What are the short-term and long-term side effects of a full hysterectomy. How does the type of hysterectomy affect recovery time and potential complications. What emotional impacts can women experience after undergoing a hysterectomy.

Types of Hysterectomy and Their Impact on Recovery

A hysterectomy is a surgical procedure to remove the uterus, which can be performed for various medical reasons. The extent of the surgery and the approach used can significantly influence the recovery process and potential side effects. Let’s explore the different types of hysterectomies and their implications:

• Partial hysterectomy: Removes some or all of the uterus, leaving the cervix intact
• Total hysterectomy: Removes both the uterus and cervix
• Total hysterectomy with salpingo-oophorectomy: Removes the uterus, cervix, and one or both ovaries and fallopian tubes

The surgical approach can be through the abdomen, vagina, or using laparoscopic or robot-assisted technology. The method chosen by your surgeon can impact your recovery time and the side effects you may experience post-surgery.

How does the type of hysterectomy affect recovery time?

Recovery time varies depending on the type of hysterectomy performed. For an abdominal hysterectomy, most patients can return to their usual activities after about six weeks. In contrast, a vaginal hysterectomy typically allows for a shorter recovery period, with patients often resuming normal activities within three to four weeks.

Short-Term Physical Side Effects of Hysterectomy

In the immediate aftermath of a hysterectomy, patients may experience several short-term physical side effects. These can include:

• Pain at the incision sites
• Swelling, redness, or bruising around the incision
• Burning or itching near the incision
• Numbness near the incision or down the leg
• Vaginal discharge or bleeding

It’s important to note that these side effects are generally normal parts of the healing process. However, if symptoms persist or worsen, it’s crucial to consult with your healthcare provider.

Are there any immediate risks associated with hysterectomy surgery?

Like any major surgery, a hysterectomy carries some immediate risks. These can include infection, bleeding, adverse reactions to anesthesia, and damage to surrounding organs. Your surgeon will discuss these risks with you before the procedure and take precautions to minimize them.

Long-Term Effects and Potential Complications

While many women experience a significant improvement in their quality of life after a hysterectomy, there are some long-term effects and potential complications to be aware of:

1. Permanent cessation of menstruation
2. Inability to become pregnant
3. Potential for organ prolapse
4. Early onset of menopause (if ovaries are removed)
5. Changes in sexual function

What is the risk of organ prolapse after a hysterectomy?

A 2014 study involving over 150,000 patient records reported that approximately 12 percent of hysterectomy patients required subsequent pelvic organ prolapse surgery. Organ prolapse can occur when the vagina is no longer connected to the uterus and cervix, potentially leading to the vagina telescoping down on itself or even bulging outside the body. Other organs such as the bowel or bladder may also prolapse, potentially causing urinary problems.

Menopausal Symptoms and Sexual Side Effects

If a total hysterectomy includes the removal of both ovaries (bilateral oophorectomy), it will trigger immediate menopause, regardless of the patient’s age. This sudden onset of menopause can lead to various symptoms, including:

• Hot flashes
• Night sweats
• Vaginal dryness
• Insomnia
• Mood changes

These menopausal symptoms can have a significant impact on a woman’s sexual health and overall quality of life.

How can menopausal symptoms affect sexual function after a hysterectomy?

The sudden drop in estrogen levels following ovary removal can lead to several sexual side effects, including:

• Vaginal dryness
• Pain during intercourse
• Decreased sex drive

It’s important to discuss these potential effects with your healthcare provider, as there are treatments available to help manage these symptoms, such as hormone replacement therapy or lubricants.

Emotional and Psychological Impacts of Hysterectomy

The emotional and psychological effects of a hysterectomy can be significant and vary greatly from person to person. Some women may experience a sense of relief, particularly if the surgery alleviates chronic pain or other health issues. However, others may struggle with feelings of loss or changes in their sense of femininity.

Can a hysterectomy affect a woman’s emotional well-being?

Yes, a hysterectomy can have profound emotional impacts. Some women may experience:

• Grief over the loss of fertility
• Changes in body image
• Feelings of depression or anxiety
• Conflicting emotions about the end of menstruation

It’s crucial for women to have access to emotional support and counseling before and after the procedure to help process these feelings.

Preventive Measures and Management of Side Effects

While some side effects of hysterectomy are unavoidable, there are steps that can be taken to minimize risks and manage symptoms effectively:

1. Pelvic floor exercises: Performing Kegel exercises before and after surgery can help strengthen the muscles supporting internal organs, potentially reducing the risk of prolapse.
2. Hormone replacement therapy: For women experiencing menopausal symptoms, hormone replacement therapy may be an option to alleviate some side effects.
3. Regular follow-up care: Maintaining regular check-ups with your healthcare provider can help address any concerns or complications promptly.
4. Lifestyle modifications: Adopting a healthy diet, regular exercise, and stress management techniques can support overall recovery and well-being.

How can women prepare for the potential side effects of a hysterectomy?

Preparation is key to managing the potential side effects of a hysterectomy. Women can:

• Discuss all possible outcomes with their healthcare provider
• Join support groups or connect with others who have undergone the procedure
• Prepare their home environment for recovery
• Arrange for help during the initial recovery period
• Educate themselves about the procedure and potential side effects

By taking these steps, women can feel more empowered and better equipped to handle the physical and emotional challenges that may arise post-surgery.

Alternatives to Hysterectomy and Decision-Making Process

While a hysterectomy may be the best option for some women, it’s important to explore all available alternatives before making a decision. Depending on the underlying condition, alternatives may include:

• Medication
• Endometrial ablation
• Uterine artery embolization
• Myomectomy (for fibroids)
• Watchful waiting

How can women make an informed decision about undergoing a hysterectomy?

Making an informed decision about a hysterectomy involves:

1. Thoroughly discussing the pros and cons with your healthcare provider
2. Getting a second opinion if you’re unsure
3. Considering your personal health goals and lifestyle
4. Exploring all available treatment options
5. Assessing the potential impact on your quality of life

It’s crucial to take the time to weigh all factors and feel comfortable with your decision before proceeding with surgery.

Long-Term Health Considerations Post-Hysterectomy

While a hysterectomy can resolve many health issues, it’s important to be aware of potential long-term health considerations:

• Increased risk of cardiovascular disease (if ovaries are removed before natural menopause)
• Potential for decreased bone density
• Changes in urinary function
• Alterations in sexual response

How does a hysterectomy affect long-term health risks?

The long-term health effects of a hysterectomy can vary depending on the type of procedure and the age at which it’s performed. For example:

• Women who have their ovaries removed before natural menopause may have an increased risk of osteoporosis and cardiovascular disease due to the loss of estrogen
• Some studies suggest a potential link between hysterectomy and an increased risk of certain health conditions, though more research is needed in this area

Regular health check-ups and a focus on overall wellness can help mitigate potential long-term health risks.

Understanding the potential side effects and long-term implications of a hysterectomy is crucial for women considering this procedure. By being well-informed and working closely with healthcare providers, women can make the best decisions for their health and well-being. Remember, every woman’s experience with hysterectomy is unique, and with proper care and support, many women report improved quality of life following the procedure.

Short- and Long-Term, Questions to Ask

A hysterectomy is a surgery to remove the uterus, which may be necessary to help treat certain conditions. It can cause short- and long-term side effects, and like any major surgery, it also carries some immediate risks.

There a several types of hysterectomy, depending on what’s removed:

• A partial hysterectomy removes some or all of the uterus but leaves the cervix intact.
• A total hysterectomy removes both uterus and cervix.
• A total hysterectomy with salpingo-oophorectomy removes the uterus, cervix, and one or both ovaries and fallopian tubes.

Hysterectomies are performed through either the abdomen or the vagina. Some can be done laparoscopically or with robot-assisted technology. The approach your doctor uses can play a role in the side effects you might experience after surgery.

Read on to learn more about hysterectomy side effects.

Having a hysterectomy can cause several short-term physical side effects. Some may also experience emotional side effects during the recovery process.

Physical side effects

Following a hysterectomy, you may need to stay in the hospital for a day or two. During your stay, you’ll likely be given medication to help with any pain as your body heals. A laparoscopic hysterectomy sometimes doesn’t require a hospital stay.

As you recover, you’ll likely notice some bloody vaginal discharge in the days or weeks after the procedure. This is completely normal. You may find that wearing a pad during this part of recovery helps.

The actual amount of time you’ll need to recover depends on the type of surgery you have and how active you are. Most people can return to their usual activity level about six weeks after an abdominal hysterectomy.

If you have a vaginal hysterectomy, your recovery time is typically shorter. You should be able to return to your usual activities within three or four weeks.

In the weeks following your hysterectomy, you may notice:

• pain at the incision site
• swelling, redness, or bruising at the incision site
• burning or itching near the incision
• a numb feeling near the incision or down your leg

Keep in mind that if you have a total hysterectomy that removes your ovaries, you’ll immediately begin menopause. This can cause:

• hot flashes
• vaginal dryness
• night sweats
• insomnia

Emotional side effects

The uterus is a crucial organ for pregnancy. Removing it means that you won’t be able to get pregnant, which can be a hard adjustment for some. You’ll also stop menstruating after having a hysterectomy. For some, this is a huge relief. But even if you’re feeling relieved, you can still experience a sense of loss.

For some, pregnancy and menstruation are crucial aspects of femininity. Losing the capacity for both in a single procedure can be a lot to process for some people. Even if you’re excited by the prospect of not having to worry about pregnancy or menstruation, conflicting feelings can come up after the procedure.

Before you have a hysterectomy, consider checking out HysterSisters, an organization dedicated to providing information and support to those considering a hysterectomy.

Here’s one woman’s take on the emotional aspects of having a hysterectomy.

Following any type of hysterectomy, you’ll no longer have your period. You also can’t get pregnant. These are permanent effects of having a hysterectomy.

Problems with organ prolapse can happen after a hysterectomy. A 2014 study of more than 150,000 patient records reported that 12 percent of hysterectomy patients required pelvic organ prolapse surgery.

In some organ prolapse cases, the vagina is no longer connected to the uterus and cervix. The vagina can telescope down on itself, or even bulge outside the body.

Other organs such as the bowel or the bladder can prolapse down to where the uterus used to be and push on the vagina. If the bladder is involved, this can lead to urinary problems. Surgery can correct these issues.

Most women do not experience prolapse after hysterectomy. To prevent prolapse problems, if you know you are going to have a hysterectomy, consider doing pelvic floor exercises to strengthen the muscles supporting your internal organs. Kegel exercises can be done anytime and anywhere.

If you have your ovaries removed during the procedure, your menopause symptoms can last for several years. If you don’t have your ovaries removed and haven’t gone through menopause yet, you may begin menopause sooner than expected.

If you have your ovaries removed and go into menopause, some of your symptoms may impact your sex life. Sexual side effects of menopause can include:

• vaginal dryness
• pain during sex
• decreased sex drive

These are all due to the change in estrogen produced by your body. There are several things you can consider to counteract these effects, such as hormone replacement therapy.

However, many women who have a hysterectomy do not experience a negative impact on their sex life. In some cases, relief from chronic pain and bleeding improves sex drive.

Learn more about sex after a hysterectomy.

Hysterectomy is a major surgery. Like all surgeries, it comes with a number of immediate risks. These risks include:

• major blood loss
• damage to surrounding tissues, including the bladder, urethra, blood vessels, and nerves
• blood clots
• infection
• anesthesia side effects
• bowel blockage

These types of risks accompany most surgeries and don’t mean that having a hysterectomy isn’t safe. Your doctor should go over these risks with you before the procedure and inform you about steps they’ll take to minimize your risks of more serious side effects.

If they don’t go over this with you, don’t feel uncomfortable asking. If they can’t provide this information or answer your questions, they may not be the doctor for you.

A hysterectomy can be a life-changing procedure with major benefits and some potential risks. That’s why it’s so important to find a doctor that you trust and feel comfortable talking to before having the procedure.

A good doctor will set aside time to listen to your questions and concerns before surgery. While you should bring up any questions on your mind, here are some specific questions to consider asking:

• Are there any nonsurgical treatments that may improve my symptoms?
• Which type of hysterectomy do you recommend and why?
• What are the risks of leaving my ovaries, fallopian tubes, or cervix in place?
• Which approach to surgery will you take and why?
• Am I a good candidate for vaginal hysterectomy, laparoscopic surgery, or robotic surgery?
• Do you use the latest surgical techniques?
• Is there any new research related to my condition?
• Will I continue to need Pap smears after my hysterectomy?
• If you remove my ovaries, would you recommend hormone replacement therapy?
• Is general anesthesia always necessary?
• How long will I need to be hospitalized after my surgery?
• What is the standard at-home recovery time?
• Will I have scars, and where?

Hysterectomies can cause several short- and long-term side effects. They can also help to alleviate excruciating pain, heavy bleeding, and other frustrating symptoms. Work with your doctor to weigh the benefits and risks of the procedure and get a better idea of what to expect after surgery.

Having Sex After a Hysterectomy

Overview

A hysterectomy is surgery to remove the uterus (womb) — the hollow organ where babies grow and develop during pregnancy.

Having this procedure can relieve pain and other symptoms from conditions like fibroids or endometriosis. And if you have uterine or cervical cancer, it could save your life.

Any surgery can have both short-term and long-term side effects. A hysterectomy can cause side effects like pain and bleeding. Once you have this procedure, you won’t be able to carry a child.

A hysterectomy can also impact your sex life in the weeks following the procedure. Yet it shouldn’t prevent you from having sex — and enjoying it — once you’re healed.

Here’s a look at how a hysterectomy can affect your sexuality and what you can do to ensure you don’t lose this important part of your life.

Most of the surgery-related side effects should go away and your body should heal within two months.

The American College of Obstetricians and Gynecologists and U.S. Department of Health and Human Services recommend that you not insert anything in your vagina for the first six weeks after your surgery.

Doctors can perform different types of hysterectomy:

• Total hysterectomy. This is the most common type. It removes the whole uterus, including the bottom part, the cervix. The surgeon might also remove your ovaries and fallopian tubes.
• Partial (also called subtotal or supracervical) hysterectomy. Only the top part of the uterus is removed. The cervix is left in place.
• Radical hysterectomy. The surgeon removes the uterus, cervix, tissue on either side of the cervix, and the top part of the vagina. This type is often used to treat cancer of the cervix or uterus.

You might have some light bleeding and discharge after your surgery, and you’ll no longer get regular menstrual periods.

Pain, burning, and itching around the incision site are also normal. If your ovaries were removed, you’ll likely have menopause-like side effects like hot flashes and night sweats.

A hysterectomy will put your sex life on pause for a few weeks, but it shouldn’t end it.

According to one review of studies, most women said their sex life either stayed the same or improved after the procedure. They were finally free from the pain or heavy bleeding that caused them to have the surgery.

Having your ovaries removed during the procedure could dampen your desire for sex, though. That’s because your ovaries produce testosterone and estrogen — hormones that are integral to your libido.

Can I still have an orgasm?

Some women do report that they have less intense orgasms or no orgasms at all after surgery. This is because removing the uterus can cut nerves that enable you to climax.

Also, the cervix contains nerves that are stimulated during sex. If your cervix was removed during the procedure, the surgeon may have cut these nerves. This is rare and not the norm for most people who have the surgery, though.

Will sex still feel the same?

A hysterectomy shouldn’t affect sensation in your vagina. However, removing your ovaries will put you into menopause, which can dry out the tissues of the vagina and make sex more painful.

What’s the safest way to start having sex again?

First, make sure you wait at least six weeks — or as long as your doctor recommends — before you start having sex again. Take your time easing back into sex.

If vaginal dryness is making sex too painful, ask your doctor about using vaginal estrogen creams, rings, or tablets. Or, try a water-based or silicone-based lubricant like K-Y or Astroglide when you have sex.

If you’re having difficulty getting back to your normal sex life after a hysterectomy, try these tips to get back on track:

1. Take your time

When you have sex, don’t rush. Give yourself time to get aroused.

2. Experiment

Try different positions until you find one that’s most comfortable. Explore options other than vaginal sex, like oral or manual stimulation.

3. Be honest

Be open with your partner about what feels good and what hurts.

If these tips don’t work, consider seeing a sex therapist or counselor with your partner.

Once you pass the six-week mark after your surgery, you should be able to go back to a normal sex life. If you’re still having problems with arousal, orgasm, or comfort during sex, don’t just accept it. See your doctor.

Here are a few questions to ask your doctor:

• What’s the safest way to ease back into sex after my surgery?
• What should I do if sex is painful?
• How can I overcome a lack of desire?
• What should I do if my partner is getting frustrated or isn’t helping?

Together, you and your doctor can strategize ways to make your sex life as good as — or even better than it was — before your surgery.

Removal of the uterus – pain and complications after surgery

Complications after hysterectomy are early and late. Pain after removal of the uterus appears on the first day and is directly related to the operation. In the late period, pain syndrome may be associated with the formation of adhesions. In women, after the intervention, bleeding, suppuration of the postoperative wound may occur. If after the operation the legs begin to hurt sharply, or chest pain and shortness of breath appear, this may be evidence of pulmonary embolism or veins of the lower extremities. The slightest violations and problems that a woman feels after the operation should be reported to the attending physician.

The period after removal of the uterus, pain and other symptoms

The postoperative period for removal of the uterus is divided into early and late. During the early period, the woman stays in the hospital, under medical supervision. Then he is rehabilitated at home. The duration of recovery depends on the type of intervention. Hysterectomy is performed in several ways. The organ is removed through an incision on the anterior wall of the abdomen, through the vagina, or by laparoscopy. In the first two cases, the early postoperative period lasts 8-10 days; in the last case, the patient is discharged home already on the 3rd-5th day. Laparoscopic removal of the uterus can significantly reduce pain and other unpleasant consequences.

The first day is the most difficult in the postoperative period. After the removal of the uterus, the stomach begins to hurt, and this is a normal reaction. After all, a serious surgical intervention was performed. Hypersensitivity persists for 3-10 days. Women come out of anesthesia differently, some may experience nausea, sometimes vomiting, confusion, severe weakness, increased thirst. In the first day, most have no appetite. Also in the first days after the operation, intoxication associated with the effects of anesthesia and blood loss may occur.

Pain after surgery is relieved with non-steroidal anti-inflammatory drugs and narcotic analgesics. Antibiotics are mandatory to prevent bacterial infections. In the first 2-3 days, anticoagulants are prescribed to prevent thrombosis. Patients are also shown intravenous infusions of glucose and saline to relieve intoxication and replenish the volume of circulating blood. With significant blood loss, transfusion of plasma or erythrocyte mass is indicated. It is recommended to get out of bed after laparotomy after a day, and after laparoscopy – after 7-8 hours. Early activity of patients prevents the occurrence of many complications.

Complications in the early postoperative period

The early postoperative period requires constant monitoring by doctors, since it is in the first days that there is a high risk of complications. Pain after removal of the uterus may increase if there is inflammation in the area of ​​​​the sutures or a purulent complication. In this case, the skin around the wound turns red, swelling, serous or purulent discharge appears. In some cases, the seams may diverge, the healing of the postoperative wound slows down. The patient may have a fever.

A formidable complication of hysterectomy is peritonitis. Most often, it is observed during operations performed according to emergency indications, necrosis of fibromatous nodes, and the decay of cancerous tumors. The abdomen begins to hurt after removal of the uterus, its walls are tense, due to sharp pain it is difficult to palpate. The general condition of the patient worsens, the temperature rises to 39 degrees and above, symptoms of general intoxication appear. The sutures may not change, but more often in the area of ​​​​the postoperative wound there is swelling, purulent discharge, and divergence of the edges. First, conservative therapy is carried out with the use of 2-3 antibiotics, intravenous infusions. If it turned out to be ineffective, a second operation is performed.

Another complication that may occur after removal of the uterus is pain – impaired urination. It manifests itself in the form of pain, resembling the symptoms of cystitis, and is associated with trauma to the urethra during surgery. In rare cases, women experience acute urinary retention. A dangerous complication is bleeding. It can be external (from the vagina or postoperative wound) or internal. The only symptoms of massive internal bleeding may be abdominal pain, weakness, and a drop in blood pressure. Clarify the diagnosis with the help of ultrasound. To stop bleeding, anticoagulants are administered, with massive blood loss, a second operation, blood transfusion may be necessary.

If a woman begins to get sick after removal of the uterus behind the sternum, shortness of breath, tachycardia, pressure drops, this may be evidence of pulmonary embolism. The severity of the condition depends on the level of blockage. When blood clots enter small arteries, the patient’s condition deteriorates slightly, she may experience pneumonia, bronchospasm, and a heart attack in a small area of ​​the lung. When a blood clot enters a large artery, the complication can be fatal. For relief, thrombolytics, infusion therapy, oxygen masks are prescribed. Treatment is carried out in intensive care.

Pain in the legs, redness of the skin in the area of ​​the lower leg, may be associated with thrombophlebitis. This complication does not occur very often. For its prevention, anticoagulants are administered, it is recommended to wear compression underwear on the lower extremities immediately after the operation.

Pain after removal of the uterus and complications in the long term after surgery

Rehabilitation after removal of the uterus takes approximately 1.5-2 months. During this period, late complications may occur that require medical attention. Most common:

• Urinary incontinence
• Vaginal prolapse
• Fistula formation
• Chronic pain after hysterectomy

Urinary incontinence and vaginal prolapse are due to a violation of the anatomical relationship between the organs of the small pelvis and the weakening of its muscles. Women may complain of both a slight leakage of the contents of the bladder, and the complete inability to hold urine. This condition creates discomfort, limits the physical activity of a woman, leads to frequent urethritis, cystitis and even pyelonephritis. Sometimes the lower back begins to hurt after removal of the uterus, there is discomfort or a sensation of a foreign body in the perineum. These signs are symptoms of vaginal prolapse. Although in many cases the complication is asymptomatic.

Fistulas are abnormal channels that can connect the vagina to the bladder or rectum. A complication rarely occurs. The main symptoms are the discharge of feces or urine from the vagina. Removal of the uterus can cause chronic pain in the late postoperative period due to the formation of adhesions. They occur more frequently with laparotomy than with laparoscopy. The adhesive process can provoke early postoperative complications (peritonitis, suppuration of sutures, bleeding). Also, a number of patients have a genetic predisposition to the formation of adhesions and keloid scars. In such situations, the stomach can not only hurt after removal of the uterus. The adhesive process is accompanied by flatulence, constipation, urinary incontinence.

Consequences of removal of the uterus

Hysterectomy is a major operation in which one of the organs is removed, so it cannot be without consequences. They depend on the volume of surgical intervention, the presence of complications after the operation. A woman after the operation will not be able to conceive and endure a baby. If the uterus was removed along with the appendages, she has a menopause. It is associated with a sharp decrease in the amount of hormones that are synthesized in the ovaries. It can be accompanied by hot flashes, mood swings, weight gain, decreased sex drive. Removing the uterus can cause bone pain. They are also associated with hormonal changes. In menopause, the amount of calcium in the blood and bone tissue decreases, which leads to osteoporosis. To prevent these complications and relieve the symptoms of early menopause, patients are prescribed maintenance hormone therapy.

If the uterus was removed without appendages, there are no sharp hormonal disorders. The woman does not have her period, she remains infertile. If a small stump remains, minor bleeding may occur once a month. The stomach will hurt after removal of the uterus while it will be insignificant. Many patients ask if it is possible to have sex after a hysterectomy. In most cases, sexual life is not disturbed, sexual desire can persist even when the ovaries are removed. Sometimes pain after surgery during sex is associated with the surgical removal of part of the vagina and a decrease in its length. But many partners adapt to this situation, find certain positions that do not cause discomfort.

In most cases, removal of the uterus does not cause pain after 2-3 months. In addition to the above consequences, no other symptoms are observed in women. They can live normally, work, relax, and engage in moderate sports. The operation does not affect life expectancy. If the hysterectomy was due to cancer, a course of chemotherapy or radiation therapy may be needed.

Free appointment with a reproductive specialist

until June 30, 2023

23 days left

Dear patients! Clinic “IVF Center” invites you to a free appointment with a reproductologist with an ultrasound scan and a treatment plan .

Start your journey to happiness – right now!

Name *

Telephone *

E-mail *

Message *

By submitting this form, I confirm that, in accordance with the requirements of the “Federal Law on Personal Data No. 152-FZ” and in accordance with the Terms, I consent to the processing of my personal data

Leave this field blank

Other articles

Artificial insemination: what is it and how is it carried out?

Read article

Do’s and don’ts after IVF?

Read article

Licenses and certificates

Hysterectomy (extirpation of the uterus) – prices in Moscow

Uterine extirpation is a surgical operation that is a type of hysterectomy. This is the name of the operation to remove the uterus. This is a total hysterectomy, in which the body of the organ is removed along with the neck. Appendages in the form of fallopian (fallopian) tubes and ovaries are preserved. The operation is performed as a radical method of treating certain diseases in which the preservation of the uterus is not possible due to the high risk to the health of the woman.

Purpose of surgery

The main goal of the operation is to restore the patient’s health and improve her well-being by getting rid of the signs of the disease that bothers her. After removal of diseased tissues, the symptoms of pathology disappear completely. These can be uterine bleeding, the uterus falling out of the vagina and other conditions that significantly complicate the life of a woman.

In oncological diseases, hysterectomy allows you to eradicate the malignant process, if it has not yet had time to spread to other organs and tissues. In this case, the risk of oncology recurrence is reduced, the woman’s well-being improves, and her life expectancy increases.

When amputation of the uterus is indicated

Hysterectomy is indicated for the following pathologies of this organ:

• Neoplasms of the body and cervical part of the organ, appendages – benign or malignant. Benign tumors (myomas, fibromyomas) are an indication if they rapidly increase in size. cause violations of the menstrual cycle according to the type of bleeding. In malignant processes, removal of the uterus is indicated regardless of the size of the formation.
• Adenomyosis is a type of endometriosis in which the mucous membrane lining the cavity from the inside grows into the muscle wall. The disease is dangerous because it does not cause symptoms in the early stages of development. But as the endometrium grows in the muscle layer, scarring of the walls occurs. They lose their elasticity and ability to stretch. Adenomyosis can cause severe uterine bleeding, leading to the development of anemia.
• Prolapse or prolapse of the uterus. If conservative methods of correcting the position of the organ are ineffective, it is removed.
• Severe inflammation, covering the body, appendages. Hysterectomy is performed if conservative treatment is ineffective and impractical, and the preservation of the woman’s reproductive function is not required.

Preoperative preparation

Extirpation of the uterus requires special preparation. Before the operation, the patient is prescribed an examination, during which the diagnosis is clarified and possible contraindications are identified. The preoperative examination includes the following procedures:

• General urine and blood tests.
• Blood test for coagulation, sugar level, latent infections, tumor markers, determination of the group and Rh factor.
• Fluorography – X-ray examination of the respiratory system.
• ECG (electrocardiography) to assess the bioelectrical activity of the heart.
• Ultrasound, CT or MRI of the pelvic organs.
• Colposcopy – examination of the cervix using an optical device that magnifies the image many times over.
• Cytological smear from the intracervical canal.
• Consultation of a general practitioner, anesthesiologist, and, if necessary, other narrow specialists.

If no contraindications are identified, the woman is prescribed preparation for surgery. It includes:

• Cancellation of blood thinners (Aspirin, anticoagulants) 7 days before the procedure.
• No food 8-10 hours before surgery. You should refrain from drinking for 4-6 hours. The last meal should be in the evening. A light dinner is recommended.
• A cleansing enema the day before the procedure.
• Hygienic shower and hair removal from the pubis, perineum.

Before surgery, the bladder must be emptied. If the patient was unable to do this on her own, a bladder catheterization is performed to remove the accumulated urine.

Types of hysterectomy according to the volume of intervention

Depending on which structures are to be removed, the following types of hysterectomy are distinguished:

• Subtotal (supravaginal). During the operation, only the body of the uterus is removed, preserving its appendages and cervix. All manipulations are performed over the vagina. This is where the name of the procedure comes from.
• Total (extirpation of the uterus). Together with the body, the neck of the organ is amputated. In terms of the degree of intervention, this type of operation is superior to subtotal hysterectomy.
• Radical (full). The surgeon removes the body and neck, as well as adnexal structures – the ovaries, fallopian tubes.

The volume of surgical intervention is determined by the attending physician, taking into account the age of the patient, the presence of concomitant pathologies of the reproductive system and other organs. In malignant tumors, preservation of the cervix is ​​usually impractical, since it increases the risk of recurrence of oncology – in this case, hysterectomy is indicated.

The main advantage of the total technique before radical hysterectomy is that the ovaries continue to function. They produce hormones that are responsible for shaping a female figure, regulating the menstrual cycle, sexual desire and cell renewal throughout the body. This is especially important if the patient is a woman of childbearing age. In this case, the extinction of the functions of the reproductive system occurs naturally with the onset of menopause. To maintain a normal hormonal background after a radical hysterectomy, lifelong use of drugs containing female sex hormones is indicated.

Classification of the operation according to the type of access to the removed organ

To remove the uterus along with its cervix, the surgeon must have convenient access to the removed organs. You can approach the uterus through the vagina and the anterior abdominal wall. In the latter case, surgical manipulations are performed through a long incision or small punctures about 1 cm long. Each method of hysterectomy has its own characteristics, pros and cons.

Abdominal

Abdominal hysterectomy is an operation to remove the uterus with access through the abdomen. It is also called laparotomy. This means that access to the operated organ is provided through a large vertical or horizontal incision made with a scalpel on the anterior abdominal wall. The benefits of laparotomy include:

• Easy access to structures to be removed – the surgeon can visually control the manipulation directly through the incision.
• Versatility – all types of hysterectomy (subtotal, total, radical) can be performed with access through the abdomen.
• Efficiency – sometimes laparotomy is the only possible way to amputate the uterus. This happens, for example, with very large tumors, when it is not possible to extract it through small incisions on the abdominal wall or vagina.

The disadvantages of the method include the extensiveness of the surgical intervention. Due to the high morbidity, the risk of postoperative complications significantly increases. The recovery period after surgery also increases, the patient has to stay in the hospital longer.

The operation is performed under epidural or general anesthesia (narcosis). Its duration is from 1 to 2 hours. During the procedure, the surgeon cuts the skin, subcutaneous fat, muscle layer with a scalpel and exposes the uterus. Then he fixes it and brings it out. Then he bandages the uterine ligaments and tubes, blood vessels. After that, he cuts off the body of the uterus along with the cervix and forms the stump of the vagina. At the end, the surgeon performs stitches and applies a sterile dressing.

Laparoscopic

With the laparoscopic method of removing the uterus, access to the organ is also carried out through the abdominal wall. The method differs in that the surgeon performs not one large incision, but 3-4 small ones. Their length does not exceed 10–15 mm.

Advantages of the method:

• Versatility. Laparoscopy can be used for total, total, and supravaginal hysterectomy.
• Minimally invasive. Surrounding tissues are injured to a lesser extent.
• Low risk of serious complications. Since the surrounding organs and tissues are less damaged during laparoscopy, postoperative complications develop less frequently.
• Fast recovery period and short hospital stay.

The main disadvantage of laparoscopic hysterectomy is the impossibility of using the method for large tumors.

The operation is performed under anesthesia or epidural anesthesia, lasts from 1.5 to 3.5 hours. The surgeon monitors the progress of the procedure using an endoscope, a long flexible tube with a light and a video camera at the end. He introduces her into one of the holes. The endoscope transmits an image to a computer monitor. Otherwise, a hysterectomy resembles a laparotomy – with the help of special instruments inserted through punctures, the surgeon selects and fixes the uterus, bandages the vessels, ligaments, and tubes. Then he cuts off the organ and brings it out. At the end, stitches and a sterile bandage are applied.

Attention! A variation of laparoscopic hysterectomy is robot-assisted hysterectomy. It differs from conventional laparoscopy in that all manipulations are performed by a robot controlled by the surgeon using a console.

Vaginal

The uterus can be accessed through the vagina. In this case, a hysterectomy is called a vaginal hysterectomy. Advantages of the method:

• Minimally invasive. Access to the amputated uterus is through the vagina. Therefore, it is not necessary to dissect the abdomen.
• Low risk of complications. The less tissue damage, the lower the likelihood of serious consequences for the patient’s health.
• Possibility of simultaneous plastic surgery of the vagina, correction of the muscles of the pelvic floor.
• Fast rehabilitation period. After a vaginal hysterectomy, patients recover the fastest.

There are also disadvantages to the vaginal amputation method. Thus, the method does not allow the body of the uterus to be removed through the vagina while preserving the cervix. With its help, it is also impossible to remove tumor formations of very large sizes. Vaginal extirpation of the uterus is most often performed when it is prolapsed or prolapsed.

Despite the low trauma, the operation requires the use of general anesthesia or epidural anesthesia. It takes from 1 to 1.5 hours. Using a scalpel, the surgeon cuts the wall of the vagina. Through the incision, he cuts off the ligaments that hold the uterus in the pelvis. Then he seals the vessels through which blood enters the removed organ, and completely cuts it off. At the end, the doctor sutures the vagina, if necessary, performing plastic surgery (colporrhaphy).

What are the contraindications

Contraindications for all types of operations considered are:

• Acute inflammation of the reproductive system. First, the inflammatory process is stopped with medication, then amputation is performed.
• Severe pathologies of the liver, kidneys, heart, in which surgical intervention threatens the life of the patient.

Possible postoperative complications

During or after amputation of the uterus, the following complications may develop:

• Intra-abdominal bleeding. May develop during and after surgery.
• Hematomas of the parametrial structure surrounding the uterus.
• Injury to the ureters, bladder – the risk increases during surgery if adhesions occur in the abdominal cavity and small pelvis.
• Peritonitis, sepsis – infectious complications caused by the penetration of pathogenic microflora into an open wound.
• Formation of blood clots – the blood thickens, clots form, which can move through the blood vessels.
• Pelvic prolapse – after the intervention, the vault may descend along with the bladder, rectum.
• Difficulties with urination – occur after vaginal hysterectomy.

Within 6-8 days after the operation, the patient is in the hospital, where she is monitored by medical workers. Every day, a woman’s blood pressure, body temperature are measured, urine and blood tests are taken several times, and ultrasound of the small pelvis is done. All this helps to timely identify possible complications and carry out treatment. After being discharged home, it is important to continue to monitor your well-being on your own. With the appearance of severe pain, fever, general malaise, you should call an ambulance – these symptoms indicate the occurrence of complications.

Rehabilitation after hysterectomy

The rehabilitation time for a woman after amputation of the uterus depends on the method of the operation. After laparotomy, the recovery period lasts about 2-3 months. Minimally invasive techniques can reduce it to 6-8 weeks.

Features of recovery after hysterectomy:

• The patient is in the intensive care unit for 24 hours after the operation. At this time, you can not get out of bed.
• Dressings are changed daily after laparotomy.
• The load should be increased gradually.
• A compression bandage is recommended for the first 2-4 weeks. It prevents the formation of blood clots, promotes the outflow of lymph.

Return to the previous way of life is possible after full recovery, which occurs in 1.5-2 months. During this time, it is necessary to refuse to take hot baths, visit the bath, sauna. Until full recovery, it is important to observe sexual rest, to exclude heavy physical exertion.

Within 7-10 days, a woman is recommended to take antibacterial drugs to prevent infectious complications. She is also shown painkillers. If necessary, drugs are prescribed for the treatment of iron deficiency anemia. Their reception is best combined with ascorbic (vitamin C) and folic acid (B9). They significantly increase the absorption of iron.

Attention! If the uterus has been removed along with the uterus, the woman is given hormone replacement therapy.

Hysterectomy in Moscow can be performed at the multidisciplinary medical center “Clinical Hospital on Yauza”. Our clinic employs experienced surgeons who constantly improve their skills. Before surgery, we carefully examine the condition of the woman, which reduces the likelihood of severe postoperative consequences. See the prices for operations on the clinic’s website or find out by phone. To make an appointment for an initial appointment, call us or request a call back.

Sources

1

Bazarova Z.Z., Sobirova S.E. Hysterectomy as an effective method of therapy for severe obstetric complications // Science and Education. 2018..

2

Kostyakhin A.E., Gutikova L.V. Laparoscopic hysterectomy – fifteen years of experience // Educational Institution “Grodno State Medical University”. 2019..

3

Iozefson S.A., Khaven T.V., Golygin E.V., Kuklin S.I., Shalneva E.V., Kargina D.S., Efimtseva I.P., Triputin A.A. Hysterectomy in women of reproductive age // Editorial and Publishing Center of the Chita State Medical Academy.