Hysterectomy

The removal of the uterus or womb. It is recommended as a treatment for heavy bleeding, irregular bleeding, fibroids, prolapseand painful periods (endometriosis, adenomyosis). Hysterectomy is also performed in the treatment of various gynaecological cancers

There are three types of hysterectomy

  • Total Laparoscopic Hysterectomy

  • Vaginal Hysterectomy

  • Abdominal Hysterectomy

Total Laparascopic Hysterectomy

Dr Mariud has particular expertise in Total laparoscopic hysterectomy after having trained and worked in an advanced laparoscopic unit for many years.

WHAT IS TOTAL LAPARASCOPIC HYSTERECTOMY?

Total laparoscopic hysterectomy is a surgical procedure for the removal of the uterus and cervix. In this technique, the uterus is separated from its attachments to the pelvis and removed through the vagina. The ovaries and fallopian tubes can also be removed. Dr Mariud will discuss this with you

WHY IS A LAPARASCOPIC HYSTERECTOMY PERFORMED?

Dr Mariud performs 99% of hysterectomies as a Total Laparoscopic Hysterectomy procedure. Laparoscopic hysterectomy has benefits such as shorter recovery period, with faster return to usual activities, reduced postoperative pain, minimal scarring and less risk of post-operative adhesions. Few gynaecologists have the skills necessary to perform a Total laparoscopic hysterectomy. Most hysterectomies in Australia are still performed open (Open Abdominal Hysterectomy).

Please make an appointment to see me for a second opinion if you have been advised to have a Open Abdominal Hysterectomy and before you commit to having a large scar.

ARE THERE OTHER ALTERNATIVES TO THIS TREATMENT?

There are other conservative interventions which may be appropriate for your particular condition. Dr Mariud will discuss the other options with you to help you make a well informed decision regarding what is right for you.

Dr Mariud will discuss with you the role for removal of the ovaries. If the ovaries are not removed you will not experience menopausal symptoms including hot flushes and night sweats.

HOW IS A LAPARASCOPIC HYSTERECTOMY PERFORMED?

The procedure is done under general anesthesia in the operating room. A small incision is made just below your umbilicus. The abdomen is inflated with gas and a fibre-optic instrument called laparoscope is inserted to view the internal organs.

Three other small incisions are be made on your abdomen through which tiny surgical instruments are passed. Then, the uterus, cervix and tubes are removed along with or without both ovaries.

The current recommendation is to concurrently remove both tubes as this has been shown to be associated with a lower incidence of ovarian cancer. Total operating time is about 90 minutes.

WHAT CAN BE EXPECTED DURING THE RECOVERY PERIOD?

You will be in the recovery room when you wake up from anesthesia. You may feel sleepy for the next few hours. You may have pain in the shoulder or back which is because of the gas used in the procedure. It resolves within a day or two. You will start eating and drinking normally within a short period of time.

You may have some discomfort or feel tired for a few days after the procedure. Constipation is very common. You will be in hospital for two days following the procedure. Dr Mariud will ensure that your stay in hospital is as comfortable as possible.

Contact Dr Mariud if pain and nausea does not go away or is becoming worse. You should avoid strenuous activities or exercise until you recover completely. Most women will take two weeks off work and return to work at the start of the third week. Dr Mariud will review you again one week after your discharge from hospital.

You may have some vaginal discharge (old blood) for several days after the procedure. You can return to normal activity after two weeks but complete recovery may take longer. After the procedure, you will no longer be menstruating and be unable to conceive. Avoid intercourse for 6 weeks - to allow top of vagina adequate time to heal.

Many women are concerned by a possible change to sex. Many women can feel liberated now they are free of troublesome bleeding, pain with periods, discomfort from prolapse and no further need for contraception. Libido can be improved with an improvement in wellbeing.

POSSIBLE RISKS OF A LAPARASCOPIC HYSTERECTOMY?

As with any surgical procedure, there are associated risks and complications which include:

  • Problems due to the anaesthesia

  • Injury to the internal organs - 1/1000 risk of inadvertent damage to bladder, bowel or ureter

  • Bleeding

  • Infection

Any specific risks and complications will be discussed prior to the procedure.

Vaginal Hysterectomy

WHAT IS VAGINAL HYSTERECTOMY?

In this procedure, the uterus is removed through the vagina rather than through the incision in the abdomen.

What are the advantages of the vaginal hysterectomy?

Recovery following vaginal hysterectomy is fast. You may be discharged from the hospital in a day or two and you can return to your daily activities within a few weeks after the surgery.

HOW IS VAGINAL HYSTERECTOMY PERFORMED?

You may be given general or regional anaesthesia. An incision is made in the vagina and the uterus is removed through it. The incision in the vagina is then closed with absorbable stitches.

WHAT ARE THE RISKS OF VAGINAL HYSTERECTOMY?

Vaginal hysterectomy is generally safe. Complications may include infection, blood loss, blood clot usually in the leg vein or damage to the nearby organs in the abdomen and pelvic region such as urinary bladder, ureter or bowel. Obesity, diabetes and high blood pressure increase the chances of complications due to surgery.

WHAT TO EXPECT AFTER THE VAGINAL HYSTERECTOMY?

Recovery after vaginal hysterectomy is fast. Medicines are prescribed for pain and to prevent infection.

Bleeding from the vagina is normal and will last for a few weeks after the surgery. Use of sanitary pads should be preferred as tampons increase the risk of infection. You will not have periods and cannot conceive after the vaginal hysterectomy.

You will be able to do normal activities in around two weeks after the surgery, but should not lift heavy objects or have vaginal intercourse until the sixth week post operatively.

WHAT IF I COME ACROSS ANY PROBLEM DURING THE RECOVERY PERIOD?

You should seek immediate medical attention if you experience any of the below mentioned conditions:

  • Fever

  • Offensive vaginal discharge or heavy bleeding

  • Severe nausea or vomiting

  • Inability to empty your bladder or bowels

  • Severe pain

Abdominal Hysterectomy

A 10 cm incision is made in the lower abdomen. This is performed if the uterus is significantly enlarged by numerous fibroids or if there is gross pelvic pathology including adhesions.

WHAT ARE THE ADVANTAGES OF ABDOMINAL HYSTERECTOMY?

The main advantage is to the surgeon who has greater access to the pelvis. The procedure lasts about 60-90 minutes.

WHAT CAN I EXPECT FROM AN ABDOMINAL HYSTERECTOMY?

You will be in hospital for about 3 days. It will be about 4 weeks to recover at home. Most women will return to work by the start of the 5th week.

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