Hysterectomy is an operation to remove a woman’s uterus.   A woman may consider having a hysterectomy for a number of reasons but the operation is usually only performed when other treatments are unsuitable or have been tried without success.  It is one of the most common operations performed in Australia, and hysterectomy may be necessary if you have:

• Uterine prolapse
• Fibroids
• Endometriosis not cured by medicine or surgery
• Cancer
• Severe vaginal bleeding that persists despite other treatments
• Chronic pelvic pain. Surgery can be a last resort

There are different types of hysterectomy and these include:

• Subtotal hysterectomy – This removes the uterus but the cervix remains.  This is not common.
• Total hysterectomy – This involves removing both the uterus and cervix.
• Hysterectomy with salpingectomy – This involves removal of one or both fallopian tubes.
• Hysterectomy with oophorectomy – This involves removal of one or both ovaries.

The uterus itself does not produce female hormones and therefore its removal should not change the level of female hormones in the blood.  However if the ovaries are removed at the same time and you are not already menopausal, this will bring on menopause.  Therefore if you are younger than the age of menopause you may need to be counselled about hormone replacement therapy.

A hysterectomy may be performed in several different ways including abdominal, vaginal and laparoscopic.  Most hysterectomies performed by Dr Marshall nowadays are laparoscopic (keyhole) or vaginal and therefore recovery is much quicker, with patients often going home within a couple of days, and return to normal activities after a couple of weeks.  Dr Marshall will discuss the most suitable operation for your condition based on your medical history, diagnosis, previous treatment and the extent of disease.

• Abdominal hysterectomy – This is performed through a horizontal “bikini-line” incision of about 10 cm in length.  Very rarely a vertical cut from the umbilicus to the bikini line might be necessary.  This might be necessary if there are huge fibroids, huge ovarian cysts or extensive disease. 
• Vaginal hysterectomy – The operation is performed through the vagina and therefore there are no cuts in the abdomen.  In a lot of cases hysterectomy can be performed vaginally especially if there is prolapse.  Recovery is quicker than abdominal or laparoscopic hysterectomy.  Sometimes vaginal hysterectomy will be performed with the assistance of laparoscopy, especially if there is pelvic disease that needs to be treated laparoscopically.
• Laparoscopic hysterectomy – Hysterectomy can also be performed using a laparoscope and the surgeon views the operation on a TV monitor.  It usually involves 3 or 4 small keyhole incisions through which the surgical instruments are passed.  The uterus is detached from the surrounding tissues and the blood vessels sealed and then it is removed through the top of the vagina.  The advantages of laparoscopic hysterectomy over abdominal hysterectomy include smaller incisions and less discomfort, as well as shorter hospital stay and a quicker return to normal activities. 

Possible Complications of Hysterectomy

Hysterectomy is major surgery with well-established risks.  The good news is that complications are far less frequent nowadays compared to years ago.  The complication rates differ for different routes of hysterectomy.  The possible risks of hysterectomy include:

• Haemorrhage
• Injury to organs near the uterus – bowel, bladder, ureter
• Conversion to open surgery
• Pulmonary embolus
• Anaesthetic problems
• Infection – wound, bladder, pelvic
• Haematoma (bruise)

To some extent these risks can be reduced by use of preventive antibiotics and anticoagulants (drugs used to “thin” the blood).  Complication rates are significantly reduced with a gynaecologist who has extensive experience and operates regularly.