Alternative Names abdominal hysterectomy, removal of uterus, abdominally
Definition Abdominal hysterectomy is a surgery that removes the uterus and cervix through a cut in the abdomen. The ovaries and fallopian tubes may or may not be taken out.
Who is a candidate for the procedure? This procedure may be used for the following problems:
abnormal or heavy bleeding from the uterus
fibroids, which are noncancerous tumours that grow in the muscle of the uterus
adenomyosis, or noncancerous tumours made of gland tissue and muscle
endometriosis, which occurs when small pieces of the uterus lining attach to tissue outside the uterus
abnormal appearing cells growing in the lining of the uterus or cervix that are suspicious for very early cancer, or pre-cancer
uterine prolapse, which is when the uterus falls from its normal position
Women also may need this procedure if they suffer from certain types of cancer, such as:
uterine cancer, or cancer of the uterus, or womb. The uterus holds a baby during pregnancy.
ovarian cancer, or cancer of the ovaries. The ovaries are the female sex organs located on either side of the uterus that release a woman's eggs.
cervical cancer, or cancer of the cervix. The cervix is the lowest part of the uterus that attaches to the vagina.
fallopian tube cancer, or cancer of the "tubes." These tubes connect each ovary to the uterus, letting an egg to travel toward the uterus to allow pregnancy.
How is the procedure performed? Before surgery, several things are usually done.
An IV is placed in a vein, usually in the hand or arm. This is a tube that can be used to replace fluids and give medication or a blood transfusion, if needed.
A catheter, or tube, is placed in the bladder so the doctors can see how much urine the body is making. It also drains the bladder through the night so that a woman does not have to get up to go to the bathroom.
Blood tests may be done to check for any common problems, such as a full blood count. This test can check for anaemia, or a low blood count.
An anaesthetist meets with the woman. He or she will discuss the type of pain control, any allergies to medications and other possible disorders.
The belly and vulvar area, which is the area between the legs, are sometimes partly shaved.
Medications needed before surgery are given.
In the operating room, the woman is given a general anaesthetic to prevent pain. The skin around the vagina is cleaned with a soapy solution to remove any bacteria. A cut is then made in the lower belly area. This exposes the tissue, such as blood vessels, that surrounds the uterus and cervix. These tissues must be cut and tied off to remove the uterus. Stitches are placed in these deep structures. These will heal during the weeks following surgery and do not need to be removed. The uterus is removed from the top of the vagina, and the vagina is closed at the top.
The surgery usually takes 60 to 90 minutes. At times, the ovaries and tubes may be removed, and other organs may be repaired or removed if needed for other reasons. All tissue is sent to a laboratory to be analysed.
Other procedures may also be needed during the surgery if there is cancer, such as:
checking the lymph nodes, or "glands," to see if cancer has spread
removing as much cancer as possible
fixing, altering, or removing other organs
What happens right after the procedure? The woman usually stays in the hospital for 1 to 5 days. The catheter in the bladder is usually removed the next morning if no bladder repair or trauma occurred. The IV is usually removed if there is no evidence of fever or infection, and the woman is able to drink fluids without getting nauseated or vomiting.
The results of surgery often depend on what caused the problem. Removing the uterus ends abnormal uterine bleeding, pelvic pressure, and removes fibroids. Some other conditions, such as cancer, may come back. After this operation, a woman does not need to use birth control since she cannot become pregnant. If the ovaries are removed along with the uterus and cervix, hormone replacement therapy with oestrogen is often advised. This helps prevent symptoms and other health problems of menopause. If the procedure was performed for cancer, further treatment, such as radiation, may be necessary. The exact treatment will depend on the laboratory results and the advice of the cancer doctor.
What happens later at home? Women having this surgery are advised to follow certain tips at home.
A balanced diet with iron replacement should be followed to promote healing.
Stool softeners should be used and 8 glasses of fluids should be taken in each day. This helps prevent constipation and straining during bowel movements, which may disturb the healing wounds.
Heavy lifting should be avoided for 4 to 6 weeks.
Walking is advised every day.
Antibiotics and pain relievers should be taken as directed if needed.
Exercise programs should be followed as directed.
Sex should be avoided for 4 to 6 weeks after surgery to allow the vagina and internal structures to heal.
What are the potential complications after the procedure? There are always problems that can occur during surgery. The risks and benefits of any surgery should be discussed before the operation. Possible problems include:
infection
those caused by anaesthesia, such as breathing trouble, reactions to drugs and poor pain relief
internal bleeding
mild nausea and vomiting
trauma to the bladder or ureter, the tube that carries urine from the kidney to the bladder
bowel trauma
fistula formation, which occurs when a hole forms between the bladder, intestines and vagina
pelvic scar formation
prolonged paralysis of the bowels
allergic reactions to antibiotics or pain medication
bleeding, which may require blood transfusions
stitches breaking apart
blood collecting below the cut
blood clots in the legs, lungs, heart or brain
death
Most women, however, have few or no complications. It should be remembered that cancer can come back even after a proper operation in some cases.
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
