Hysterectomy refers to the surgical procedure for removal of the uterus. If the procedure involves the removal of the cervix, body, and fundus of the uterus, then it is called total or complete hysterectomy and if it is performed while leaving the cervix intact, then it is referred to as partial hysterectomy. The incision can be made either in the abdomen or the vagina. When the uterus is removed through an incision in the abdomen, it is termed as abdominal hysterectomy.

Why a hysterectomy is done?

  • Fibroids

Fibroids also called leiomyomas or myomas, are benign uterine tumors which cause heavy and prolonged menstrual cycles, anemia, pelvic pain, or bladder pressure. Hysterectomy can be considered as a permanent solution for fibroid. Nonsurgical options are also available to treat fibroid, but it depends on the patient and the size and nature of the fibroid. In most of the cases, fibroid does not cause severe symptoms and disappear naturally.

  • Gynecological Cancer

Hysterectomy can be used to treat cancer in the uterus, ovaries or cervix. The women in the early stages of cervical cancer can be cured with a major chance of full recovery by undergoing hysterectomy along with BSO (Bilateral Salpingo-Oophorectomy), and evaluation of surrounding lymph nodes. Radiation and chemotherapy can be included in the procedure depending on the stage and type of cancer. Total Abdominal Hysterectomy(TAH), or Total Laparoscopic Hysterectomy(TLH), or robot-assisted hysterectomy can be considered for the procedure.

  • Abnormal Vaginal Bleeding

Heavy or prolonged menstrual bleeding, called menorrhagia can lead to anemia and fatigue. Heavy bleeding can also be a symptom of uterine cancer. If you experience such symptoms, make sure to undergo evaluation. Hysterectomy is a permanent treatment that can cure heavy menstrual bleeding. However, it can have complications and may require up to six weeks for a full recovery. You need to keep in mind that pregnancy is not possible after hysterectomy, and the menstrual cycle will stop. Other nonsurgical treatments are also available like Nonsteroidal anti-inflammatory drugs (NSAIDs), Hormonal intrauterine device, Shot, Antifibrinolytic medicines, and Gonadotropin-releasing hormone (GnRH) agonists.

  • Chronic pelvic pain

Chronic pelvic pain is a prolonged pain of around six months that occurs in the pelvic region that is, below the belly button. There can be numerous reasons for this symptom including musculoskeletal, gastrointestinal, urologic, gynecologic, and body-wide disorders. Hysterectomy can be considered as a last option to treat pelvic pain when it is clear that the pain is arising from the uterus. Surgical methods comes with its own complications and risks, and hysterectomy can alleviate the pain, and might not be the permanent solution. It is important that you discuss and evaluate your concerns properly before opting for this procedure. Surgery in which some of the nerves are cut in the pelvis has been found to be an effective treatment but it is advised to seek careful evaluation before going for this method.

  • Cervical Abnormalities

The cells that line the cervix and vagina are called squamous cells. When these cells do not appear normal and are found to be precancerous, then they are termed as Atypical squamous cells (ASC). The level of risks involved and the grade of cancer can be determined by screening. Different treatment options are available for different age groups and conditions like pregnancy.  For example, in pregnant women, a biopsy of the cervix is only done if there is a high concern regarding a precancerous or cancerous lesion. Hysterectomy can be performed as the last step in treating cervical cancer when other procedures proved to be ineffective.

  • Uterine prolapse

This is a condition in which the uterus descends or falls into your vagina when supporting ligaments and tissues become weak. It is caused due to the stretching and weakening of the ligaments and pelvic muscles. It is more common in women who have been pregnant and/or had vaginal childbirth. It is also found in those with certain genetic factors, lifestyle factors (such as repeated heavy lifting over the lifetime), or chronic constipation. Urinary incontinence, pelvic pressure or difficulty with bowel movements can be caused by uterine prolapse. Hysterectomy is an effective and necessary procedure to treat such a condition.

  • Endometriosis

Endometriosis is the condition in which the tissues lining the inside of the uterus grows in the body in other places outside the womb like on your ovaries, fallopian tubes, or other pelvic or abdominal organs. It can sometimes lead to endometrial cancer. You can undergo hysterectomy along with Bilateral Salpingo-Oophorectomy(BSO) to treat endometriosis after other methods have proved to be ineffective.

Why abdominal hysterectomy?

There are some factors which are considered for choosing the route of hysterectomy, which includes:

  • Accessibility to the uterus
  • Shape and size of the vagina and the uterus
  • The extent of extrauterine diseases
  • Available technology and facilities in the hospital
  • The need for concurrent procedures.
  • The experience of the surgeon.
  • Average case volume.

An abdominal hysterectomy is preferred over other procedures in the following cases:

  • If your surgeon wants to check other pelvic organs for possible diseases or risks.
  • If your uterus is large.
  • If your surgeon feels it is the better option.

 Vaginal and laparoscopic hysterectomy is considered minimally invasive procedures since a smaller incision is required to be made as compared to abdominal hysterectomy which leads to a shorter hospital stay and faster recovery. You must clearly understand your needs and concerns and discuss in proper details to choose the method best suited for you. The doctors at Apollo Cradle understands and considers the concerns and doubts a patient faces before undergoing such procedures. You can schedule a session with your doctor where you can understand everything you need to take care of for the procedure.

Bilateral salpingo-oophorectomy

Salpingo-oophorectomy refers to the removal of the ovary and fallopian tube. A unilateral salpingo-oophorectomy is a procedure where only one ovary and fallopian tube is removed whereas in Bilateral Salpingo-oophorectomy or BSO, both ovaries and fallopian tubes are removed. A salpingo-oophorectomy may be recommended to reduce the risk of ovarian or breast cancer. Women who have high chances of ovarian cancer due to family or medical history can choose to go for this procedure. Bilateral salpingo-oophorectomy causes infertility and may lead to surgical menopause, which causes long-term side effects because of the hormonal disruptions involved. If you are undergoing this procedure, you should consult your doctor to understand the related risks and side effects and how to manage them. Laparoscopic surgery is a minimally invasive procedure available to some patients undergoing a salpingo-oophorectomy. Bilateral salpingo-oophorectomy is generally one of three types:

  • prophylactic in women with increased risk of ovarian cancer, or
  • elective at time of hysterectomy for benign conditions, or
  • because of malignancy.

Why Bilateral salpingo-oophorectomy is done?

A salpingo-oophorectomy can be used as a treatment for the following conditions:

  • Endometriosis

Endometriosis is the condition in which the tissues lining the inside of the uterus grows in the body in other places outside the womb like on your ovaries, fallopian tubes, or other pelvic or abdominal organs. It can sometimes lead to endometrial cancer. This can cause severe pain and discomfort and sometimes requires the removal of the ovaries, uterus or fallopian tubes. You can undergo hysterectomy along with Bilateral Salpingo-Oophorectomy (BSO) to treat endometriosis after other methods have proved to be ineffective.

  • Ovarian torsion

The ovary is connected to the pelvic wall by a thin ligament or tissues. Ovarian torsion also called adnexal torsion is caused when these ligaments twist around the ovaries and forms knots which eventually cuts off the blood and nerve supply. It is a painful condition and calls for a medical emergency which can lead to loss of the ovary if not treated on time. You might experience ovarian torsion if you have ovarian cysts. You may be able to reduce your risk by using hormonal birth control or other medications to help reduce the size of the cysts, as it causes the ovaries to swell and increase in size. If your condition is severe and prolonged loss of blood flow has caused the surrounding tissue to die, your doctor may suggest to remove it through salpingo-oophorectomy.

  • Ectopic pregnancy

Ectopic pregnancy is an emergency condition in which the fertilized egg implants into a location other than the uterus. Nausea and breast soreness are common symptoms in ectopic pregnancy. If immediate treatment is performed, it reduces the complications like it increases your chances for future, healthy pregnancies, and reduces future health complications. If the condition is not severe, your doctor might suggest medications. If the embryo gets implanted into the fallopian tube, it should be removed.

  • Ovarian mass

It is required to remove the entire ovary or fallopian tube if benign (non-cancerous) tumors, cysts, or abscesses develops in these areas, especially if the mass is putting pressure on nearby structures or is causing pain or pressure. Sometimes the symptoms of ovarian cancer can mimic symptoms of an ovarian cyst. Therefore, it is important to consult the doctor and undergo proper diagnosis to find the nature of the cysts. Ovarian torsion discussed above can also be a complication caused by ovarian cysts. It can cause fever, dizziness, and severe pelvic pain.

  • Ovarian Cancer

The removal of healthy ovaries and fallopian tubes in women who have an elevated risk for ovarian cancer is termed as Risk-reducing salpingo-oophorectomy (RRSO). Bilateral risk-reducing salpingo-oophorectomy has been shown to be a highly effective tool to lower the risk for both ovarian cancer and breast cancer in women at increased risk for ovarian cancer. Women between the ages of 35 – 40 or after childbearing is completed, with BRCA1 mutations undergo bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). The average age of ovarian cancer onset is 8-10 years later than in BRCA1 mutation carriers, therefore, delaying RRSO until age 40-45 is “reasonable” for BRCA2 mutation carriers who have undergone a risk-reducing mastectomy. The women undergoing this surgery might experience immediate surgical menopause which is followed by some long-term and short-term side effects. Therefore, it is advised to consult your doctor and discuss in details your concerns regarding your risks and the risk-management decisions that will be best suited for you.

Before the surgery

  • You will be given general anesthesia to sleep before the procedure.
  • Consult your doctor about which method is appropriate for you since the surgery can be performed using a large incision, a laparoscope, or a robotic arm.
  • The ovaries produce the major amount of estrogen and progesterone in your body, you can consult the doctor regarding hormone replacement therapy since your ovaries will be removed.
  • This procedure will lead to menopause which means your estrogen levels will reduce and cause symptoms like hot flashes, night sweats, and vaginal dryness.
  • Contact your insurance company to make sure that the following procedure is covered. The staff at Apollo Cradle will provide you assistance if you need.
  • If you have other health problems, you may need preoperative testing.

Some other tips to follow before the surgery are as follows:

  • Pack some essentials like slippers or socks, a robe, and a few toiletries.
  • You are usually required to stop eating 8 hours before the surgery.
  • You won’t be able to drive, so arrange for some help to take you home after the procedure.
  • You will take some time to resume your work, So make sure to consult the concerned people in your company regarding short-term disability benefits.

During the procedure:

  • Before the procedure you will be given some medicines and antibiotics to prevent infections or abnormal blood clots.
  • Some tests might be performed to check for cancer like Endometrial biopsy, Cervical cytology (Pap test), Pelvic ultrasound This decision depends on your doctor.
  • You may also undergo preoperative cleansing of your vagina (vaginal douche) or preoperative cleansing of your rectum (enema).
  • This procedure is performed under general anesthesia so you will be asleep during the procedure and it will last up to around 2 hours.
  • As a first step, a catheter is passed through your urethra to empty your bladder.
  • An incision is made vertically or horizontally, depending on the reason behind the procedure. A horizontal incision is made in your lower belly about an inch above your pubic bone and a vertical incision is made above or below your belly button and it starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone.
  • Through the incision, the ovaries, fallopian tubes, and the uterus are removed depending on the issue you are facing.

After the procedure

  • You will be required to stay in the recovery room while you will be under surveillance in case of any further pain.
  • You might be required to stay in the hospital for a few days.
  • After the surgery, the incision is either stitched or glued, and covered with bandages. Do not apply lotions or ointments without the permission of your doctor.
  • You must avoid strenuous exercise and sexual activity for around 6 weeks after the procedure.
  • You will experience vaginal bleeding and discharge after the surgery and will be required to wear sanitary pads. But in case the bleeding is prolonged or excessive, you should immediately check with your doctor.
  • Your doctor might prescribe you some medicines to relieve pain.

Risks Involved:

  • Infection

If you are experiencing very high and prolonged fever, it might be the case of infection. Usually, these infections are not severe and rarely surgical methods are required to treat them.

  • Damage to other organs

The organs near the pelvic region like urinary bladder, ureters (small tubes leading from the kidneys to the bladder), and large and small intestines can get injured during the procedure and is usually identified and corrected then itself.

  • Blood clots

There is a risk for a blood clot in the legs or lungs after pelvic surgery. Treatments including compression stockings, pneumatic compression devices, and medication are given before surgery to avoid a blood clot.