred approach if you have a large uterus or if your doctor wants to check other pelvic organs for signs of disease.

Female reproductive system

Female reproductive system

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

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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 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.
• 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 nonsurgical 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 also should have this procedure done.

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 or rectum 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 or two days.

Plan for an extended recovery time once you get home. Full recovery could take several weeks. Arrange for help at home if you think you'll need it.

What you can expect

In 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) may be left in place (partial or subtotal hysterectomy) or removed (total hysterectomy). Hysterectomy may also include removal of additional organs and tissue, such as your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).

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 (Pfannenstiel incision) lies about an inch above your pubic bone. Which incision type your surgeon chooses depends on many factors, including the need to explore the upper abdomen, the size of your uterus and the presence of any scars from prior abdominal surgery.

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

• Physical aftereffects. After a hysterectomy, you'll no longer have menstrual periods and you won't be able to become pregnant.

  It takes time to get back to your usual self after an abdominal hysterectomy — about six to eight weeks for most women. It's important to adhere to activity restrictions. Get plenty of rest. Don't lift anything heavy for a full six weeks after the operation. Your doctor may recommend other restrictions, but eventually you'll return to your normal activities.

  About six weeks after your surgery, you can resume sexual activity. Having a hysterectomy shouldn't affect this aspect of your life. This issue has been carefully studied, and women with a good sex life before hysterectomy 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.

  If you have a partial hysterectomy, your risk of cervical cancer remains, so you'll still need regular Pap tests for screening.

  If you're premenopausal, having your ovaries removed along with hysterectomy initiates menopause. Discuss with your doctor ways to handle menopausal symptoms, such as hot flashes and vaginal dryness. In women who undergo hysterectomy but keep their ovaries, menopause may occur at a younger than average age.

• Emotional aftereffects. You may find hysterectomy provides relief from your symptoms, an improved sense of well-being and a chance to get on with your life. The relief of symptoms may greatly enhance your quality of 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.

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 also can include removal of the uterus, cervix, ovaries and fallopian tubes (right).

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Vertical and Pfannenstiel incisions

Vertical and Pfannenstiel incisions

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

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