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Hysterectomy
When uterine diseases and the symptoms caused by these diseases cannot be treated conservatively, operative treatment is used.
The uterus can be removed vaginally, laparoscopically and surgically through an open abdominal incision.
The fallopian tubes are usually removed during the same operation as studies have shown that this reduces the risk of ovarian cancer. Ovariectomy is assessed individually.
What do we actually treat with a hysterectomy?
With hysterectomy we can treat:
- Uterine fibroids and other non-malignant tumors.
- Abnormal or heavy bleeding that does not respond to other types of treatment.
- Prolapse of the uterus that cannot be operated on otherwise, or planned reconstruction of the pelvic floor that requires the removal of the uterus.
- Malignant diseases, with the removal of additional structures.
- Endometrial diseases such as atypical hyperplasia.
- Adenomyosis.
- Serious complications at childbirth.
What types of hysterectomies are there?
Supracervical hysterectomy is the removal of the body of the uterus only, that is, it implies "leaving, preserving" the cervix.
The benefit of this approach is to reduce the chances of subsequent prolapse of the vaginal walls.
Women who have cervical cancer are advised to have regular examinations (Pap test).
A total hysterectomy involves the removal of both the body and the cervix.
By "saving the ovaries" the hormonal status remains unchanged, and if you had cycles, menopause will not start prematurely.
A total hysterectomy with bilateral removal of the fallopian tubes and ovaries will result in the immediate entry into menopause (for women who have cycles).
Radical hysterectomy is performed in the case of malignant diseases according to the previous decision of the competent medical advisory board.
It implies the removal of the entire uterus, fallopian tubes and ovaries, as well as some surrounding connective tissues (the upper part of the vagina, surrounding connective tissues, lymph nodes, etc.).
Hysterectomy in Gyn-Fertility Clinic Milenković
Before suggesting operative treatment, we will try all less aggressive methods of treating your complaints. This is not the case in situations of malignancy. Sometimes, less aggressive treatment modalities help, and sometimes they don't, and surgical treatment remains the last option for treating your complaints.
There are several different ways to remove the uterus:
Vaginal hysterectomy is the first choice for minimally invasive hysterectomy
- It does not require an incision in the abdomen.
- The operation lasts for 45-90 minutes.
- The patient is discharged from the hospital the day after the operation and very quickly returns to her daily activities.
- "Large" uteri with myomas can also be operated on.
Through several small incisions on the abdomen, a camera and several instruments are inserted, with the help of which part of the operation is performed in this way, so that in the second act the operative approach is changed, and the operation is completed similar to a vaginal hysterectomy.
The postoperative recovery is generally similar to that of the laparoscopic approach.
Laparoscopic hysterectomy is a method where a camera and instruments are inserted into the abdomen through several small incisions (5-12 mm).
- The surgical procedure is performed with instruments under camera control.
- The uterus is removed vaginally.
- The surgery lasts 60-90 minutes, (it can last longer in cancer surgeries)
- The patient usually stays one day in the hospital and quickly returns to normal activities.
"Large" uteri with myomas can also be operated on.
Removal of the uterus through an open incision is less often performed today, mainly in the case of enlarged uteruses with myomas, as well as in malignant diseases.
The intervention usually lasts 60-90 minutes (it can last longer in the case of cancer operations).
The patient stays in the hospital for 1-4 days after the operation and the recovery is longer than with vaginal and laparoscopic hysterectomy.
Firstly, it is very important that you understand the reason for the proposed operation. We will try to explain the procedure itself so that you understand all the steps. It is also important to know the possible complications and side effects of the surgery.
If you have any concerns or questions about your surgery or recovery, please feel free to ask.
- Before the scheduled surgery, you need to do basic blood and urine tests (you will receive a list) and then have an examination with an internist.
- If you suffer from a chronic disease, bring the last report of your chosen doctor with you. There is a possibility that the internist will ask for additional analyses or examinations.
- The evening before the operation, as well as the morning before the operation, you will take a shower with an antiseptic that you will receive in the Clinic.
- It is advised to have a light dinner the day before the operation, and then to stop the intake of liquids and food.
- Surgery to remove the uterus will in most cases require a certain time of hospital recovery.
- This time depends on the type of surgical approach.
- Home recovery will also depend on the technique you have been operated on.
You will be clearly informed about these details preoperatively, so that you can organize the circumstances of your daily life for during the first period after the operation.
Recovery after hysterectomy
After vaginal and laparoscopic hysterectomy, it takes about 2 to 4 weeks of recovery.
Hysterectomy with abdominal incision sometimes takes up to 6 weeks.
You will receive clear recovery instructions when scheduling your surgery.
Risks and benefits
Removal of the uterus can improve the quality of your life if you have had heavy and irregular bleeding that does not respond to other types of treatment, resulting in anemia.
If you are at risk for uterine cancer (cervical or body), this surgery is preventive and drastically reduces that risk.
If the fallopian tubes are removed and the ovaries are left, the risk of ovarian cancer is reduced.
Hysterectomy is a “major" surgical procedure and requires some recovery.
Hysterectomy is permanent, that is, pregnancy is not possible after it.
If the ovaries are removed, menopause occurs immediately.
As with any surgery, there are potential risks.
The formation of blood clots in the veins of the small pelvis is prevented by a prophylactic dose of heparin.
Infections may occur, for which we give antibiotics during, sometimes and after the operation as well.
Bleeding can occur from incision in the skin but also inside the pelvis, sometimes requiring reoperation.
Injury to parts of the urinary tract, intestines and other surrounding tissues is possible.
There are also complications of anesthesia, which you will discuss with the anesthesiologist.
How long does hysterectomy take?
It depends on the reason for which the uterus is removed, but also on the surgical approach, and varies from about 60 minutes to sometimes over 3 hours. In addition, this time is affected by the size of the uterus, the fact that you previously had operations in the small pelvis, or whether there are adhesions in the abdomen.
What happens after a hysterectomy?
The time you will spend in the hospital depends on the type of surgery that will be performed. In each individual case, we will assess the need for intensive monitoring of your condition in the hospital. The advice is to get up and walk as soon as possible, as physical activity is the best prevention of the formation of blood clots in the veins.
If you've had an abdominal hysterectomy, you'll likely stay in the hospital for a few days. Vaginal and laparoscopic hysterectomies are less invasive and usually require a minimum of one night in the hospital after surgery.
Pre-operatively, you will receive recovery advice, including a restrictive regime of daily activities. Do not forget to ask everything you are interested in at the time of the surgery appointment.
How painful will the recovery be?
Expect discomfort and minor pain for some time after surgery. Before the operation, we will agree on the pain therapy. In the hospital, it will be therapy given through a vein, and at home you will take tablets.
How long should you rest in bed after surgery?
It is not necessary to lie down after the operation; it is more advisable to walk, as soon as possible.
What are the most common side effects of surgical hysterectomy?
The most common and unwanted effects are vaginal bleeding or discharge (from the healing of the tip of the vagina). Irritation at the incision site if any. Difficulty with urinating or passing stools. Fatigue after surgery.
If the ovaries were also removed, and you are not in menopause, you may experience symptoms typical of menopause (hot flashes, vaginal dryness, loss of libido, difficulty sleeping). We will consider HRT (hormone replacement therapy) to prevent or treat these symptoms.
What are the alternatives to hysterectomy?
We will discuss all options for solving your problems. If a hysterectomy is not absolutely necessary, some approaches to your problems may include:
- Waiting. Sometimes the symptoms you come in for can withdraw spontaneously.
- Oral hormonal contraception or replacement therapy can control the volume and amount of your bleeding or painful periods.
- If the problem is in the endometrium, it can be removed - hysteroscopically.
- Removal of fibroids.
- In the case of static disorders of the pelvic floor, we can try Kegel exercises and pessaries.
Which approach is the least invasive?
Vaginal hysterectomy is the only true minimally invasive way to remove the uterus. The entire operation is performed through the vagina where an incision is made at the junction of the uterus and vagina, so there is no need for abdominal incisions. After the surgery, the vagina is sutured with sutures that dissolve spontaneously in the tissue and there is no need to remove the sutures. This approach results in the fastest recovery (up to 4 weeks) and with very few complications. Sometimes it is possible for the operated patient to be discharged for further home treatment the day after the operation.
How is laparoscopic hysterectomy different?
A camera is introduced through a central incision in the region of your navel, with additional three smaller incisions on the abdomen that are used for instruments that are often connected to a source of some energy (electricity, ultrasound, etc.), it is possible to perform the entire operation if there are no contraindications for this approach.
Sometimes it is possible for you to leave the hospital the day after the surgery. Full recovery and the need for painkillers are shorter, that is, shorter than in classic surgery through an incision in the abdomen.
Where is the incision for abdominal hysterectomy?
The uterus will be removed through an incision in the abdomen, which is typical for a caesarean section. So, it is located above the symphysis region, usually about 10 centimeters long. If the situation requires that in the case of very large uterus, malignant process), the incision can be in the line that connects the navel and the symphysis. This approach requires a longer hospital stay and longer recovery time.
How does hysterectomy affect sex life?
These operations should not change your sex life. If your ovaries are removed during surgery and you have had a cycle before, you may experience decreased libido or vaginal dryness. If you have menopausal symptoms, we will discuss potential therapy.
