Hysterectomy
By Abbas K. Shikary, M.D.
Board Certified in OB/GYN and Pathology
Ashland OB/GYN Clinic
419-281-8961
A hysterectomy is the surgical removal of the uterus. In the United States, about 600,000 hysterectomies are performed annually. About one third of these women have a hysterectomy by the age of 60.
The most common indication for a hysterectomy is uterine fibroids, which are benign growths inside the uterus. Other indications include: menorrhagia, or excessive menstrual bleeding usually caused by hormonal changes or fibroids; endometriosis; pelvic support problems like a prolapsed uterus, where the uterus descends from its normal position into the vagina; and cancers of the uterus and cervix.
There are three basic types of hysterectomies:
1) A total hysterectomy, which includes the removal of the uterus and cervix. An optional procedure is the removal of both fallopian tubes and ovaries along with the hysterectomy.
2) In the case of uterine cancers, a radical hysterectomy is performed. The uterus, cervix, both fallopian tubes and ovaries, and pelvic lymph nodes are removed.
3) Supracervical hysterectomy or subtotal, removes the uterus while leaving the cervix intact. Studies suggest this procedure may help reduce the risk of pelvic floor prolapse and also help preserve sexual function. Again, it can be combined with the removal of the ovaries and fallopian tubes.
Just as there are different types of hysterectomies, surgeons use different procedures, including traditional abdominal hysterectomy, vaginal hysterectomy, and laparoscopic hysterectomy.
Traditional abdominal hysterectomy is done through a large incision in the abdominal wall. This procedure carries a greater risk of infection, hernia formation and adhesions later on. The recovery for a traditional abdominal hysterectomy is the longest of the three procedures.
In a vaginal hysterectomy, the removal of the uterus and cervix is performed vaginally, with no abdominal incision. Supracervical hysterectomies cannot be performed vaginally. A vaginal hysterectomy is routinely performed if there are pelvic support problems, such as a prolapsed uterus or bladder. It can be combined with removal of the fallopian tubes and ovaries, which are also removed through the vagina.
Laparoscopic hysterectomy is a relatively new procedure with notable benefits. In this procedure, three to four tiny incisions are made in the abdominal wall. A telescopic device with an attached camera produces visual images that the surgeon sees on a television screen. The uterus is removed by opening the vagina.
The benefits of undergoing a laparoscopic hysterectomy versus a traditional abdominal hysterectomy are great, and include: less pain; faster recovery; decreased risk of infection; shorter hospital stays; and a decreased risk in hernia and scar tissue formation.
Laparoscopic procedures are available for a total hysterectomy or a supracervical hysterectomy, is technically more complex, and requires special training by the physician.
In any of these hysterectomy procedures, if the ovaries are removed, you will enter menopause if you have not already done so. Therefore, you might experience the symptoms associated with menopause such as hot flashes, insomnia, vaginal dryness, irritability or depression. This may be helped with estrogen replacement therapy.
Finally, it is important to note a hysterectomy is always an elective procedure, and is rarely done as an emergency procedure. So thoroughly discuss your options with your doctor. Ask your doctor if he or she performs laparoscopic hysterectomies routinely, and if not, consider other providers. Deciding which kind of hysterectomy procedure to have is an important one, and one with which you need to be comfortable.
