Removal of the uterus

Alternative names
Vaginal hysterectomy; Abdominal hysterectomy; Hysterectomy

Definition
A hysterectomy is a surgical removal of the uterus, resulting in the inability to become pregnant (sterility). It may be done through the abdomen or the vagina.

Description

Hysterectomy is an operation that is commonly performed. However, there are often non-surgical approaches to treat certain causes of pelvic pain or bleeding. Talk to your doctor about non-surgical treatments to try first, especially if the recommendation for a hysterectomy is for a cause other than cancer.

During a hysterectomy, the uterus may be completely or partially removed. The fallopian tubes and ovaries may also be removed. A partial (or supracervical) hysterectomy is removal of just the upper portion of the uterus, leaving the cervix intact.

A total hysterectomy is removal of the entire uterus and the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina.

A hysterectomy may be done through an abdominal incision (abdominal hysterectomy), a vaginal incision (vaginal hysterectomy), or through laparoscopic incisions (small incisions on the abdomen - laparoscopic hysterectomy).

Your physician will help you decide which type of hysterectomy is most appropriate for you, depending on your medical history and the reason for your surgery.

Indications

Hysterectomy may be recommended for:

     
  • Tumors in the uterus like uterine fibroids or endometrial cancer  
  • Cancer of the cervix or severe Cervical dysplasia (a precancerous condition of the cervix)  
  • Cancer of the ovary  
  • Endometriosis, in those cases in which the pain is severe and not responsive to non-surgical treatments  
  • Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medications  
  • Prolapse of the uterus  
  • Complications during childbirth (like uncontrollable bleeding)

RISKS

Risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery are:

     
  • Bleeding  
  • Infection

Other risks that are possible from a hysterectomy include:

     
  • Injury to the bladder or ureters  
  • Injury to bowel  
  • Pain with intercourse, decreased libido, or reduced ability to have an orgasm

Expectations after surgery

Most patients recover completely from hysterectomy. Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and estrogen replacement therapy may be recommended.

Convalescence

The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 3 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy, and may include less pain.

Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine. Moving about as soon as possible helps to avoid blood clots in the legs and other problems.

Walking to the bathroom as soon as possible is recommended. Normal diet is encouraged as soon as possible after bowel function returns. Avoid lifting heavy objects for a few weeks following surgery. Sexual intercourse should be avoided for 6 to 8 weeks after a hysterectomy.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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