Hysterectomy is the commonest operation on women after caesarean section. However it should be performed only if nonsurgical methods do not get relief. For woman with uterine cancer, this surgery can mean survival. For a woman with severe pelvic pain and heavy irregular periods, a hysterectomy often means relief from troublesome symptoms improving the quality of life.
When is Hysterectomy Needed?
1. Cancer of cervix or body of uterus or ovary.
2. Fibroids (non-cancerous tumours of uterus) that cause persistent bleeding, anemia, pelvic pain or pressure symptoms. Very large or rapidly growing fibroids also warrant surgery.
3. Heavy periods/ menorrhagia– when bleeding during menstrual cycle lasts for longer duration or the amount of bleeding is more than usual or if one passes clots. This bleeding if not controlled by medical means require surgery.
4. Uterine prolapse – descent of uterus into the vaginal canal due to weakening of supporting tissues.
5. Endometriosis & Chronic pelvic pain – where there is good evidence that the pelvic pain is due to infection and inflammation in the uterus, tubes and ovaries.
What does surgery involve?
Hysterectomy is surgical removal of uterus. It ends menstruation and the ability to become pregnant. Depending on the reason for which this surgery is planned, it may involve removal of other organs and tissues in addition to the uterus. Ovaries are not removed at hysterectomy unless there is abnormality in them.
There are three primary modes through which this surgery can be performed. The surgery is same and complete in all the three types only the approach is different.
1. TOTAL ABDOMINAL HYSTERECTOMY – In this procedure the uterus is removed through an incision in your abdomen. Due to this incision the post operative pain is more and recovery takes upto 6 weeks. The hospital stay of the patient is 3-7 days.
2.VAGINAL HYSTERECTOMY – In this procedure the uterus is completely removed from vagina. It can be done in cases with or without prolapse. It is least painful and most comfortable for the patient. The post operative recovery is quick. The hospital stay of the patient is 1-2 days and the woman can resume her activity in 1-3 weeks. However this is not feasible in all cases.
3. LAPAROSCOPIC HYSTERECTOMY – This surgery is performed using small holes at the umbilicus through which a telescope is inserted. This gives the details of the uterus and the pathology. 2-3 more small incisions are made that aids in performing the surgery. Small holes give quick recovery and return to work. The hospital stay of the patient is 2-3 days.
4. ROBOT ASSITED HYSTERECTOMY– This is an advanced Laparoscopic surgery where you have the similar key hole incisions. However the robot or the computer assistance improves the surgeon’s precision to perform more complex surgery with small incisions thus reducing the conversion to open surgery. The blood loss is minimal and the postoperative pain is so less that most patient’s are discharged in 1 day. The patient’s can travel back to their country or city in weeks tome and join back their work in 10 days.
Are there any alternatives to hysterectomy?
Alternatives have given an opportunity to many women to choose non-surgical treatment for gynecological problems. The choice depends upon the diagnosis and the patient’s desire and expectations from the therapy.
1. Endometrial ablation– This is a conservative surgery that aims to destroy the lining of the uterus. This can be done either through a hysteroscope or by thermal method using special equipment.
2. Mirena– It is an Intrauterine system (IUS). It is like other types of Intrauterine Contraceptive Devices (IUCD’s or loop) in that it is fitted by a doctor and remains in the uterus for a period of five years. After 3 months use, the average blood loss is 85% less in every cycle. The hormone in the IUS prevents the lining of the uterus from becoming thick. This results in less blood loss in each cycle.
3.Uterine Artery Embolisation for fibroids – It is a method where the blood supply to the to the fibroids are cut off thus reducing their size.
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