Recovery and long term impact

During recovery from hysterectomy a person may experience pain, bleeding, and constipation. There may also be menopause-type symptoms, such as hot flashes. However, the side effects can depend on the type of procedure and reason for surgery.

A hysterectomy is a surgery that removes the uterus. According to the American College of Obstetricians and Gynecologists (ACOG), a doctor may recommend a hysterectomy if a person has:

• endometriosis
• uterine fibroids
• gynecologic cancer
• abnormal bleeding
• chronic pain in the pelvis

A doctor may also perform a hysterectomy for pelvic organ prolapse, and genetic diseases that make some cancer more likely, such as Lynch syndrome.

In this article, we focus on hysterectomies for gynecological reasons and explain:

• types of hysterectomy
• side effects of each one
• potential risks and complications
• questions to ask a doctor

Share on PinterestWearing loose clothing and keeping the surgical area clean and dry can aid recovery after a hysterectomy.

According to ACOG, there are three broad types of hysterectomy:

• Total hysterectomy: This surgery involves the complete removal of the uterus and cervix.
• Supracervical hysterectomy: During this procedure, surgeons remove the uterus but not the cervix. A doctor may also refer to this procedure as a subtotal or partial hysterectomy.
• Radical hysterectomy: This surgery removes the uterus, cervix, and surrounding support tissue. Doctors often recommend this type of hysterectomy for people with cancer.

Additionally, a hysterectomy with oophorectomy is when surgeons remove the uterus and one or both ovaries during the same surgery.

A hysterectomy with salpingo-oophorectomy involves removing the fallopian tubes.

Also, surgeons can perform a hysterectomy in several different ways. They may remove the organs through the abdomen, or they may remove them through the vagina.

A laparoscopic-assisted hysterectomy involves a surgeon performing part of the surgery through the abdomen but removing the uterus through the vagina, combining both approaches.

It is common for people to experience pain, bleeding, vaginal discharge, and constipation after a hysterectomy. Pain medication and using sanitary pads can help with these side effects.

What other short-term side effects a person may experience depend on the type of hysterectomy they have.

Hysterectomy without oophorectomy

A hysterectomy that does not involve ovary removal may still affect the ovaries.

According to a 2020 review, research studies have found some evidence suggesting that some hysterectomies that spare the ovaries may speed up the onset of menopause.

A small, older study from 2006 found that hysterectomies may affect blood supply to the ovaries, which is one theory for why this could happen.

However, the evidence for this is still very mixed and dependent on the type of hysterectomy and what organs and surrounding tissues the surgeon removes.

Scientists are still investigating the long-term effects of hysterectomies and need to do further studies on the impact hysterectomies on ovarian function.

Hysterectomy with oophorectomy

If a person has undergone a hysterectomy with oophorectomy, this means they no longer have ovaries.

The ovaries produce the hormone estrogen. Without these organs, a person who had not undergone menopause already will experience menopause symptoms.

These side effects of hysterectomy with oophorectomy include:

• hot flashes
• night sweats
• vaginal dryness
• difficulty sleeping
• mood swings and irritability
• weight gain
• hair loss
• dry skin
• incontinence
• loss of bone density
• rapid heartbeat

The duration of these symptoms will vary from person to person. Due to the sudden drop in estrogen, people who have had an oophorectomy may experience exaggerated symptoms.

A doctor can prescribe hormone replacement therapy (HRT) to reduce menopause symptoms for people who are premenopausal.

According to the Office on Women’s Health, it typically takes 3–4 weeks to recover from a vaginal or laparoscopic hysterectomy.

It may take 4–6 weeks to recover from an abdominal hysterectomy.

A person’s age and overall health also influence their recovery time.

The Dana-Farber Cancer Institute say that after a hysterectomy, an individual:

• cannot drive for 2 weeks
• cannot lift objects heavier than a bag of groceries for 6 weeks
• may experience fatigue for the first 6 weeks
• may see spotting and vaginal discharge for 8 weeks
• cannot insert anything into the vagina for 8 weeks

A person can aid their recovery by:

• doing light exercise, such as walking
• getting plenty of rest
• keeping any surgical incisions clean and dry
• avoiding tight clothing
• checking incisions regularly for signs of infection
• avoiding water directly hitting an incision in the shower
• gently cleaning the area
• taking prescribed medications correctly

A person will typically stay in the hospital for 1–2 days following the procedure before returning home to recover. This time can vary depending on the type of hysterectomy. Abdominal surgery may require a stay of 2–3 days.

If someone has a hysterectomy due to cancer, they may need to stay for longer.

According to ACOG, the risks of an abdominal hysterectomy include:

• infection
• wound bleeding
• blood clots
• nerve or tissue damage

Vaginal or laparoscopic hysterectomies typically have a lower risk for complications. However, any type of hysterectomy can potentially cause these problems.

According to a 2018 study, having a hysterectomy before 35 years of age also increases a person’s risk factor for several medical conditions, including:

• 14% increased risk of lipid abnormalities
• 13% increased risk of high blood pressure
• 18% increased risk of obesity
• 33% increased risk of coronary artery disease
• 4.6-fold increased risk of congestive heart failure
• 2.5-fold increased risk of coronary artery disease

In addition to physical changes, a person who undergoes a hysterectomy may also experience changes in their mental health.

Hysterectomies mean a person can no longer get pregnant. For some, this causes grief and sadness, particularly if they had hoped to have more children.

A person will also not have periods anymore, which can make a female feel they have lost part of their identity or womanhood.

For others, losing their periods can be a relief. If someone has a painful or difficult health condition, their symptoms may improve, along with their quality of life.

People who do not want children may also feel relieved that they cannot become pregnant.

A study of females who underwent hysterectomies without ovary removal from 1980–2002 found that they had a 6.6% higher risk for new depression diagnoses and a 4.7% higher risk for anxiety diagnoses in the 20 years following their surgery.

The researchers are not sure why this occurred, so scientists need to carry out more research to understand this trend.

Hysterectomies are not reversible, so it is a good idea for people to ask for as much information as they need to feel confident with their decision.

Questions to ask could include:

• Will the procedure cure a condition or just treat the symptoms?
• Are there any alternatives to a hysterectomy that may help with symptoms?
• Will natural menopause improve the symptoms, and, if so, is a hysterectomy necessary?
• Could symptoms return after the procedure, and if so, what happens then?
• Is there a way to preserve eggs if I want a child in the future, via a surrogate, for example?
• What type of hysterectomy would you recommend?
• Will you remove the cervix, fallopian tubes, or surrounding tissue?
• What can I expect during and after the procedure?

According to Dana-Farber Cancer Institute, a person should contact their doctor or healthcare provider if they experience any of the following symptoms after their surgery:

• heavy vaginal bleeding that soaks a pad in less than 1 hour
• foul vaginal odor
• changes in urinary frequency or inability to urinate
• fever at or above 100. 4^oF
• continuous constipation
• diarrhea
• vomiting or nausea
• swelling, pain, or tenderness around the incision
• any openings at the incision site
• chest pains or trouble breathing
• severe pain that does not improve with pain relief

Short-term hysterectomy side effects can include pain, bleeding, discharge, and constipation. A person may also temporarily experience menopause-like symptoms, such as hot flashes. These will resolve as a person recovers.

In the long term, a person may feel a sense of loss or sadness, or possibly relief following the procedure. People who have also had ovaries removed will experience menopause and may benefit from HRT.

Hysterectomies have some risks, and they also mean a person cannot become pregnant. The individual can talk to their doctor about all their options before undergoing surgery.

Recovery and long term impact

During recovery from hysterectomy a person may experience pain, bleeding, and constipation. There may also be menopause-type symptoms, such as hot flashes. However, the side effects can depend on the type of procedure and reason for surgery.

A hysterectomy is a surgery that removes the uterus. According to the American College of Obstetricians and Gynecologists (ACOG), a doctor may recommend a hysterectomy if a person has:

• endometriosis
• uterine fibroids
• gynecologic cancer
• abnormal bleeding
• chronic pain in the pelvis

A doctor may also perform a hysterectomy for pelvic organ prolapse, and genetic diseases that make some cancer more likely, such as Lynch syndrome.

In this article, we focus on hysterectomies for gynecological reasons and explain:

• types of hysterectomy
• side effects of each one
• potential risks and complications
• questions to ask a doctor

Share on PinterestWearing loose clothing and keeping the surgical area clean and dry can aid recovery after a hysterectomy.

According to ACOG, there are three broad types of hysterectomy:

• Total hysterectomy: This surgery involves the complete removal of the uterus and cervix.
• Supracervical hysterectomy: During this procedure, surgeons remove the uterus but not the cervix. A doctor may also refer to this procedure as a subtotal or partial hysterectomy.
• Radical hysterectomy: This surgery removes the uterus, cervix, and surrounding support tissue. Doctors often recommend this type of hysterectomy for people with cancer.

Additionally, a hysterectomy with oophorectomy is when surgeons remove the uterus and one or both ovaries during the same surgery.

A hysterectomy with salpingo-oophorectomy involves removing the fallopian tubes.

Also, surgeons can perform a hysterectomy in several different ways. They may remove the organs through the abdomen, or they may remove them through the vagina.

A laparoscopic-assisted hysterectomy involves a surgeon performing part of the surgery through the abdomen but removing the uterus through the vagina, combining both approaches.

It is common for people to experience pain, bleeding, vaginal discharge, and constipation after a hysterectomy. Pain medication and using sanitary pads can help with these side effects.

What other short-term side effects a person may experience depend on the type of hysterectomy they have.

Hysterectomy without oophorectomy

A hysterectomy that does not involve ovary removal may still affect the ovaries.

According to a 2020 review, research studies have found some evidence suggesting that some hysterectomies that spare the ovaries may speed up the onset of menopause.

A small, older study from 2006 found that hysterectomies may affect blood supply to the ovaries, which is one theory for why this could happen.

However, the evidence for this is still very mixed and dependent on the type of hysterectomy and what organs and surrounding tissues the surgeon removes.

Scientists are still investigating the long-term effects of hysterectomies and need to do further studies on the impact hysterectomies on ovarian function.

Hysterectomy with oophorectomy

If a person has undergone a hysterectomy with oophorectomy, this means they no longer have ovaries.

The ovaries produce the hormone estrogen. Without these organs, a person who had not undergone menopause already will experience menopause symptoms.

These side effects of hysterectomy with oophorectomy include:

• hot flashes
• night sweats
• vaginal dryness
• difficulty sleeping
• mood swings and irritability
• weight gain
• hair loss
• dry skin
• incontinence
• loss of bone density
• rapid heartbeat

The duration of these symptoms will vary from person to person. Due to the sudden drop in estrogen, people who have had an oophorectomy may experience exaggerated symptoms.

A doctor can prescribe hormone replacement therapy (HRT) to reduce menopause symptoms for people who are premenopausal.

According to the Office on Women’s Health, it typically takes 3–4 weeks to recover from a vaginal or laparoscopic hysterectomy.

It may take 4–6 weeks to recover from an abdominal hysterectomy.

A person’s age and overall health also influence their recovery time.

The Dana-Farber Cancer Institute say that after a hysterectomy, an individual:

• cannot drive for 2 weeks
• cannot lift objects heavier than a bag of groceries for 6 weeks
• may experience fatigue for the first 6 weeks
• may see spotting and vaginal discharge for 8 weeks
• cannot insert anything into the vagina for 8 weeks

A person can aid their recovery by:

• doing light exercise, such as walking
• getting plenty of rest
• keeping any surgical incisions clean and dry
• avoiding tight clothing
• checking incisions regularly for signs of infection
• avoiding water directly hitting an incision in the shower
• gently cleaning the area
• taking prescribed medications correctly

A person will typically stay in the hospital for 1–2 days following the procedure before returning home to recover. This time can vary depending on the type of hysterectomy. Abdominal surgery may require a stay of 2–3 days.

If someone has a hysterectomy due to cancer, they may need to stay for longer.

According to ACOG, the risks of an abdominal hysterectomy include:

• infection
• wound bleeding
• blood clots
• nerve or tissue damage

Vaginal or laparoscopic hysterectomies typically have a lower risk for complications. However, any type of hysterectomy can potentially cause these problems.

According to a 2018 study, having a hysterectomy before 35 years of age also increases a person’s risk factor for several medical conditions, including:

• 14% increased risk of lipid abnormalities
• 13% increased risk of high blood pressure
• 18% increased risk of obesity
• 33% increased risk of coronary artery disease
• 4.6-fold increased risk of congestive heart failure
• 2.5-fold increased risk of coronary artery disease

In addition to physical changes, a person who undergoes a hysterectomy may also experience changes in their mental health.

Hysterectomies mean a person can no longer get pregnant. For some, this causes grief and sadness, particularly if they had hoped to have more children.

A person will also not have periods anymore, which can make a female feel they have lost part of their identity or womanhood.

For others, losing their periods can be a relief. If someone has a painful or difficult health condition, their symptoms may improve, along with their quality of life.

People who do not want children may also feel relieved that they cannot become pregnant.

A study of females who underwent hysterectomies without ovary removal from 1980–2002 found that they had a 6.6% higher risk for new depression diagnoses and a 4.7% higher risk for anxiety diagnoses in the 20 years following their surgery.

The researchers are not sure why this occurred, so scientists need to carry out more research to understand this trend.

Hysterectomies are not reversible, so it is a good idea for people to ask for as much information as they need to feel confident with their decision.

Questions to ask could include:

• Will the procedure cure a condition or just treat the symptoms?
• Are there any alternatives to a hysterectomy that may help with symptoms?
• Will natural menopause improve the symptoms, and, if so, is a hysterectomy necessary?
• Could symptoms return after the procedure, and if so, what happens then?
• Is there a way to preserve eggs if I want a child in the future, via a surrogate, for example?
• What type of hysterectomy would you recommend?
• Will you remove the cervix, fallopian tubes, or surrounding tissue?
• What can I expect during and after the procedure?

According to Dana-Farber Cancer Institute, a person should contact their doctor or healthcare provider if they experience any of the following symptoms after their surgery:

• heavy vaginal bleeding that soaks a pad in less than 1 hour
• foul vaginal odor
• changes in urinary frequency or inability to urinate
• fever at or above 100. 4^oF
• continuous constipation
• diarrhea
• vomiting or nausea
• swelling, pain, or tenderness around the incision
• any openings at the incision site
• chest pains or trouble breathing
• severe pain that does not improve with pain relief

Short-term hysterectomy side effects can include pain, bleeding, discharge, and constipation. A person may also temporarily experience menopause-like symptoms, such as hot flashes. These will resolve as a person recovers.

In the long term, a person may feel a sense of loss or sadness, or possibly relief following the procedure. People who have also had ovaries removed will experience menopause and may benefit from HRT.

Hysterectomies have some risks, and they also mean a person cannot become pregnant. The individual can talk to their doctor about all their options before undergoing surgery.

procedure, recovery after surgery and consequences for the woman

10/16/2016

Contents

• Purpose of hysterectomy
• Indications for surgery
• Preparation
• Contraindications
• Procedure
• Rehabilitation
• Benefits of contacting MEDSI

Removal of the uterus (hysterectomy) is one of the most frequently performed operations in gynecology. Intervention is a real test for a woman. Not surprisingly, patients experience not only the fear of the operation itself, but also depression and vulnerability, confusion and inferiority. We will try to answer all the questions that women have. We will understand how the removal of the uterus is carried out, and how life can change after such an intervention.

Purpose of hysterectomy

Surgery is performed when other treatments have failed or are inappropriate. Emergency interventions often help save the patient’s life.

Interestingly, in a number of European countries and the United States, the operation is common among women after 40–45 years of age. This is due to the fact that it makes it possible to reduce the risks of developing fibroids and tissue growth, if any, and also avoids the appearance of malignant tumors.

Indications for surgery

Hysterectomy is performed in the following pathological conditions and diseases:

• Uterine cancer. After surgery, chemotherapy and radiation therapy are also carried out
• Multiple nodules of fibroids
• Internal bleeding with risk of anemia and other life-threatening conditions
• Acute pain syndrome
• Vaginal bleeding
• Growth of uterine lining tissue in ovaries and fallopian tubes

Preparation

Before the removal of the uterus, the woman undergoes a comprehensive examination. It allows you to assess the patient’s health status and identify possible contraindications.

The following diagnostic tests are usually performed:

• Pelvic ultrasound or MRI with contrast agent
• Vaginal swab
• Endometrial biopsy

The so-called hospital complex is obligatory.

It includes:

• general and biochemical blood test
• urinalysis
• blood test for group and Rh factor, as well as infections, clotting disorders, HIV and other diseases
• fluorography
• ECG

The patient consults with a gynecologist, internist and anesthetist.

Important! If temporary (relative) contraindications to the intervention are identified, the necessary treatment is carried out. If, for example, infectious diseases are detected, the doctor prescribes antibiotics and anti-inflammatory drugs. It is very important to achieve complete recovery or remission. Otherwise, there will be a high risk of surgical and postoperative complications. In addition, existing diseases negatively affect the rehabilitation process, lengthening it.

If a cervicalectomy or other operation is performed to remove a malignant tumor, hormonal and other drugs are prescribed. They help stop tumor growth. The therapy can make it possible to reduce the size of the formation, which will positively affect the course of the intervention, reducing tissue trauma.

Contraindications

Surgery to remove the uterus is not performed if there are the following contraindications:

• low blood clotting
• arterial hypertension
• acute infectious diseases (including small pelvis)
• angina pectoris
• anemia
• diabetes mellitus
• liver failure
• kidney failure
• allergic reactions to anesthetics

Important! There are both absolute and relative contraindications to intervention. In this case, the doctor makes the final decision on the operation. If necessary, the patient is consulted by specialists of narrow profiles.

Procedure

Hysterectomy of the uterus (including appendages) is performed under general anesthesia. The intervention usually takes 1-1.5 hours.

3 methods are used to access organs:

• Laparoscopic. The intervention is carried out through punctures in the area of ​​the abdominal wall. The technique allows to reduce tissue injuries and shorten the rehabilitation period. Usually only 4 small punctures and a specialized tool are required. It is inserted into the cervical canal. First, the ligaments of the uterus are excised, and then it is removed. After that, the walls of the vagina are coagulated and sutured
• Abdominal. This operation is traditional and the most traumatic. It requires a large incision in the abdominal wall. Mandatory for standard intervention is the fixation of intestinal loops. This avoids damage to them. The cervix is ​​cut off in the inner zone of the pharynx. After that, her stump and vaginal vaults are sutured. Then drain pipes are installed. They are removed after a few days
• Transvaginal. Access is provided through an incision in the vaginal area. After that, the surgeon peels off the bladder. Then the vessels and fallopian tubes, as well as ligaments, are separated and cut. After that, the uterus is cut off. The stumps of the pipes are sewn together

There are also 3 types of hysterectomy.

Radical

It involves the removal of the uterus, fallopian tubes, ovaries, regional lymph nodes and fatty tissue. The operation is performed for endometriosis and cancer.

Total

This hysterectomy involves the removal of the uterus with the cervix and appendages. It is prescribed for oncological diseases. The technique allows to reduce the risks of the spread of the tumor process. It is often combined with other methods of cancer therapy (chemotherapy, etc. ). Total hysterectomy can also be performed in emergency situations.

Subtotal

The cervix is ​​not removed during this operation. This intervention eliminates the risk of damage to the ureters and large vessels. It is prescribed for adhesions, pelvic endometriosis and some other pathologies.

Rehabilitation

Recovery after a hysterectomy is a lengthy process. Conventionally, rehabilitation is divided into 2 periods:

1. Early. 3-4 days after the intervention, the woman is under the control of medical personnel. The therapy is aimed at eliminating pain, preventing bleeding, restoring the body, reducing the risk of developing anemia and inflammation. The doctor also monitors the work of the intestines, the condition of the suture and the amount of discharge from the genitals. To remove fluid from the body, a urinary catheter is installed on the first day. During this time, the patient only drinks and does not eat anything. Then, low-fat broths and yogurts are gradually introduced into the diet. Eat light foods that are quickly digested. Chocolate, cabbage, legumes, corn are completely excluded, i.e. products that can cause increased gas formation and constipation. A woman should eat in small portions and at least 4-5 times a day
2. Late. With the classical method of the operation, it lasts about 1.5 months, with laparoscopic – no more than 30 days. The late rehabilitation period begins after discharge from the hospital. At this time, a woman should be attentive to her health and direct all actions towards its full recovery

There are certain recommendations that the patient should follow during rehabilitation:

• Mandatory intake of medicines prescribed by the doctor. Painkillers, anti-inflammatory, hormonal, enzymatic and general tonic agents are usually recommended
• Restriction of physical activity. It is especially important to avoid excessive pressure on the muscles of the abdomen and pelvic floor
• Do simple exercises (if recommended by a doctor)
• Refusal of sexual life. Return to it is carried out with caution. If a woman experiences discomfort, you need to contact a gynecologist. Perhaps it will prolong the period of sexual dormancy
• Healthy eating. Even after discharge from the clinic, you need to adhere to the correct diet with the restriction of alcohol, pastries, fatty foods, smoked meats, marinades
• Proper drinking regimen. A woman should drink about 1.5-2 liters of water per day. This will allow the natural detoxification of the body

Of course, the main consequence of the removal of the uterus is that the woman loses her childbearing function. Otherwise, life can remain as fulfilling as it was before.

Over time, the menstrual cycle is restored, the level of hormones returns to normal. After the removal of the uterus, even the libido can remain the same. At the same time, the ability to lead an active sex life fully returns.

Benefits of contacting MEDSI

• Experienced doctors. Our specialists are not only professionally trained to solve women’s problems, but also provide patients with an attentive and delicate approach
• Comprehensive surveys. They are carried out using modern equipment and ensure the accuracy of diagnosis and the identification of all pathologies
• Possibilities of using sparing techniques for hysterectomy of the uterus and ovaries. Operations are performed using minimally invasive methods, which increases their safety and shortens the rehabilitation period
• New high-tech equipment. It minimizes the risk of bleeding and the occurrence of complications and relapses
• Comfortable hospital stay before and after hysterectomy
• Outpatient rehabilitation and monitoring facilities

To clarify information or make an appointment, just call +7 (812) 336-33-33. Our specialist will answer all questions. Recording is also possible through the SmartMed application.

Do not delay treatment, see a doctor right now:

• Gastroenterologist appointment
• General practitioner appointment
• Gynecological appointment

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 uterine amputation 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 coagulability, sugar level, latent infections, tumor markers, determination of the group and Rh factor.
• Fluorography – X-ray examination of the respiratory organs.
• 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.
• Refusal to eat 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 stay in stationary conditions.

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.
• It is recommended to wear a compression bandage 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.