The operation to remove the uterus is performed both in benign and malignant gynecological diseases. The most common causes of hysterectomy are uterine fibroids, abnormal vaginal bleeding, endometriosis, uterine prolapse, chronic pelvic pain and cancer of the cervix, uterus, uterine (fallopian) tubes or ovaries.
Ways to remove the uterus
Depending on the volume of tissues removed, the following types of hysterectomy are distinguished:
• subtotal hysterectomy, or uterine amputation – removal of the uterus with preservation of the cervix;
• total hysterectomy, or hysterectomy – removal of the uterus with the cervix;
• hysterosalpingo-ovariectomy – removal of the uterus with appendages (fallopian tubes and ovaries);
• radical hysterectomy – removal of the uterus with the neck, appendages, upper part of the vagina, surrounding pelvic tissue and lymph nodes;
By surgical access, the following types of hysterectomy are distinguished:
• abdominal hysterectomy
• vaginal hysterectomy
• laparoscopic hysterectomy
The choice of surgical access depends on the disease, the size of the uterus and the wishes of the patient.
Total abdominal hysterectomy is one of the most commonly used hysterectomy methods. In this case, access to the uterus is carried out by opening the abdominal cavity. With a hysterectomy, the uterus is removed, but the cervix is left. If necessary, the fallopian tubes and ovaries are also removed. After the main stages of the operation are completed, the doctor heals the wounds on the abdomen. A sterile dressing is applied. The operation abdominal hysterectomy is performed under general anesthesia, i.e. during the operation the patient is unconscious. The disadvantages of abdominal hysterectomy can be called a great trauma for women, the formation of a large scar on the abdomen. In the postoperative period, the patient is prescribed painkillers and antibiotics to prevent infectious complications. After a week, the stitches are removed. You can return to normal work in 2-3 weeks.
With vaginal hysterectomy, the uterus is removed through the vagina. First, the cervix is removed, and then the rest of the uterus. Usually, a vaginal hysterectomy is performed in women who have given birth, since their vagina is wide enough to remove the uterus through it. The advantage of vaginal removal of the uterus is that after such an operation no scars remain. Usually, with vaginal hysterectmia, it takes only two days to stay in the clinic. After two weeks, a woman can return to normal work. Vaginal hysterectomy is performed when there are all conditions for this – the uterus is small in size, the absence of cancer and the flexibility of the vaginal walls. With large sizes of the uterus, a vaginal hysterectomy cannot always be performed, and in nulliparous it is practically not performed. In addition, with vaginal hysterectomy, it is not possible to remove the ovaries, since they are located in the pelvic cavity above the uterus.
Laparoscopic methods of hysterectomy consist in the fact that the operation is performed without any large incisions on the abdomen. The entire operation is carried out using laparoscopic equipment, when tubes are inserted into the abdominal cavity through small incisions, and through them the corresponding instruments, as well as a video camera. Through the cannula introduced at the very beginning, gas is introduced into the abdominal cavity, which raises the abdominal wall above the organs, giving the surgeon an overview and the opportunity to access the uterus.
Possible consequences of hysterectomy
Possible complications of hysterectomy include the risk of infection, hematoma formation, numbness of the skin in the scar area, the formation of a keloid scar (with a predisposition), as well as the formation of adhesions in the abdominal cavity. In addition, when the uterus is removed along with the fallopian tubes and ovaries, the woman begins menopause.
In the body, sex hormones cease to be synthesized, which are necessary not only for the function of the genital organ and menstrual cycle, but also participate in the metabolism. Therefore, hormone replacement therapy (HRT) is usually prescribed for such patients.