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Laparoscopically-Assisted Vaginal Hysterectomy (LAVH)
This information leaflet is written for women who are considering having a laparoscopically-assisted vaginal hysterectomy (LAVH). The information is of a general nature and your care will be tailored to your own needs.
What does the surgery involve?
A vaginal hysterectomy is the removal of the uterus (womb) and the cervix through a small cut in the top of the vagina. When this operation is facilitated by performing a laparoscopy, the operation is known as an LAVH. Removal of the ovaries is usually possible at the same time. There are several types of hysterectomy and an LAVH is usually chosen when there is a desire/need to remove both the cervix and the ovaries. Not all women are suitable for a LAVH and it can be difficult if the womb is very enlarged, if you have had multiple caesarean sections, or not had any vaginal births.
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.
- Prolapse can often, but not always, be controlled by a plastic pessary inserted into the vagina. However, a pessary is not usually suitable for women who want to remain sexually active.
What should I do before the operation?
You will usually come to the hospital a few weeks before the operation and have a variety of simple tests to make sure you are fit for surgery. Smoking increases the risk of complications so, if possible, please try to stop smoking a month before the operation.
You will be admitted to hospital on the day of the operation where you will be seen by me and I will answer any questions or worries that you might have. Also my anaesthetist will come and discuss with you the options of a general anaesthetic where you go to sleep, or regional anaesthesia (like an epidural). More information is available at the Royal College of Anaesthetists website.
What happens during surgery?
- A ‘drip’ will be placed in your arm or hand to give you any fluids or drugs that you might need.
- The operation takes between 30 and 100 minutes.
- A small tube will be put in your bladder to drain urine. This is called a catheter.
- A gauze pack may be put in the vagina to prevent bleeding.
What happens after surgery?
You will be taken to the recovery room and kept there until you are fully awake and stable; then you will be taken back to the ward. You will be given pain relief to keep you comfortable. There are different ways of treating any pain you might have, from injections, tablets, to suppositories. Another method is called Patient Controlled Analgesia (PCA) and it lets you press a button attached to a pump containing the medicine. This pump is specially built to prevent you giving yourself too much medication.
You will receive daily injections of Clexane, a drug which “thins” the blood to help prevent clots forming in your legs.
It is usual to feel some pain or discomfort after a major operation but we will try hard to minimise this. Assuming you are eating and drinking normally, the drip will be removed after 24 to 48 hours. If you have a vaginal pack, it will usually be removed on the day following surgery. The catheter will normally be removed from your bladder after 2-3 days.
How will it affect me?
You can expect to stay in hospital for around 2-3 days, whilst you gradually get back to normal. Once you are ready for home, you will be given a supply of pain relief if required. It is common to feel more tired after any major operation, and it is important to keep mobile but take it easy. You should avoid heavy lifting and strenuous exercise for about 3 months. You should check with your insurance company if you feel able and wish to drive before 6 weeks. The time before you can return to work will depend on your job, and you can discuss this with your doctor.
I will see you for a check-up approximately 6-8 weeks after the operation. You will be advised when other normal activities can be resumed, such as sport and sexual intercourse. Removing your uterus should not affect your sex drive (libido) and you can usually resume sexual intercourse after your check-up.
Potential complications of hysterectomy
Every treatment has its benefits, but there are also possible risks that you should be aware of before you agree to having a hysterectomy.
Rare but potentially serious risks
More frequent but less serious risks
- Injury to the bladder or bowel or ureter (the tube between the kidney and bladder).
- Bleeding needing a blood transfusion.
- Going back to theatre to control bleeding or repair injury. This may require a cut in your abdomen.
- Serious infection in the pelvis or in the bloodstream.
- Thrombosis-a blood clot in the leg or lung.
- Passing urine more frequently.
- Minor infections eg. of chest, bladder, wound, pelvis.
- Collection of blood (haematoma) in the pelvis
- Persistent abdominal pain which can be related to adhesions within the pelvis.
- You may find it difficult to empty your bladder properly after surgery. A catheter may need to be put back into the bladder temporarily if this happens.
Additional procedures that may be necessary during your operation
If you suffer with increased bleeding during or after your hysterectomy, it may be necessary to give you a blood transfusion. About 15 women out of every 1000 having this operation will need blood. If you feel strongly against this then please discuss it with me beforehand.
A laparotomy (an incision in your lower abdomen) is sometimes necessary. Reasons include: to control bleeding, the repair of an injured internal organ, or if it is technically not possible to remove your womb through the vagina.
It is important to remember that extra procedures during the course of your hysterectomy will only be done if it is necessary to save your life or prevent serious harm to your future health.
Further help and information
NHS Direct 0845 46 47 - www.nhsdirect.nhs.uk
Hysterectomy Association 60 Redwood House, Charlton Down, Dorchester, Dorset, DT2 9UH
Tel: 0871 781 1141 - www.hysterectomy-association.org.uk
The Amarant Menopause Trust - www.amarantmenopausetrust.org.uk
National Endometriosis Society - www.endo.org.uk
Author - Robert MacDermott 2007