A hysterectomy is an operation to remove your womb (uterus) and may also involve removing one or both of the fallopian tubes and one or both of the ovaries, depending on the reason why the operation is being carried out.
The following are the three most common reasons for having a hysterectomy:
- Uterine prolapse - where the uterine support becomes weak, causing the womb to drop down into the vagina
- Heavy periods not controlled by other treatments and often when a cause cannot be found - dysfunctional uterine bleeding
- Fibroids - where the muscle of the womb becomes overgrown
- There are also some less common reasons and your gynaecologist will discuss with you why they have recommended a hysterectomy.
A laparoscopic hysterectomy is performed under general anaesthetic and although sometimes a spinal anaesthetic may be used.
Your gynaecologist will make a small cut near your umbilicus so an instrument which inflates your abdominal cavity with gas can be inserted. Several small cuts will be made around your abdomen to insert surgical instrument and a flexible telescope.
Instruments will be inserted through your vagina separate your womb, fallopian tubes and ovaries (if they need to) from their supporting structures. The operation will be completed either by removing your womb and cervix through the small cuts or a cut may be needed around the cervix at the top of the vagina. Your cut will then be closed with stitches and the support ligaments of your womb will usually be stitched to the top of your vagina to reduce the risk of a future prolapse.
A vaginal hysterectomy is performed under general anaesthetic and normally requires a hospital stay of two to four days.
Your gynaecologist will make a cut around the cervix at the top of your vagina so your womb and cervix can be removed. Your gynaecologist will firstly separate your womb and remove it through your vagina using special instruments. They can then remove your ovaries through the same cut at the top of your vagina, although this is not always possible. Your cut will then be closed with stitches and the support ligaments of your womb will usually be stitched to the top of your vagina to reduce the risk of a future prolapse.
You will be given fluids through a drip for the first 24 hours after your operation and you will probably feel some pain and discomfort which will be treated with painkillers.
The drip and catheter (if one is fitted) will usually be removed the next day and you will start drinking and eating. You should expect a slight discharge or bleeding from your vagina and you will be recommended exercises to get you back to normal as soon as possible.
You will usually be released from hospital one to three days after the procedure.
For the first two weeks at home you should rest and continue to do the exercises that you were shown in hospital. You can usually go back to work after six to twelve weeks and after three months you should be feeling more or less back to normal.
A laparoscopic hysterectomy is a routinely performed operation but nevertheless carries some small risks.
- Pelvic infection or abscess - less than 1%
- Damage to internal organs - the bladder, ureters, bowel and blood vessels lie close to the womb and may be damaged during the operation - risk less than 2%
- Conversion to abdominal hysterectomy - This involves a cut in the abdomen which may be necessary if the vaginal approach is difficult to perform
- Developing a haematoma - Normally small collections of blood inside the abdomen which can be treated with antibiotics