Hysterectomy: FAQ'S

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 Hysterectomy: FAQ'S



 


  • Do I need a hysterectomy? Why?

 A hysterectomy is a surgery to remove the uterus. Depending on your age and the disease, your doctor may also remove your fallopian tubes and ovaries during a hysterectomy. 

You may require a hysterectomy if you suffer from any of the following conditions-

  • What other options are available?
Depending on your condition (which led to a hysterectomy), your doctor may offer alternatives to the procedure. For instance, heavy menstrual bleeding may respond well to a mirena, and a fibroid to a certain medication which arrests its growth. Exercises (such as the Kiegel's) may be performed to strengthen the muscles around a prolapsed uterus; alternatively, a 'pessary' may be used to position it back into the pelvis. 
A hysterectomy is, in fact, a last resort for many diseases, which have not shown any improvement despite multiple drug therapies.




Fig 1

  • How can a hysterectomy relieve my symptoms?

Having a hysterectomy can help improve the quality of life, especially if you suffer from heavy and irregular bleeding. If you’re at a higher risk of uterine cancer, a hysterectomy can lower this risk and potentially be life-saving.

  • Which type of hysterectomy is recommended and why?

The different types of hysterectomy that are performed are-

  • Partial Hysterectomy- The uterus is removed, while sparing the cervix, fallopian tubes and the ovaries
  • Total Hysterectomy- The uterus, cervix and fallopian tubes are removed, while the ovaries are spared.
  • Total Hysterectomy with oopherectomy- The uterus, cervix, fallopian tubes as well as the ovaries are removed.

Different surgical approaches or methods may be adopted depending on the reason for having a hysterectomy.
The surgical options will be discussed by your doctor ahead of time.

Vaginal hysterectomy
  • The uterus is removed through the vagina. There is no external incision.
  • Most commonly performed in cases of uterine prolapse.
  • This approach is associated with the least complications and fastest recovery.

Laparoscopic hysterectomy (Fig 1)

  • A laparoscope (a thin tube with a light and camera at the end) is inserted in the lower abdomen through a small incision near the belly button.
  • Surgical tools are inserted through two (or three) other small incisions.
  • The uterus can be removed through these incisions or through the vagina.
  • Full recovery is shorter and less painful than an abdominal hysterectomy.


                                                                                        Fig 2

Robotic-assisted laparoscopic hysterectomy (Fig 2)

  • The surgeon performs the procedure with the help of a robotic machine.
  • A laparoscope is inserted into the abdomen to view the pelvic area.
  • Small, thin surgical tools are inserted through three to five incisions around the belly button. Robotic arms and instruments are controlled by the surgeon.
  • The recovery is similar to a laparoscopic hysterectomy.

Abdominal hysterectomy

  • The abdomen is opened near the bikini line with a six-inch-long incision.
  • Most commonly used when the uterus is enlarged or when the disease spreads to other pelvic areas eg. cancer.
  • It generally requires a longer hospital stay (two or three days) and a longer recovery time.

What are the complications or side effects of a hysterectomy?

The potential complications of the surgery may include:

  • infection at the surgical site
  • heavy bleeding during or after the surgery necessitating additional procedures
  • injury to other organs such as the bladder, bowels
  • breathing or heart complications from anesthesia
  • trouble urinating
Complications are more common in abdominal hysterectomies compared to the other, less invasive types.
If you have your ovaries removed as part of the procedure and you haven’t gone through menopause yet, the surgery could cause you to experience menopausal symptoms, such as:
  • hot flashes
  • vaginal dryness
  • mood swings

Ovary removal also puts you at risk for developing other medical conditions like bone loss, heart disease, and urinary incontinence.

  • Can i become pregnant again after the surgery?
A hysterectomy is a permanent procedure. Having undergone the surgery, you won’t be able to become pregnant. It is thus, best performed when you have completed your family and don't plan on having more children.


Other questions which you may ask your doctor before you plan for a hysterectomy.

  • What are the benefits and downsides of having a hysterectomy for my particular condition?
  • If I don’t have a hysterectomy, what will happen?
  • Will I need any medications after surgery?
  • What will my recovery be like?
  • Do you use the latest surgical techniques?
  • Will I continue to need Pap smears after my hysterectomy?
  • If you remove my ovaries, would you recommend hormone replacement therapy?
  • Will I have scars, and where?

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