Hysterectomy - Types , and Risk Factors

What Is a Hysterectomy?

A hysterectomy is a surgical procedure performed to remove the uterus of a woman. The uterus, also known as the womb, has the main function of developing and holding the baby until the time of birth. Also, the inner lining of the uterus is responsible for producing menstrual blood.

If the patient has some problems pertaining to the uterus or some long-term pain, then a hysterectomy is done to help the patient overcome her problem. There are many possible reasons for which the patient has to undergo a hysterectomy, ranging from chronic pain to cancer.

Hysterectomy generally describes the process of completely removing the uterus, along with the ovaries and fallopian tubes. But based on the reason for surgery, it might differ from one person to another. Once a hysterectomy is done, the menstrual cycle will stop, and also, it will make the woman unable to conceive.

What Are the Reasons for Which Hysterectomy Is Performed?

As mentioned earlier, a hysterectomy can be suggested by your doctor if you have any of the following:

• Chronic pelvic pain.

• Uterine, cervical, or ovarian cancer.

• Uterine prolapse – A condition when the uterus drops down through the cervix and projects outside the vagina.

• Uncontrollable vaginal bleeding.

• Endometritis – A condition where the inner lining of the uterus begins to grow outside the uterine cavity, causing severe pain and bleeding

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• Fibroids – The benign tumors that develop in the uterus.

• Adenomyosis - A similar condition to that of endometritis, where the inner lining of the uterus begins to grow into the uterus muscle.

• Pelvic inflammatory disease – A serious infection of the reproductive organs.

For non-cancerous tumors, hysterectomy is considered the last treatment option, only if all the other treatment methods have not shown any progress.

What Are the Types of Hysterectomies?

The surgical procedure of hysterectomy is different for each person, and it differs based on the exact reason as to why the procedure is required. Hence based on the reason, the surgeon might choose to remove the entire uterus or only some parts of the uterus. Thus, depending on the parts removed during the procedure, hysterectomy is classified into three as:

• Supracervical or Subtotal Hysterectomy: In this procedure, only the upper part of the uterus is removed, and the cervix is left in its place.

• Total Hysterectomy: In this procedure, the entire uterus along with the cervix is removed.

• Radical Hysterectomy: In this procedure, the entire uterus, along with tissues present in the side of the uterus, the cervix, and the top part of the vagina, is removed. This procedure is done only in the case of cancer.

Hysterectomy and Bilateral Salpingectomy-Oophorectomy:

Other parts such as the ovaries and the fallopian tubes are also connected to the uterus. The ovaries are the organs that are used to produce hormones such as estrogen and progesterone. And fallopian tubes are responsible for transporting the eggs from the ovary to the uterus. Hence if the hysterectomy procedure involves removing the tubes and the ovaries, then it is called hysterectomy and bilateral salpingectomy-oophorectomy.

Also, the surgery differs in approach based on the surgeon’s experience, the reason for the procedure, and the patient’s other health conditions. They are classified into two based on the approach, which are:

1. Open Surgery Hysterectomy: The open surgery hysterectomy is also called abdominal hysterectomy. This is the most common approach and accounts for more than 55% of the procedure done for non-cancerous diseases. This procedure involves a 5 to 7-inch incision across the belly (above or below or side to side). The surgeon will make use of this incision to remove the uterus.

After the open surgery hysterectomy, the patient will have to stay in the hospital for 2 to 3 days for medical care. And this procedure will produce a visible scar at the site of the incision even after full healing.

2. MIP Hysterectomy: MIP is nothing but a minimally invasive procedure wherein the approach is not very invasive and has only a slight cut or incision. There are three different approaches used for MIP hysterectomy, which are:

• Vaginal Hysterectomy: As the name suggests, the surgeon will make a small incision inside the vagina and remove the uterus through the vagina. This will have no scars as the incision will be closed inside.

• Laparoscopic Hysterectomy: This procedure is done through a small tube called a laparoscope which has a lighted camera. Other surgical tools are inserted through several cuts made in the belly. Also, there is another method called the single-site laparoscopy, where a single small cut is made in the belly button, and the surgery is performed from outside the body with the help of the video from the camera.

• Laparoscopic Vaginal Hysterectomy: This procedure is similar to the vaginal hysterectomy, but the only difference is that the laparoscopic tools in the belly are used to assist in the procedure.

• Robot-Assisted Laparoscopic Hysterectomy: This is similar to the generic laparoscopic hysterectomy, but the doctor will control the tools using a well technologically advanced system of the robot. This will give the surgeon more accessibility and free movement of the wrist.

What Are the Risks of Hysterectomy?

Hysterectomy is similar to any other major surgery and has its own set of complications. But there have not been any life-threatening conditions that have occurred as a result of a hysterectomy. Some of the possible complications of hysterectomy procedure include:

• Urinary incontinence.

• Chronic pain.

• Vaginal prolapse.

• Fistula formation in the vagina – The connection between the vagina and the bladder or vagina and the rectum.

• Surgical complications such as blood clots, hemorrhage, infections, injury to the surrounding organs, etc.

What to Expect After the Hysterectomy Procedure?

Hysterectomy is a big procedure, and there might be some physical and emotional traumatic experiences that may be associated with the surgery. If the ovaries are removed during the procedure, then the patient will enter into menopause. Even if the ovaries are not removed, and only the uterus is removed, even then, the patient will enter into menopause at a very early age.

There might be occasional bleeding or light brown discharge from the vagina for the first three to four weeks. And like any other surgery, there might be swelling, pain and redness, or bruising at the site of the incision. Also, your doctor might ask you to refrain from indulging in certain activities for a certain period of time, such as:

• Lifting heavy items.

• Bending.

• Pushing or pulling objects such as vacuum cleaners or furniture.

• Sexual intercourse.

Conclusion:

The type of surgery will decide the recovery rate and the activities that you can perform. For instance, if the surgery is vaginal or laparoscopic, then the recovery time is usually three weeks, and you can return to your regular activities. But if you have had an abdominal hysterectomy, then the recovery time is usually around six weeks.

There might also be some changes in your sexual life as well. If the ovaries are removed, then there might be a reduction in the sex drive and an increase in vaginal dryness. But there are other treatments that are available to overcome such conditions that are associated with the hormones, such as estrogen therapy.