Know about Hysterectomy

Hysterectomy is the surgical removal of the uterus (or the womb). It may be done with or without the removal of ovaries (if both ovaries are removed, it is called hysterectomy with bilateral salpingo oophorectomy).It can also be total or subtotal hysterectomy. A total hysterectomy is one where the cervix is left behind. The type of hysterectomy done will depend on the reason for which the operation is being done and the profile of the patient.

Hysterectomy is done for several conditions like:

• Uterine fibroids – which are non-cancerous tumours of muscle cells in the wall of the uterus.
• Prolapse of uterus – where the uterus slides down into the vagina due to weakness of its supports.
• Heavy menstrual bleeding is the commonest reason for hysterectomy. Usually hysterectomy is done when the bleeding is very distressing to the patient and other treatments have failed. In some cases, the patient can become severely anaemic due to this bleeding.
• Pelvic Inflammatory Disease – characterised by chronic pain in the lower abdomen and vaginal discharge.
• Endometriosis – a condition where patches of the lining of the uterus (endometrium) break away and settled down into the abdomen. These patches can still spread to the monthly changes in the hormone level and hence can bleed and form sticky barriers between them and other organs, called adhesions.

There are three different approaches for removal of the uterus – abdominal, vaginal and laparoscopic. The choice of method will depend on the indicaton for hysterectomy, size of the uterus, profile of patient and expertise of the doctor in the particular route.

• Abdominal hysterectomy, incision is made in the abdomen like a caesarian operation.
• Vaginal hysterectomy is done through the vagina. The cut is made inside the body on top of the vagina, so no scar is visible and the uterus is taken out through the vagina.
• Laparoscopic hysterectomy, also known as keyhole surgery, it uses a laparoscope, which is inserted through a very small hole in the navel. Two or three small cuts are made in the abdomen to act as channels to introduce other instruments required for the surgery. Once the uterus is snipped free, it is removed through the vagina or the abdomen.

The patient is kept in the hospital from 2-5 days depending on post-operative condition. A thin tube is attached to the bladder to drain it so that she does not have to get up. She is encouraged to sit up and move around a little bit on the first day after the surgery. A liquid diet is maintained for the first couple of days which is gradually shifted to a soft and finally a normal diet. Some breathing exercises may be prescribed to the patient if she was put under general anaesthesia. Leg exercises are also prescribed to prevent a clot from forming in the legs.

Hysterectomy involves risks like any other surgery. The risks can be minor or major and can occur at any stage of the procedure. During surgery, risks include that of anaesthesia, bleeding and injury to the neighbouring organs.

Post operative risks may include nausea, vomiting, infection, trouble in breathing and other complications which include:

• Paralysis of bowel (ileus)
• Untimely breakage of stitches
• Blood clots in lungs, heart, legs and the brain
• Allergy to the medications
• Internal bleeding.

It is important to have help at home. The patient may need to rest and avoid heavy work for the first few weeks. Gentle exercise everyday is important. Resumption of normal activity depends on the type of operation and the post operative period. There may be some vaginal discharge for 3-4 weeks. It may be red or brown and is due to healing of the wound and dissolving of the stitches. If the bleeding is fresh, heavy or smelly, the doctor's opinion must be sought. Recovery time is usually 4 weeks for vaginal hysterectomy and 8 weeks for abdominal hysterectomy.

Job can be resumed depending on the type of job and the hours of work. One can return to work about 6 weeks after the operation after consultation with the doctor. Driving can be resumed 4 weeks after the surgery. Sexual intercourse can be started 6 weeks after the post operative check up. There is no need for any contraceptive as the uterus has been removed and the patient cannot have a baby.

HRT or hormone replacement therapy must be discussed with the doctor. If the ovaries have been removed, HRT may be begun soon after surgery, since removal of the ovaries brings about sudden menopause and hence menopausal symptoms like hot flushes, poor sleep, mood swings, frequency of urine and dryness of vagina may be experienced.