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is the surgical removal of the uterus .
types of hystrectomy
• Total hysterectomy : Complete removal of the uterus and cervix.
• Subtotal hysterectomy : removal of the uterus, leaving the cervix in situ.
• Radical hysterectomy : complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are also usually removed in this situation.
Indications for hystrectomy
• Certain types of reproductive system cancers (uterine, cervical, ovarian, endometrium) or tumors, including uterine fibroids
• Severe and intractable endometriosis (growth of the uterine lining outside the uterine cavity) and/or adenomyosis (a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature)
• Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical haemorrhage.
• Several forms of vaginal prolapse
Techniques of hystrectomy
Hystrectomy can be done through abdominal approach , by midline or transverse incisions ,vaginal hystrecomy or laparoscopic assisted vaginal hystrectomy .
Complications and side effect
Bleeding. As with any surgery, excessive bleeding is a risk with hysterectomy. It may require transfusion of blood products or even return to the operating room if severe.
Infection. After a hysterectomy, infection can occur in the incision, the vagina, and bladder or inside the abdomen. Infection occurs in about 10% of women who undergo a hysterectomy even after receiving preventative antibiotics before the procedure. Very rarely, infections can progress to an abscess, which is collection of bacteria and pus that must be drained.
Damage to Surrounding Pelvic Organs. It is rare (1-3%) like bladder injury, it is usually easily repaired and only requires that a Foley catheter remain in place one week after surgery. Very rarely, there may be serious bowel injuries that may require a temporary colostomy.
Blood Clots. Many pelvic surgeries including hysterectomy increase the risk of getting blood clots either in the legs or in the lungs. Usually after surgery, patients are given a small dose of blood thinner or special stockings to wear on the legs to prevent this complication. Women who do get a blood clot after hysterectomy may need to be on a blood thinner for three to six months after surgery.
Earlier Menopause. Women who have a hysterectomy without the removal of their ovaries usually go through menopause about four years earlier.
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