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This information leaflet is written for women for whom an abdominal hysterectomy is being considered. The information is of a general nature and your care will be tailored to your own needs.
What does the surgery involve?
A total abdominal hysterectomy is the removal of the uterus (womb) and the cervix (neck of womb) through a cut in the abdomen. A subtotal abdominal hysterectomy means that the cervix is not removed. The usual reasons for performing an abdominal hysterectomy are large fibroids, endometriosis/ menstrual pain and bleeding not responding to medical treatment, or cancer of the cervix, womb or ovaries. In women who have a prolapsed womb, a vaginal hysterectomy is usually more suitable.
It is possible to remove the ovaries and the fallopian tubes at the same time I will discuss the advantages and disadvantages of doing this. It is advisable to have the ovaries removed if you have already gone through the menopause, you have severe endometriosis or have a cancer of the womb or ovary. Many women who are approaching the menopause opt to have their ovaries removed in order to prevent getting ovarian cancer in later life, the risk of which is 1% (ie 1 in 100 women).
Alternatives to surgery
A hysterectomy is not usually performed for period problems unless other, more simple treatments have been tried. Alternative treatments for heavy periods include tablets, a Mirena coil and endometrial ablation.
Before the surgery
- You will come to the hospital about a week before the operation to make necessary preparations and to ensure that you are fit for surgery
- You will have blood tests and may also need to have an ECG (tracing of your heart) and possibly a chest x-ray
- You will be asked some general questions about your health.
- Smoking increases the risk of complications. It is advisable to stop smoking 1 month before your operation.
- There is no need to stop HRT before the operation.
Admission to hospital
- You will usually be admitted to hospital on the day of the operation. You will be seen by a nurse who will take down certain information, perform some simple tests, and help you become familiar with the ward. Any questions that you have will be answered.
- You will be seen me and you a further opportunity to ask questions. I will ask you to sign a form giving your consent to surgery.
- Before your operation, you will be seen by your anaesthetist who will discuss your anaesthetic options, any allergies you may have, and make sure that you are fit enough for the surgery to take place. More information is available at the Royal College of Anaesthetists website.
- You will be asked not to eat for 6 hours before your operation. You will be able to have water (but no tea or coffee) until 2 hours before the operation.
- You will also be given elastic stockings to wear to help prevent the formation of blood clots in your legs
- An intravenous line (drip) will be placed in the hand or arm so that fluids, drugs or blood can be given if needed.
- A catheter will be placed in the bladder to drain urine.
- A cut will be made in your abdomen, usually across the lower part above the hairline, but in some cases vertically.
- One or more tube drains may be left so that any fluid inside the abdomen after the surgery can drain away.
After the Surgery
- You will be given appropriate pain relief. This may be given through the intravenous line for the first 24-36 hours and is known as “Patient-Controlled Analgesia” (PCA) because you can increase the dose yourself by pressing a button. Other types of pain relief include injections, suppositories and tablets.
- You may be given an anti-sickness injection if necessary.
- You will be kept 'nil by mouth' at first to enable you to recover from the anaesthetic. You will usually be able to drink once you are properly awake, slowly increasing the amount, and then starting solid foods.
- The drip in your arm will be supplying you with fluids until you are drinking normally.
- The catheter will enable you to pass urine, and is usually removed the following morning. The amount of urine you pass each time will be recorded to make sure you are emptying your bladder completely.
- Any drains in the abdomen will be removed when the amount of fluid being drawn off has settled down.
- You will get out of bed on the day following the operation because this reduces the risk of complications.
- If you have stitches that need to be removed they will be taken out at around 5-6 days after the operation. Your district nurse can do this if you have gone home before they are ready to be removed. If you had a vertical cut during the operation the stitches will need to stay in for longer.
- If your ovaries have been removed the possibility of starting hormone replacement therapy will be discussed with you before you go home.
Potential complications of the surgery
- All operations carry a risk of complications. Most complications are relatively minor and can be easily put right. Examples include infections of the chest or bladder.
- Bleeding may occur during or after surgery and can usually be stopped without difficulty, although a blood transfusion may occasionally be necessary. Very rarely women need to return to theatre to stop the bleeding.
- Some women find it difficult to empty their bladder properly after surgery. A catheter (tube) may need to be put back into the bladder if this happens.
- Injury to the bladder or bowel is fairly rare and, if recognised, can usually be repaired during the operation. Women who have an injury to the bladder need to have a catheter in their bladder for 1-2 weeks whilst the injury heals. On very rare occasions, such an injury does not heal completely and further surgery is needed at a later date.
- There may be problems with the wound, including infection, rupture during healing and, much later, an ‘incisional hernia’, where the healed wound is weak and bulges out.
- You will not have any further periods after the operation.
- If the ovaries are removed and you have not yet reached the menopause, you may experience hot flushes and night sweats. These can usually be controlled by hormone replacement therapy.
- If the ovaries are not removed, there is a chance that you will reach the menopause early.
- If you have a subtotal hysterectomy, the cervix is still present and you will therefore need to continue to see your doctor for smear tests every three years.
- Rare, but potentially serious, complications of all operations include allergic reactions to anaesthetic drugs, deep vein thrombosis (a blood clot in the leg), pulmonary embolus (a blood clot in the lung), heart attack and stroke. The risk of serious complications increases with age, and also if you have other significant medical problems.
Once you are eating, drinking and passing urine normally, you will be discharged home. This usually takes around 2 days. Your individual recovery and home circumstances will be taken into account when deciding when you can go home.
After leaving hospital
- You may be prescribed antibiotics and pain-killing medicines and these should be taken as prescribed.
- Sexual intercourse should be avoided for 6 weeks after surgery to enable the internal structures to heal.
- You should not drive and you should avoid lifting for 4 weeks. You should avoid heavy lifting for 3 months.
- You should check with your motor insurance company before driving a car.
- Prevent constipation and straining, and damage to the surgery site, by drinking lots of fluids and eating foods with a high fibre content e.g. fruit, vegetables, wholemeal bread.
- Walking is good for you and you should gradually increase the distance covered, reducing the distance if you develop pain and become very tired.
- You will be given an appointment to see me for a check-up in around 6 weeks time.
- It is normal to have some lower abdominal discomfort and mild vaginal bleeding/ discharge for 6-8 weeks following surgery. However, if you have increasing vaginal bleeding or abdominal pain then you should telephone the ward at Fawkham Manor Hospital on: 01474 879900