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Hysterectomy

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Overview

Hysterectomy is the surgical removal of the uterus. It may also involve the removal of the cervix, ovaries, Fallopian tubes, and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may be total or partial.

Types of Hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed.

A supracervical or subtotal hysterectomy

Removes only the upper part of the uterus, keeping the cervix in place.

A total hysterectomy removes the whole uterus and cervix.

A radical hysterectomy removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

Total Hysterectomy & Bilateral Salpino-Oophorectomy (BSO)

The surgeon may remove the ovaries -- a procedure called oophorectomy -- or may leave them in place. When the tubes are removed that procedure is called salpingectomy. When the entire uterus, both tubes, and ovaries are removed, the entire procedure is called a hysterectomy and bilateral salpingectomy-oophorectomy.

Indications

Gynaecologic Cancer

If you have a gynaecologic cancer such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.

Fibroids

A hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumours that often cause persistent bleeding, anaemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumour size. Many women with fibroids have minimal symptoms and require no treatment.

Endometriosis

In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, you might need a hysterectomy along with the removal of your ovaries and fallopian tubes (Bilateral Salpingo-Oophorectomy).

Uterine Prolapse

Descent of the uterus into your vagina can happen when supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy may be necessary to treat these conditions.

Abnormal Vaginal Bleeding

If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.

Chronic Pelvic Pain

Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, a hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery.





Surgical Techniques for Hysterectomy

Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and the patient's overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.

There are two approaches to surgery: a traditional or open surgery and surgery using a minimally invasive procedure or MIP.

Open Surgery Hysterectomy

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 54% of all benign disease.

To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.

Following an abdominal hysterectomy, a person will usually spend 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.

MIP Hysterectomy

There are several approaches that can be used for a MIP Hysterectomy:

Vaginal Hysterectomy:

The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.

Laparoscopic Hysterectomy:

This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.

Laparoscopic-assisted Vaginal Hysterectomy:

The surgeon uses laparoscopic tools in the belly to assist in the removal of the uterus through an incision in the vagina.

Robot-assisted Laparoscopic Hysterectomy:

This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.

Comparison of MIP Hysterectomy & Abdominal Hysterectomy

Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an Abdominal Hysterectomy.

With an MIP, people are generally able to resume their normal activity within an average of 3-4 weeks, compared to 4-6 weeks for an Abdominal Hysterectomy. And the costs associated with an MIP are considerably lower than the costs associated with open surgery, depending on the instruments used and the time spent in the operating room. Robotic procedures, however, can be much more expensive. There is also less risk of incisional hernias with an MIP.

Not everyone is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, the size of the uterus, and health status can all affect whether or not an MIP is advisable. You should talk with your doctor about whether you might be a candidate for an MIP.




Risks of Hysterectomy

Most people who get a hysterectomy have no serious problems or complications from the surgery. Still, a hysterectomy is major surgery and is not without risks. Those complications include:

  • Urinary incontinence
  • Vaginal prolapse (part of the vagina coming out of the body)
  • Vaginal fistula formation (an abnormal connection that forms between the vagina and bladder or rectum)
  • Chronic pain
  • Other risks from hysterectomy include wound infections, blood clots, haemorrhage, and injury to surrounding organs, although these are uncommon.
What to Expect After Hysterectomy

After a hysterectomy, if the ovaries were also removed, you'll be in menopause. If the ovaries were not removed, you may enter menopause at an earlier age than you would have otherwise.

Most people are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.

After a hysterectomy, most people surveyed say they feel the operation succeeded at improving or curing their main problem (for example, pain or heavy periods).

Sign & Symptoms

State of the art equipments

Diagnostic HysteroscopyNow the question is ‘’Who should have a Diagnostic Hysteroscopy?’’

Most women with menstrual disorders will not require a diagnostic hysteroscopy. However, a diagnostic hysteroscopy is often necessary for women who develop menstrual abnormalities after the age of 40 or for younger women with severe menstrual disturbances. Here are some of the common situations in which a diagnostic hysteroscopy may be helpful.

  • Women who develop a menstrual abnormality who are over 40 years of age.
  • Women with irregular menses who may be at increased risk for endometrial hyperplasia.
  • Women with suspected endometrial polyps.
  • Women with suspected uterine fibroids.
  • Women who experience postmenopausal bleeding.
  • Postmenopausal women with an abnormally thickened uterine lining.
  • Women in whom a congenital abnormality is suspected.
  • Women who have “lost” IUDs where the IUD strings are no longer visible on speculum examination.



Robotically-assisted Hysterectomy

Robotic Hysterectomy is often touted as a minimally invasive gynaecologic surgery. Robotically-assisted Hysterectomies offer various advantages in women with a variety of gynaecologic cancers, severe endometriosis and pelvic adhesive disease. There are other factors that may cause a GP to favour the use of robotic assistance compared to other methods.


A large number of studies have found little difference in complications and recovery time between laparoscopic and robotic hysterectomy. Without question, robotic surgery is far more expensive than laparoscopic hysterectomy.


Other studies have shown that robotic hysterectomy requires the patient to be under anaesthesia for longer periods of time. In most cases robotic surgery requires a greater number of incisions than Laparoscopic Hysterectomy. Although Robotic-assisted Hysterectomy clearly has a place in modern gynaecologic surgery it is less clear that it is “minimally invasive” compared to other forms of hysterectomy such as Laparoscopic or Vaginal Hysterectomy. Further studies are needed before the exact role of Robotic-assisted Hysterectomy can be determined.

Procedure & Advantage

• The main reason for women to undergo ysterectomy is abnormal uterine bleeding.

• Hysterectomy relieves abnormal uterine bleeding which is painful and distressing.

• Hysterectomy prevents uterine cancer and is a lifesaver for women who have a family history of cancerous growths in their uterus.

Frequently asked questions

Can a woman still come after a hysterectomy?

It's still possible to have an orgasm following a hysterectomy. In fact, many women may experience an increase in the strength or frequency of orgasm. Many of the conditions for which hysterectomy is performed are also associated with symptoms like painful sex or bleeding after sex.

How long do you have to be on bed rest after a hysterectomy?

Most women go home 2-3 days after this surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You should not be doing housework until you talk with your doctor about restrictions.

Will my stomach go down after a hysterectomy?

You will probably notice that your belly is swollen and puffy. This is common. The swelling will take several weeks to go down. It may take about 4 to 6 weeks to fully recover.

Do you gain weight after hysterectomy?

While a hysterectomy isn't directly linked to weight loss, it may be related to weight gain in some people. A 2009 prospective study suggests that premenopausal women who've had a hysterectomy without the removal of both ovaries have a higher risk for weight gain, compared with women who haven't had the surgery.

What is the effect on fertility?

Women are infertile after hysterectomy.

Is there any effect on mood and depression?

There is considerable evidence that some women feel very depressed after hysterectomy. This may be due to the changes in hormone levels, the psychological feeling of loss of femininity or on-going illness. It can be very debilitating to those suffering from it.

Will my pelvic organs prolapse later?

Pelvic organ prolapse occurs when the pelvic floor muscles that hold your reproductive organs in place become weakened or damaged. As a result, the organs may prolapse or drop out of position.
Minimally invasive hysterectomy usually does not increase the risk of pelvic organ prolapse. Your doctor may recommend exercises to strengthen your pelvic floor muscles and prevent organ prolapse. In rare cases where treatment is needed, minimally invasive surgery can correct the condition.

Will I go into menopause early?

Removing only your uterus will not send you into menopause. You will still ovulate, but you will not have a menstrual period or be able to become pregnant. If your ovaries are removed as well, you will no longer ovulate and will be in menopause.
“The type of hysterectomy that is best for you depends on your medical condition, your plans for a family and other individual factors.

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