Abdominal Hysterectomy Surgery
An abdominal hysterectomy is an operation that requires an opening in the abdominal cavity to allow removal of the uterus with the possibility of other reproductive organs being taken out at the same time.
Types of Abdominal HysterectomySub-Total HysterectomyThe most commonly performed procedure is a total hysterectomy in which the uterus and cervix are removed together.
Total HysterectomyFollowing this is the sub-total hysterectomy in which the uterus is removed but dissected off the cervix, which remains in situ. As the cervix is a site for possible cancer growth most surgeons prefer to remove it but others believe it is important in supporting the pelvic floor and some women have mentioned that it increases their sexual pleasure; each surgeon has their own preferences but if you are in any doubt please do discuss this with your surgeon.
Total Hysterectomy and Salpingo-Oopherectomy (Unilateral Or Bilateral)This procedure removes not just the uterus and cervix but also the fallopian tubes and ovaries. These may be taken from only one side if seemed the most sensible option by the surgeon, or can involve the removal of both. If only the fallopian tubes are taken, this is called a total abdominal hysterectomy and salpingectomy.
Wertheims Procedure/Radical HysterectomyThis procedure involves the removal of all of the reproductive organs and parts of the vagina and pelvic tissues also. It may also require the biopsy and/or removal of the lymphatic system in the pelvis.
It is not commonly performed any longer thanks to good diagnostic tests that can detect problems before they have a chance to develop to a large extent. It is usually performed on those who have a large amount of cancerous development in the pelvic organs.
The decision as to which operation is carried out sometimes cannot be assessed until the surgeon has accessed the pelvis and assessed the organs for disease or damage. It may be that the ovaries are not planned to be removed but upon inspection are found to be severely damaged and in the patient's best interests to be removed.
You will be advised on all of the possibilities when you sign your consent form.Where possible it is preferable to leave the ovaries in tact in younger women as to remove them enforces menopause and necessitates the need for hormone replacement therapy.
Why do I Need an abdominal Hysterectomy?Your doctor will have performed lots of diagnostic tests that will have all added up to making the decision to have this operation. It is an invasive procedure and the decision to perform it will be made after lengthy discussion with you explaining all other options if there are any.
For some women it may be that one or more of the reproductive organs in known to be cancerous and the operation is needed to prevent the spread of the cancer, for others they may have troublesome fibroids, cysts or severe endometriosis.
The OperationFollowing the administration of the anaesthetic, the surgeon will make a small incision in the abdomen. This is normally in the same place as a Caesarean section incision and will start small and made bigger if needed. If you are known to have large fibroids or cysts it may not be possible to do the operation using this incision and a larger one will be needed running from just under the navel upwards.
As the surgeon makes his way down the layers to the uterus blood vessels are sealed and anatomy is identified and assessed.
The uterus is removed by a process of clipping, cutting and tying or suturing the vessels, muscles and ligaments until the organ is free. If the cervix, and the fallopian tubes and ovaries, it is possible to remove these all together as long as there are no large fibroids or cysts blocking the visibility of the area in which case they will be removed separately.
Most of the stitches used will be absorbable with the exception of the skin stitch which is selected per surgeon and may involve the use of skin clips or even skin glue.It is normal to have a wound drain in situ to allow for any free fluids to drain away but also to allow for assessment of bleeding.
A dressing will normally be used over the wounds which will be checked regularly.The removed organs will be sent to a laboratory for analysis to see if there is any disease present.
After SurgeryIt is likely that you will feel uncomfortable after the surgery and sleepiness and nausea can continue for some hours. You will be prescribed medications to try and overcome this so please ask if you are having trouble managing these discomforts.
The nursing staff will want to check your wound to assess for signs of bleeding and infection and will also monitor your blood pressure, pulse and temperature regularly for the same reasons and to monitor your progress.
It is likely that you will have a sanitary pad in situ as it is normal to experience some blood loss for a few days after the operation regardless as to whether your cervix was removed.. It is not advised that tampons are worn as these can introduce infection.
Abdominal hysterectomy is a major operation and will not be performed without having a good reason. It is no longer offered purely as a method of birth control.