Vaginal Hysterectomy

	What does the surgery involve?		What is a prolapse?
	Alternatives to surgery		What should I do before the operation?
	What happens during surgery?		What happens after surgery?
	How will it affect me?		Potential complications of hysterectomy
	Additional procedures that may be necessary during your operation

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. Removal of the ovaries is sometimes possible although not commonly done at the same time. The usual reasons for performing a vaginal hysterectomy are heavy periods or a prolapsed womb. Not all women are suitable for a vaginal hysterectomy and it can be difficult if the womb is enlarged or if you have not had vaginal births. Sometimes I will use laparoscopy to help perform a vaginal hysterectomy (commonly known as a Laparoscopically-Assisted Vaginal Hysterectomy) It is not usually possible to remove the ovaries during a vaginal hysterectomy unless I also perform a laparoscopy.

Vaginal hysterectomy can be performed either on its own or as a combined operation with other procedures such as a vaginal repair, a TVT or a Sacrospinous fixation.

What is a prolapse?

A prolapse is due to a weakness which causes a bulge in the vagina. It may involve the womb alone, the vagina alone, or both the womb and the vagina. There are three common types of vaginal prolapse: cystocele, rectocele and enterocele. The surgery that is performed will depend on the type of prolapse

A cystocele is a bulge in the front wall of the vagina which allows the bladder to move downwards.
A rectocele is a bulge in the back wall of the vagina which allows the back passage (rectum) to move downwards.
An enterocele is a less common type of prolapse in which the small bowel bulges down through the vagina.

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 12 to 24 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 1-2 days.

How will it affect me?

You can expect to stay in hospital for around 2 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 2-3 months. You should check with your insurance company if you feel able and wish to drive before 4 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

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.

More frequent but less serious risks

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 if this happens.
Women who have an operation for prolapse have a risk of developing another prolapse in the future. This is because their body tissues are already weak, having usually been damaged during pregnancy and childbirth.

Additional procedures that may be necessary during your operation Blood transfusion.

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.

Repair of bowel, bladder or ureter. This will be in the rare event of any injury to these organs during the operation.

The control of bleeding or the repair of an injured internal organ may require a laparotomy to be performed. This is an incision in your lower abdomen.

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.

Written 2007