1. What is a hysterectomy?
It is a surgical procedure where the uterus is removed
2. What are the indications for a hysterectomy?
- severe pain due to uterine factors
- abnormal bleeding
- possible reasons being polyps or fibroids
- failed medical treatment of abnormal bleeding
- adenomyosis of the uterus with symptoms usually of pain and bleeding
- severe endometriosis
- abnormal cervical cytology in someone that has completed her family
- fibroids that are symptomatic
- endometrial pathology
3. What are the alternatives
- medical therapy like the contraceptive pill, hormone tablets
- intra-uterine device containing hormones
- endometrial ablation
4. What is the difference between a total and a subtotal hysterectomy?
- During a total hysterectomy the uterus and cervix (mouth of the uterus where we take PAP-smears from) is removed.
- During a subtotal hysterectomy the cervix is left behind. This is currently only done during a combination with prolapse surgery
5. What about the ovaries?
- The ovaries are only removed when they are abnormal with cysts that can progress to cancer or when you are older than 55 - although this will be discussed and individualised.
- The ovaries are retained to continue to supply your normal hormones after the hysterectomy
- This means you can still have ovarian cysts, can still have PMS and you will still be able to ovulate
6. Will I need hormone tablets after the surgery?
- Only if the ovaries have been removed or are non-functional
- In other words, if you have menopausal symptoms
7. What about my tubes?
- The tubes will always be removed at the time of the hysterectomy
- They have been associated with a possible higher risk of cancer if left behind
- They also pose a possibility of fluid building up in the tubes after the hysterectomy that can lead to discomfort and pain and to remove them is very difficult surgery
8. What are the risks of the surgery?
Risks are higer in patients with various risk factors like severe endometriosis, a number of previous c/sections, previous gynae surgery or any open surgery
1. Injury to the bladder
- most of the time in patients that had previous c/sections
2. Injury to the ureters (kidney pipes)
- this will depend on various factors, but usually relevant in severe endometriosis and lots of adhesions
- in case of injury, a stent will be placed, the defect sutured and the stent removed after 6 weeks and the kidney pipe evaluated by the urologist
3. Injury to the bowel
- again an issue especially in severe endometriosis
4. A haematoma at the top of the vagina
- this can happen in any hysterectomy, usually because of a small bleeding at the top of the closed vagina.
- one tries not to burn all the bleeders there as that can also lead to a possible complication of breakdown of the vaginal closure area
- this is usually due to the fact that the vagina was open into the abdominal cavity and normal organisms in the vagina can lead to sepsis at this area
- to decrease this risk, this area is rinsed copiously to minimize the possible bacterial load
How long will I stay in hospital?
- between 1 and 2 nights
How long will I be off work?
- 2 - 4 weeks
When can I drive again?
- 1 week
Can I climb stairs?
Can I lift my child, gand-child
How long do we need to abstain?
- 6 weeks
What are the things I should look out for to contact the doctor following the surgery?
- not feeling well
- vaginal bleeding
- vaginal discharge that is foul smelling
- pain that does not improve on pain medication
- you should improve daily and if not, contact me immediately