Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. Other organs, such as the cervix, ovaries, Fallopian tubes, lymph nodes and parts of the vagina may also be removed at the same time.

Why a hysterectomy is done

A hysterectomy may be done to:

• treat cancers of the female reproductive organs (gynecological cancers)
  • cervix
  • uterus
  • ovary
  • Fallopian tube
  • vagina
• find out how far the cancer has spread (staging)
• remove as much of the cancer as possible before using other therapies such as chemotherapy or radiation therapy

A hysterectomy may be done for medical conditions other than cancer.

How a hysterectomy is done

A hysterectomy is a major operation, and it is done in the hospital under general anesthesia. It can be done using different incisions:

• An abdominal hysterectomy is done through a large incision in the abdomen.
  • This is the most common way of doing a hysterectomy for gynecological cancer.
• A laparoscopic hysterectomy is done by inserting a laparoscope and other instruments through small incisions in the abdomen.
• A vaginal hysterectomy is done using incisions in the upper part of the vagina. The uterus is removed through the vagina.
  • This may be used in early stage cancers of the cervix and uterus.

The type of surgery done depends mainly on the type of cancer and the size or stage of the cancer. Other factors include the woman's age, her desire to have children in the future, her overall health and prior treatment if any.

There are different types of hysterectomy surgery.

Partial hysterectomy

In a partial hysterectomy, only the upper part of the uterus is removed. The cervix and the other organs are left in place. This type of surgery is not done for gynecological cancers.

Total hysterectomy

In a total hysterectomy (also called a simple hysterectomy), the cervix and the uterus are removed. This is the most common type of hysterectomy done for gynecological cancers.

Radical hysterectomy

In a radical hysterectomy, the cervix and the uterus are removed, along with the upper part of the vagina next to the cervix, some of the supporting tissues and nearby lymph nodes in the pelvis.

Salpingo-oophorectomy

A salpingo-oophorectomy is a surgery that removes the ovaries and the Fallopian tubes. It may be done at the same time as a hysterectomy for cancer of the uterus or cervix. It is always done as a surgical treatment for ovarian and Fallopian tube cancer.

• A bilateral salpingo-oophorectomy (BSO) removes both ovaries and Fallopian tubes.
• A unilateral salpingo-oophorectomy removes just one ovary and Fallopian tube. This may be used in younger women who wish to have children in the future or to keep the hormonal function of an ovary.

What happens after a hysterectomy

A woman will stay in the hospital for a few days after surgery. The doctor may prescribe antibiotics to prevent infection, and pain medication.

Complete recovery from an abdominal hysterectomy will take 6 to 8 weeks.

• Get plenty of rest for the first 2 weeks after surgery.
• Heavy lifting (more than 20 pounds) is not recommended for 2 weeks after surgery.
• The level of activity and exercise can be slowly increased after 2 weeks.
• The doctor will recommend when it is safe to resume:
  • work – especially if the woman has a physically demanding job
  • heavy or strenuous exercise
  • taking baths
  • sexual intercourse

Women who have had a vaginal hysterectomy generally recover more quickly and resume regular activities sooner than women who have had an abdominal hysterectomy.

Potential side effects

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.

Side effects of surgery will depend mainly on the:

• type of hysterectomy
• woman’s overall health

Short-term side effects

Short-term side effects can happen during, immediately after or a few weeks after a hysterectomy. They are usually temporary.

• pain
• bleeding
• wound or pelvic infection
• lung infection (pneumonia)
• bladder problems
  • losing the feeling of having to urinate because of damage to nerves that supply the bladder muscle
  • not emptying the bladder completely
• decreased bowel activity (paralytic ileus)
  • an inactive intestine means that the contents cannot move through it
  • can lead to a blockage of the intestine
• blood clots in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)

Long-term side effects

Long-term side effects can show up long after a hysterectomy is over and can last a long time. All women who have had a hysterectomy will be infertile (not able to get pregnant) because their uterus has been removed. Some women may also experience:

• lymphedema
  • may occur when lymph nodes in the pelvis are removed during a radical hysterectomy
• changes to the function of reproductive organs
  • treatment-induced menopause – only occurs if both ovaries are removed in premenopausal women
  • vaginal shortening – may occur after a radical hysterectomy
• blockage of the intestine (bowel obstruction) caused by bands of scar tissue
• fistulas (abnormal openings) between the bladder and vagina or the ureters and vagina, or between the rectum and vagina, which may cause some leakage of material (urine or feces) through the vagina
• loss of interest in sex
  • reported by some women after a hysterectomy, but most women do not report any changes