What is an abdominal hysterectomy?
An abdominal hysterectomy is a procedure in which the uterus (womb) is removed through a cut in the abdomen. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.
Other female organs may also be removed when the uterus is removed.
A radical hysterectomy is the removal of the uterus, cervix, ovaries, fallopian tubes, and pelvic lymph nodes.
A total hysterectomy is the removal of the uterus and the cervix, but not the ovaries or tubes.
A subtotal hysterectomy is the removal of the uterus, but the ovaries, cervix, and fallopian tubes are left in place.
When is it used?
There are many reasons why you and your primary healthcare provider may decide to take out your uterus. Some of the problems that may be treated with a hysterectomy are:
· Tumors in the uterus
· Constant heavy bleeding that has not been controlled by medicine or dilatation and curettage (D&C)
· Endometriosis – a condition in which the cells that normally line the uterus (womb) grow outside of the uterus, usually in the pelvis that causes pain or bleeding and may not respond to other treatments
· Chronic pelvic pain
· A fallen (sagging) uterus
· Precancerous or cancerous cells or tissue on the cervix or in the uterus.
Examples of possible alternatives to an abdominal hysterectomy are:
· Having the uterus removed through the vagina (vaginal hysterectomy)
· Taking medicines to treat some types of problems
· Having a hysteroscopy or laproscopy.
· A hysteroscopy is a procedure where a thin tube with a light on the end( called a hysteroscope) allows your primary healthcare provider to view the inside of your womb. This tube is put in through your vagina.)
· A laparoscopy is a minor surgical procedure. A small incision (cut) is made near your navel (belly button) and a tiny tube with a light on the end is put inside your abdomen through the cut. This allows the doctor to see inside your abdomen and look for signs of endometriosis or other abnormalities.
· Continuing to have D&Cs to control abnormal bleeding
· Treating precancerous cells of the cervix with conization (removing a cone-shaped part of the cervix)
· Removal of an area of endometriosis without removing the uterus
· Removal of tumors (fibroids) without removing the uterus
· Choosing not to have treatment, recognizing the risks of your condition.
You should ask your primary healthcare provider about these choices.
How do I prepare for an abdominal hysterectomy?
Plan for your care and your recovery after the operation, especially if you are having general anesthesia. Allow for time to rest. Try to find other people to help you with your day-to-day duties.
Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery. Follow your primary healthcare provider’s instructions about not smoking before and after the procedure
If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your primary healthcare provider at least one week before your surgery if you need to stop taking the aspirin before your surgery.
Be sure to tell your primary healthcare provider what medicines you are taking, including nonprescription drugs and herbal remedies.
Follow any other instructions your primary healthcare provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.
Your primary healthcare provider may give you a laxative to take the night before the surgery or an enema the morning before the surgery.
Your healthcare primary healthcare provider may shave your lower abdomen down to the top of the pelvis.
What happens during the procedure?
You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It will keep you from feeling pain during the operation. A general anesthetic relaxes your muscles and causes a deep sleep. It will prevent you from feeling pain during the procedure.
Usually a catheter (small tube) is placed into your bladder through the urethra (the place where your urine comes out). The catheter drains urine from the bladder.
You will have a needle in a vein in your arm (an IV) to give you fluids and medicines, including antibiotics.
The doctor makes a cut in the abdominal wall and the uterus is removed
What happens after the procedure?
The IV and catheter are removed 1 or 2 days after the surgery. You may stay in the hospital for 3 to 5 days.
After you go home, get plenty of rest. Do not do any heavy lifting or otherwise strain the stomach muscles for 4 to 6 weeks. Follow your healthcare primary healthcare provider’s instructions for dealing with pain and preventing constipation. Ask your primary healthcare provider what other steps you should take and when you should come back for a checkup.
If you were having menstrual periods before the surgery, you will no longer have them after the operation. You also cannot become pregnant. If your ovaries were removed, menopause starts right away and your healthcare primary healthcare provider may prescribe hormone therapy. Be sure to discuss any concerns you have about these effects and treatments with your primary healthcare provider before the surgery.
Talk to your health care primary healthcare provider about when you can resume sexual activity.
What are the benefits of this procedure?
A hysterectomy takes care of problems you may have been having with your uterus. For example, it removes any tumors that may have been in your uterus and it stops menstrual periods and any pain you may have been having.
What are the risks associated with this procedure?
There are some risks when you have general anesthesia. Discuss these risks with your primary healthcare provider.
· You may develop an infection or bleeding.
· The incision may open.
· You may develop a hernia (weakening of the abdominal muscles, causing the intestines to push into the weakened area) in the incision.
· The cut in your abdomen (incision) may have to be reopened to stop any bleeding.
· Your bladder or the tubes leading to it may be injured and need surgical repair.
· A piece of blood clot may break off, enter your bloodstream, and block an artery in the lung.
· Your intestine (bowel) may be injured during the surgery.
Ask your primary healthcare provider how these risks apply to you.
When should I see my primary care provider?
See your primary care provider right away if:
· You develop a fever over 100°F (37.8°C) by mouth.
· You become dizzy and faint.
· You have nausea and vomiting.
· You have chest pain.
· You become short of breath.
· You have heavy bleeding from the vagina.
· You have leakage from the incision or the incision opens up.
· You have pain when you urinate.
· You have swelling, redness, or pain in your leg.
· You have diarrhea that does not stop.
See your primary care provider during office hours if:
· You have questions about the procedure or its result.
· You want to make another appointment.