Understanding Total Abdominal Hysterectomy (TAH)

A total abdominal hysterectomy (TAH), also called an extrafascial hysterectomy, is a common surgery in which the uterus and, in some cases, the cervix are removed through an incision in the abdomen. This procedure is usually recommended when other treatments haven’t worked or when conditions such as large fibroids, persistent pelvic pain, heavy bleeding, or certain cancers make surgery necessary.

It’s normal to feel nervous or have questions if you’re preparing for this procedure. This guide explains what the surgery entails, why it may be necessary, how to prepare, and what the recovery process looks like. With clear information, you can approach the surgery with a better understanding and reassurance. 

What is a Total Abdominal Hysterectomy?

A hysterectomy is a surgical procedure to remove the uterus and, in some cases, the cervix (depending on the patient’s condition and the surgical plan). Unlike other types of hysterectomy, such as vaginal hysterectomy (removal of the uterus through the vagina) or laparoscopic hysterectomy (performed through small incisions using a camera), a total abdominal hysterectomy involves a larger abdominal incision.

In a TAH, the surgeon makes an incision in the abdominal wall to access the uterus. This incision is typically about 5 inches long and passes through the skin and connective tissue. It can be made in two ways:

• Horizontal (bikini-line incision) - runs approximately one inch above the pubic bone.
• Vertical incision - starts in the middle of the abdomen and extends from just below the navel to just above the pubic bone.

TAH is considered a major operation and is usually recommended when less invasive treatments are not suitable or effective. It allows the surgeon a clear, unobstructed view of the uterus and surrounding organs, as well as more working space during the procedure. This is especially important in cases where cancer is suspected or when the patient has large fibroids.

In many cases, TAH is performed together with a salpingo-oophorectomy, where the cervix, uterus, fallopian tubes, and ovaries are removed in a single surgery. After this procedure, menstrual periods stop permanently, and pregnancy is no longer possible.

Who Should Have This Surgery?

There are several conditions in which a total abdominal hysterectomy procedure becomes the only treatment option:

• Gynaecologic Cancer

This includes cancer of the uterus or cervix. Depending on the type and stage of cancer, other treatment options might include radiation or chemotherapy. 

• Fibroids

A TAH is the only permanent solution for fibroids. Fibroids are benign tumours in the uterus that, if left untreated, can cause anaemia, bladder pressure, pelvic pain, and persistent bleeding. However, many women experience minimal symptoms and may not require treatment.

• Endometriosis

In this condition, the endometrium (the tissue lining inside the uterus) grows outside the uterus, such as on the ovaries, fallopian tubes, or other abdominal or pelvic organs.

• Uterine Prolapse

This occurs when the uterus descends into the vagina due to weakened supporting tissues and ligaments. It can lead to pelvic pressure, difficulty with bowel movements, and urinary incontinence.

• Abnormal Vaginal Bleeding

If other methods cannot control your irregular, heavy, or prolonged periods, your doctor may recommend a hysterectomy.

• Chronic Pelvic Pain

Some women experience chronic pain originating from the uterus, for which a TAH may be the only solution. However, it is important to carefully evaluate your condition before undergoing such a major surgery, as an unnecessary hysterectomy can create new problems.

A total abdominal hysterectomy will end your ability to get pregnant. If you are planning to conceive in the future, this procedure is not suitable. Additionally, after TAH, hormone replacement therapy may be recommended to address the sudden deficiency of hormones in your body.

How to Prepare for TAH

Feeling nervous before any surgery is completely normal. Here are some steps you can take to feel more prepared:

• Get Informed and Prepare Your Body

Before scheduling your surgery, gather all the information to make an informed decision. Consult your doctor about the procedure and the steps involved. This will help you feel at ease and more self-assured.

In addition, focus on improving your overall health. Eat nutritious foods, get regular exercise, maintain a healthy weight (if recommended), avoid junk food and sugary drinks, and quit alcohol and smoking.

• Follow the Instructions

Ensure your doctor knows your complete medication history. Ask whether you need to adjust any medications a few days before the procedure. This includes prescription drugs, over-the-counter medications, herbal preparations, and dietary supplements.

• Type of Anaesthesia

Decide beforehand what type of anaesthesia will be used. For a total abdominal hysterectomy, general anaesthesia is typically administered so that you remain unconscious during the procedure.

• Plan for Your Hospital Stay

The length of your hospital stay depends on your condition, the type of hysterectomy, and your doctor’s recommendations. Some women can go home the same day, while others may need to stay one to two days.

• Preoperative Tests

Before surgery, you may need to undergo tests, including:

• Cervical Cytology (Pap test) - Checks for abnormal cervical cells or cervical cancer.
• Endometrial Biopsy - Detects abnormal cells or endometrial cancer in the uterine lining.
• Pelvic Ultrasound - Evaluates the size of uterine fibroids, ovarian cysts, or endometrial polyps.
• Blood Test - Identifies any medical conditions that could impact the surgery.

• On the Day of Surgery

You may be asked to shower with a special soap provided by your doctor to reduce the risk of infection. You will also receive a preoperative cleansing of the vagina before the procedure.

Total Abdominal Hysterectomy Procedure

A total abdominal hysterectomy is performed under general anaesthesia and typically lasts about 1 to 2 hours. First, a urinary catheter is inserted through the urethra to empty the bladder. Before the surgery begins, the vagina and abdomen are cleaned with a sterile solution.

The total abdominal hysterectomy procedure steps include making an incision in the lower abdomen using one of two approaches: a vertical incision or a horizontal incision. The choice of incision depends on factors such as the reason for the hysterectomy, the size of the uterus, whether the abdomen needs to be explored, and the presence of any existing scars.

Once the incision is made, the uterus is detached from the ovaries, fallopian tubes, upper vagina, blood vessels, and connective tissue. The lower part of the uterus, called the cervix, is also removed.

Postoperative Care after TAH Surgery

After a total abdominal hysterectomy, you will first spend a few hours in the recovery room. During this time, your vital signs will be closely monitored, you will be given medications to manage pain and prevent infection, and you may be encouraged to start walking as soon as it is safe. Early movement helps improve circulation and reduces the risk of complications such as blood clots.

Most patients stay in the hospital for about 1 to 2 days, although the length of stay can vary depending on their overall health and the reason for surgery. Once you return home, it is normal to experience light vaginal bleeding or bloody discharge for several weeks. Use sanitary pads during this period. If the bleeding becomes heavy, similar to a menstrual period, or if you pass large clots, contact your doctor immediately. 

The abdominal incision will gradually heal, but it will leave a visible scar. Keeping the incision site clean and dry is essential to reducing the risk of infection. Your doctor will give you specific instructions on wound care and when you can resume activities such as bathing, driving, or lifting objects.

Total Abdominal Hysterectomy Recovery

Full recovery after TAH surgery can take up to 6 months. Following the total abdominal hysterectomy procedure steps, give your body enough time to heal and follow your doctor’s advice closely. To support recovery and reduce complications, keep the following in mind:

• Wait at least 6 weeks before resuming sexual activity
• Avoid lifting heavy objects
• Stay mobile, but limit strenuous exercise
• Ensure you rest and give your body adequate time to recover
• Ask someone to help with day-to-day tasks, or consider hiring assistance

A TAH surgery also brings permanent changes, such as:

• Menstrual periods will stop
• Pregnancy will no longer be possible
• If your ovaries are removed, you will enter menopause immediately
• If your ovaries are preserved, menopause may occur earlier than average

Risks and Complications of TAH 

Now that you know the recovery and steps for a total abdominal hysterectomy, let’s understand the possible risks and complications. 

As with any surgical procedure, TAH carries a risk of complications, including:

• Infection can occur at the surgical site, in the urinary tract, or internally.
• Excessive bleeding during or after surgery, sometimes requiring a transfusion.
• Blood clots may form in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
• Damage to surrounding organs, such as the bladder, ureters, or intestines.
• Adverse reactions to anaesthesia, including nausea, breathing difficulties, or allergic responses.
• Scar tissue (adhesions) that may form inside the abdomen and cause discomfort.
• Chronic pelvic pain, which may persist even after recovery.
• Menopause-related symptoms if the ovaries are removed (e.g., hot flashes, mood changes, or bone loss).
• Emotional impact, such as sadness, anxiety, or a sense of loss, after surgery.

Conclusion

A total abdominal hysterectomy is a major procedure. However, it can provide relief and improve the quality of life for women experiencing conditions such as fibroids, chronic pain, or certain cancers. Understanding what to expect, from the reasons for the surgery to the recovery process, can help make the experience less stressful. Open communication with your doctor, careful preparation, and allowing yourself time to heal can make you feel more informed and confident throughout the surgery. 

At Apollo Cradle Kondapur, we are committed to providing top-quality medical care to our patients at an affordable price. Our experienced team of doctors and staff specialise in performing hysterectomies and are dedicated to ensuring you receive the best possible care.