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What is hysterectomy?

Monday, June 12th 2017. | Hysterectomy

Hysterectomy is the surgical removal of the womb of a woman. The reasons to remove the womb may be very large fibroids, severe uterine bleeding, prolapse of the uterus, cancers or endometriosis. The uterus may also be removed as a preventive measure in those genetically predisposed to cancers.

 

The most common method to remove the uterus is through an incision in the abdominal wall. The incision is usually horizontal along the pubis but may be vertical when more extensive surgery is required. This method is called an abdominal hysterectomy. It is usually done under general anaesthesia.Hysterectomy

 

The advantages of an abdominal hysterectomy is that the whole of the abdomen and pelvic cavity can be explored to check for any spread of cancer or endometriosis. The Fallopian tubes and ovaries can also be removed if required. The disadvantages are that there is more bleeding and recovery takes much longer.

Vaginal hysterectomy involves the removal of the uterus through the vaginal canal. Where it is feasible the vaginal route is easily the safest and most cost effective procedure for removal of the uterus. However, only about 22% of cases are good for the vaginal route. It can never be carried out in pregnancy or cancers. Also if the uterus is large, or the vagina or pubic arch is narrow, then vaginal hysterectomy is not possible.

Vaginal hysterectomy can be performed with either general anaesthesia or regional anaesthesia. The vaginal route, compared with all other routes for hysterectomy, yields better outcomes and fewer complications.

Laparoscopy-assisted vaginal hysterectomy gives even better results. A laparoscope is used along with the vaginal hysterectomy. A laparoscope is a very thin viewing tube used to visualise structures within the abdomen. It allows the upper abdomen to be carefully inspected during surgery to check for any cancers.

Laparoscopic vaginal hysterectomy has certain advantages: a faster return to normal activity, shorter hospital stay, reduced intra operative blood loss, and fewer wound infections. The disadvantages are a longer operating time and higher rate of urinary tract injury.

Types of hysterectomy:

Types of Hysterectomies

In supra cervical hysterectomy the uterus is removed. The cervix is spared as it anchors the vagina into place. The possibility of developing cancer in this remnant cervical “stump” remains. It is never done if there are abnormal Pap smears or cervical cancer. It is a simple and quick procedure.

With laparoscope assisted supra cervical hysterectomy recovery is generally faster than with other types of hysterectomy. The inner lining of the cervix is cauterised thereby reducing any chance of period bleeding.

Radical hysterectomy is a more extensive surgery because it includes removing tissues surrounding the uterus and removal of the upper vagina. It is usually performed for early cervical cancer. There are more complications with radical hysterectomy compared to a simple abdominal hysterectomy. These include injury to the bowels and urinary system.

With laparoscope assisted supra cervical hysterectomy recovery is generally faster than with other types of hysterectomy. The inner lining of the cervix is cauterised thereby reducing any chance of period bleeding.

Sometimes the ovaries as well as the Fallopian tubes may have to be be removed when there are complications of infection, or for cancer. Occasionally, women with inherited types of cancer of the ovary or breast will have their ovaries removed as preventive surgery. This reduces the risk of future cancer of the ovary or breast.

 

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