Hysterectomy

Hysterectomy is a surgical removal of uterus, recommended in treatment of endometriosis, uterine fibroids, uterine prolapse, uterine cancer, ovarian cancer and uncontrolled vaginal bleeding. Endometriosis is a common gynaecological problem affecting women of reproductive age. It occurs when the endometrium lining the uterus start growing on surfaces of other organs in the pelvis. Endometrium may grow on ovaries, fallopian tubes, outer surface of uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum. Patients may experience painful cramps in the lower abdomen, back or in the pelvis during menstruation, heavy menstrual bleeding, painful bowel movements or urination and infertility.

Uterine fibroids are the non-cancerous growths in the uterus of women of childbearing potential. Hormone oestrogen has thought to play a role in development of fibroids. These fibroids may be small or large enough to fill the entire uterus. These fibroids may develop in various regions of uterus such as within the wall of uterus, within the inside layer of uterine wall, outside the uterus or within the outside layer of the uterine wall. These fibroids may cause irregularities in menstrual cycle, severe pain, difficult urination, abdominal cramps, constipation, miscarriages and infertility.

Uterine prolapse is the sliding or dislocation of uterus from its position in pelvic cavity into the vaginal canal. Uterus slips down from its position because of weakening of the muscles and connective tissues that hold the uterus in place. Uterine prolapse is often seen in women who had one or more vaginal births. Other risks include ageing, lack of oestrogen after menopause, chronic cough & obesity. Women may experience frequent & urgent urination, low back pain, painful intercourse, bladder infections, and vaginal bleeding.

For all these gynaecological conditions, hysterectomy may be performed but as the last treatment resort. The initial treatment includes conservative treatment options such as pain medications and hormonal preparations and only if these options remain unsuccessful then hysterectomy may be recommended. Also, hysterectomy is performed only if patient is not willing to become pregnant in future.

During hysterectomy, your surgeon may remove complete or a part of uterus, alone or with other surrounding organs such as fallopian tubes and ovaries. The three types of hysterectomies include:

• Partial hysterectomy – Upper part of the uterus is removed without removing cervix (supracervical hysterectomy)
• Complete hysterectomy – Uterus along with cervix will be removed
• Radical hysterectomy – Uterus, upper part of vagina along with the tissues on both sides of cervix will be excised. Radical hysterectomy is most commonly recommended in uterine cancer patients.

Hysterectomy may be performed through abdominal hysterectomy (abdominal incision of 5-7 inch), vaginal hysterectomy (vaginal incision), minimally invasive or laparoscopic hysterectomy through abdominal or vaginal incisions. The advanced procedure is robotic-assisted hysterectomy and this procedure is preferred in patients with uterine cancer or if patient is obese and if vaginal procedure is considered unsafe. Your surgeon will decide on the appropriate procedure depending on your medical history and the cause for the uterine hysterectomy.