Abdominal Hysterectomy

What is Abdominal Hysterectomy?

Abdominal Hysterectomy is a surgical procedure to remove the uterus in females through an incision in the lower abdomen. The uterus is in females is the womb that carries the baby when pregnant. 

A hysterectomy involves either the complete removal of the uterus and cervix or partial hysterectomy, which removes only the uterus, leaving the cervix intact.

A hysterectomy where the uterus, cervix, one or both of the ovaries and the fallopian tubes are removed is referred to as a total hysterectomy along with salpingo-oophorectomy. 

Abdominal hysterectomies are preferred in the following cases:

• The doctor thinks this will be best suited for the patient
• The doctor wants to evaluate a predicted disease spread in the peripheral pelvic organs
• The patient undergoing the surgery, has a large uterus

Why is a hysterectomy performed?

Hysterectomy is a treatment for certain gynecological conditions as described below:

Fibroids: They are benign uterine tumors often causing continued bleeding, anemia and bladder pressure or pelvic pain. Hysterectomy can be a permanent solution for fibroids. 

Endometriosis: Endometrium is a tissue lining the inner side of the uterus. When this tissue grows as an outer lining of the uterus on the ovaries, fallopian tubes, and peripheral pelvic organs, conservative treatment may not resolve the issue. A total hysterectomy with bilateral salpingo-oophorectomy is performed. This procedure removes the uterus, both the ovaries and associated fallopian tubes

Gynecologic cancer: Cancer of the uterus or cervix. 

Uterine prolapse: This is a condition where the uterus descends into the vagina. This happens when the ligaments and tissues holding the uterus in position weaken. Uterine prolapse can lead to other problems such as increased pressure on the pelvic region, incontinence and labored bowel movements. A hysterectomy resolves these complications. 

Chronic pain in the pelvis: This seat of the pain is usually the uterus and while removal of the uterus may resolve the issue, it can even lead to further problems. Thus, it is extremely important to carefully deliberate hysterectomy in such a case

Abnormal vaginal bleeding: Periods with abnormally heavy bleeding with extended and irregular cycles. 

Abdominal Hysterectomy: How does your doctor evaluate?

Before the surgery the surgeon will consider certain evaluations to rule out cancer.

These examinations are important as they are the deciding factor for the surgeon to plan the surgery. These include:

Pap test (cervical cytology): Determines abnormal cells indicative of cervical cancer

Endometrial biopsy: To test for endometrial cancer, by detecting abnormal cells in the endometrium

Pelvic ultrasound: This is to examine presence of endometrial polyps, ovarian cysts and uterine fibroids (size determination)

The doctor may give a few instructions that you may need to follow on the day of the surgery as a measure to prevent infections after the surgery. Just prior to the surgery, you may be injected with antibiotics intravenously. 

Abdominal Hysterectomy: The Procedure

A hysterectomy typically is performed under general anesthesia, so you won't be awake during the surgery.

The procedure itself generally lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.

The procedure begins with inserting a catheter in the urinary bladder to empty the bladder. The catheter remains there throughout the procedure and for a short time even after the surgery.

The abdomen and vagina are cleaned with a sterile solution to minimize risk of infection. 

The type of incision for the hysterectomy is decided by the condition the hysterectomy is meant to resolve.

Additional factors are also considered if the patient has scars from any previous surgery.

The surgeon might take two incision approaches:

Vertical incision: It begins in the middle of the abdomen, extends below the navel – just above the pubic bone. This is generally preferred for hysterectomies performed for large fibroids, endometriosis and gynecological cancers.

Horizontal bikini-line incision: It is made above the pubic bone

Abdominal Hysterectomy: Post-surgery

The patient is shifted to the recovery room to recover from anesthesia.

The patient is monitored for signs of pain. Painkillers and antibiotics are administered to prevent pain and infections respectively.

The patient is encouraged to move so that the mobility is reinstated as early as possible. 

The patient is discharged with prescribed medications and instructions for care at home after about two days. This stay could be longer, depending on the recovery pace of the patient. 

There will be bloody vaginal discharge for many days post-surgery, which the patient will have to manage with sanitary pads.

The degree of bleeding expected is communicated to the patient. If the bleeding seems to be very heavy, the patient needs to intimate the surgeon for further investigation. 

The incision from the surgery will leave a visible scar even after complete recovery.