Hysterectomy may be performed to treat:

• Abnormal uterine bleeding that is not controlled by other treatment methods
• Severe endometriosis (uterine tissue that grows outside the uterus)
• Uterine fibroids (benign tumors) that have increased in size, are painful or cause bleeding
• Increased pelvic pain related to the uterus but not controlled by other treatment
• Uterine prolapse - (uterus that has “dropped” into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements
• Cervical or uterine cancer
• Complications during childbirth (like uncontrollable bleeding)

There are four types of hysterectomies in which can be performed depending on the condition and severity of the patient. These four types are:

• Vaginal hysterectomy
• Laparoscopic hysterectomy
• Minilaparotomy (a “short incision”) hysterectomy
• Abdominal hysterectomy

These procedures are listed in order of preference, ranked by criteria such as scarring and recovery time.

With this procedure, the doctor accesses the uterus through the vagina. A vaginal hysterectomy and is often preferred by patients because:

• It does not leave any visible scars: the internal sutures are the same as the other procedures, but because the access point is different, there are no scars or open wounds on the skin.
• There is a significant reduction in the time it takes to become active after the surgery.
• Lower complication rate:
• There is less of a chance of any infection to the surgical site.
• There is far less of a chance of causing damage to any other organ.

In the past, vaginal hysterectomies were only used when the conditions were optimal for the procedure. Now, as the skill of our surgeons has grown, vaginal hysterectomies can be used even under complicated conditions. It is important to note that it is possible to have this procedure if you have had a Caesarean section.

This procedure must be done by a surgeon specifically trained in the vaginal hysterectomy method.

This type of hysterectomy is often use when a vaginal hysterectomy cannot be done, usually because of some complications. With a laparoscopic hysterectomy, there are typically three incisions made: one in the belly button, and two into the pelvis area.

While there is a chance of scarring from this type of procedure, because the incisions are usually approximately 8 to 12 mm in length, any scarring would be minimal.

 

Vaginal Hysterectomy Research

• American Congress of Obstetricians and Gynecologists
• Allmedicaldiseases.com
• NCBI – PubMed Information

In some cases neither a vaginal hysterectomy nor a microscopic hysterectomy may be possible. In these cases, a minilaparotomy hysterectomy may be required.

Essentially, this type of procedure uses a 5 cm incision point to operate on the uterus. This type of procedure is usually quite quick for the surgeon to perform, as they have a lot more room in which to do the operation. The cost of the procedure may also be less than other types of hysterectomies, so each patient must determine the cost vs. benefit ratio (however, the cost may not be less as it the cost must be reviewed on a per patient basis).

A Minilaparotomy hysterectomy will take more time to recover an a vaginal hysterectomy or a laparoscopic hysterectomy. In addition, there’s an increased chance of scarring in the abdominal area. However, the incision is made below the “bikini line”.

Abdominal hysterectomies are usually performed only when needed. These types of operations typically require a 15 cm incision to perform. While an abdominal hysterectomy is quite safe to perform, it has a longer recovery time and more risk of scarring. Hence in more advanced hospitals, and in conditions which allow it, other types of hysterectomies are performed.

A hysterectomy generally takes 1 to 3 hours. It may be performed under general or regional anesthesia. During a Hysterectomy, the uterus may be completely or partially removed. The fallopian tubes may also be removed. After surgery, a catheter may remain in place for 1 to 2 days to help the bladder pass urine. The average hospital stay depends on the type of surgery, but is usually 1 to 3 days.

There are possible risks and complications associated with anesthesia, including respiratory or cardiac malfunction. Other complications include:

• Wound complication (i.e. abscess, disruption)
• Excessive bleeding or blood clots
• Infection
• Bladder, ureter or bowel injury
• Pain with intercourse, decreased libido, or reduced ability to have an orgasm
• Temporary abdominal distention due to bowel ileus or transient decreased bowel movement

Following surgery, some women may feel a sense of loss or become depressed, but these emotional reactions are usually short-lived.

Risks can be reduced by following the surgeon's instructions before and after surgery.

Alternate treatment options will depend very much on the source of the problem. The surgeon may discuss alternative approaches to Hysterectomy:

• Birth control pills or other medications may be helpful in treating prolonged bleeding
• Endometrial ablation (removal of the lining of the uterus) may help with very heavy periods
• Drugs can be used to shrink uterine fibroids
• Myomectomy, or surgical removal of fibroids, is major surgery; one in three women have tumors recur in 5 years
• Chronic pain may be treated with anti-inflammatory drugs, birth control pills, or physical therapy

Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and estrogen replacement therapy may be recommended.