Hysterectomy is the removal of the uterus through the surgical process. Sometimes the removal of the ovaries, cervix and fallopian tubes is also included in the surgery. The process of hysterectomy could be total (removal of body, cervix, and fundus of the uterus) or partial (removal of the whole uterine body except the cervix). Removal of the uterus left the patients unable to conceive babies with long-term effects and surgical risk. Thus, it is only recommended if other treatment options have been unsuccessful.

VAGINAL HYSTERECTOMY – WHY IT IS DONE?

Vaginal hysterectomy is the same procedure but the removal of the uterus is done through the vagina. During the vaginal hysterectomy, the doctor detaches the uterus from the fallopian tubes, ovaries, upper vagina, blood vessels and the connective tissues which supports the uterus. A shorter period of stay is required in the hospital during vaginal hysterectomy as compared to abdominal surgery. However, your doctor may opt for abdominal surgery depending on the shape and size of the uterus.

The reasons for this surgery treats various gynecological issues:

-ENDOMETRIOSIS: This problem occurs when endometrium which is a tissue lining the uterus starts growing outside the uterus, including fallopian tubes, ovaries, and other organs also. Women having this problem are generally recommended abdominal hysterectomy or robotic hysterectomy or a laparoscopic hysterectomy and in some cases, vaginal hysterectomy is also recommended.

– GYNECOLOGICAL CANCER: If a person is having cancer inside the uterus, ovaries, or cervix and experiencing pre-cancerous changes then the doctor might recommend them a hysterectomy. Most often in cases of ovarian cancer, the doctor recommends an abdominal hysterectomy but in the cases of cervical or endometrial cancer, vaginal hysterectomy is recommended.

– CHRONIC PAIN IN PELVIC: People who experience pain which is caused by uterine conditions, hysterectomy is recommended to them. Chronic pelvic pain may have many causes so an appropriate diagnosis is critical before undergoing the surgery.

– UTERINE PROLAPSE: When ligaments and tissues supporting pelvic gets weaken or stretched out, then the uterus can also sag inside the vagina which might cause urine leakages, pressure on the pelvis. Removal of the uterus and repairing of the tissues and ligaments is recommended by doctors in such cases. 

– FIBROIDS: Fibroids are benign tumors and many hysterectomy surgeries are done for the permanent treatment of fibroids which in the future can cause bleeding, pelvic pain, anemia, and pain during intercourse. For the removal of large fibroids, the doctors might recommend surgery to remove the uterus through the lower abdomen. So, an abdominal hysterectomy will be recommended.

– ADENOMYOSIS: This problem occurs when the tissues which usually lines the uterus starts growing inside the uterus and as a result, heavy period flow and an enlarged uterus happens.

– ABNORMAL UTERINE BLEEDING: It occurs when very long or heavy periods do not get controlled by medicines or other surgical procedures. The doctor might recommend a hysterectomy.

ABDOMINAL HYSTERECTOMY – WHY IT IS DONE?

Abdominal hysterectomy is another surgical process for the removal of the uterus through the lower abdomen. Sometimes the surgery of hysterectomy includes removal of both the ovaries as well as fallopian tubes, which is called a total hysterectomy. An abdominal hysterectomy is recommended by the doctors when patients have a large uterus, if the doctor wants to diagnose other organs present inside the pelvis or if the surgeon feels that abdominal hysterectomy is the best surgery for the specific reasons. The surgery of hysterectomy ends the ability to become pregnant. While in cases of cancer, hysterectomy is the only option left. During abdominal hysterectomy, the surgeon might also do a procedure to remove more than one ovary and even fallopian tubes which the patient should discuss prior the surgery with their doctors because this process can result as surgical menopause. The symptoms of surgical menopause begin suddenly for some of the women immediately after the surgery is performed.

An abdominal hysterectomy is usually done under general anesthesia where patients are not awake during the procedure. This surgery lasts for almost two to three hours. During the surgery, one of the members of the surgical team passes the catheter (urinary catheter) through the urethra to make the bladder empty. During the surgery, the catheter remains at the place for a short time. Then, the vagina and lower abdomen are cleansed with a solution before the beginning of the surgery. To perform the surgery, the surgeon makes an incision in the lower abdomen. The incision could be either a vertical, which begins at the middle of the abdomen and goes up to the just under the navel or the horizontal incision. The incision types depend upon many factors from the reasons involved behind the surgery of hysterectomy to the size of the uterus and if there are any scars from early surgeries. However, surgeries done for endometriosis, gynecologic cancers and fibroids are mainly conducted through the vertical incision. After the abdominal hysterectomy, it takes almost six weeks to get back to normal life. During these six weeks, patients are advised to take plenty of rest, stay active but to avoid strenuous activities, no sexual activities during these six weeks, do not lift any heavyweights after the operation and follow the doctor’s recommendations.

PREPARATION

Hysterectomy is one of those surgeries which is done when other options are not working. It is very normal to feel nervous before undergoing the procedure. Here is the preparation list for you to do.

  1. Gather all the information about what is going inside your body, about the surgery and about your surgeon too. Get all the related information and feel confident before the surgery.
  2. Follow the medicinal instructions given by your doctor. And be very sure to inform your doctor about the extra medications if you take like dietary supplements or herbal medicine.
  3. Discuss with your doctor about the anesthesia. People usually prefer general anesthesia which makes them unconscious during the operations but there is another option which is regional anesthesia (spinal block or epidural block). During the vaginal hysterectomy, regional anesthesia will be recommended by the doctors which will block the feelings of the lower half of the body.

During the surgery, the surgeon makes a cut inside the vagina to make a path to the uterus. Then using long surgical instruments, the surgeon detaches the uterine blood vessels and separates the uterus from its connective tissues, fallopian tubes, and ovaries. Now, the surgeon will remove the uterus from the vaginal opening and some stitches would be used to control bleeding in the pelvis. Some people also experience an LAVH laparoscopically assisted vaginal hysterectomy or robotic hysterectomy. This procedure allows the surgeon to perform removal of the uterus vaginally. The surgeons recommend laparoscopically assisted vaginal hysterectomy only if there is any scar tissue on the pelvic organs from the early surgeries or endometriosis.

RISKS

Vaginal hysterectomy is generally very safe but there are always some minor risks involved in the surgery. Risks including in this surgery are Blood clots inside the legs and lungs, infection, damage to the organs surrounded to the uterus, heavy bleeding or adverse reaction of anesthesia. In the long term reactions, people also face an increased risk of heart and blood vessel diseases with some metabolic conditions especially if the patient has undergone the surgery before the age of 35. Uteral injury is also a risk that happens in every 0.2 cases of per 1000 cases in the vaginal hysterectomy. 

After the hysterectomy, some women report an improvement in their sexual lives and pelvic pain while some women report in worst sexual lives and pelvic pain. This picture states that hysterectomy is completely different for every person. People who undergo hysterectomy for chronic pelvic pain, reports suffering pelvic pain even after the surgery and develops painful sexual intercourse.

PRE MENOPAUSE AND ITS SIDE EFFECTS

During the hysterectomy when the ovaries are removed, the estrogen levels fall readily. This condition is mainly referred to as “surgical menopause” which is different from the natural menopause state. As the surgery and the removal of the ovaries is a sudden shock for the body, which causes a rapid change in the menopausal symptoms like the hot flashes. Some studies show that the risk of cardiovascular diseases is increased in women who had undergone hysterectomy before or at the age of 50 years. The risk gets higher when ovaries are removed but noticeable. While some other studies have found that increased risk of the bone fractures and decrease in the bone density are also associated with hysterectomy. The effect of estrogen on calcium and the drop in levels of estrogen levels after menopausal state cause bone wasting (excessive loss of calcium). Hysterectomy has also been linked with the higher rates of weakened bones and heart diseases. Those who have both of their ovaries removed during a hysterectomy have reduced levels of testosterone. Increased testosterone levels in women are for the great sense of sexual desires while the reduction in levels of testosterone is predictive of loss in height and occurs as a result in low density of bones.

AFTER HYSTERECTOMY

The surgery of hysterectomy changes many aspects of life permanently. After the surgeries, the patient will no longer be able to have menstrual periods. The patients will never get pregnant again. If menopause has not occurred yet to the patients then after the hysterectomy in which ovaries have been removed, it is a possibility to experience menopause. If the patients have undergone partial hysterectomy and their cervix remains the same then there is a very high risk of developing cervical cancer. If patients have undergone hysterectomy before menopause and kept the ovaries, then there are chances that they might experience menopause at an early age than usual.  The relief from the symptoms might greatly enhance the patient’s life with an improved sense of well-being. These surgeries are successfully conducted by Apollo Cradle Jayanagar which has an expert team of equipped doctors, nurses, and surgeons, who all are capable to handle these cases with ease. They are leaders when it comes to utilization of the advanced hysterectomy techniques. The staff makes sure to use the minimally invasive procedure with the help of small abdominal incisions.