Hysterectomy: Procedure, Benefits, Side Effects, Recovery

Hysterectomy is a surgical procedure involving removing a woman's uterus entirely or partially as needed. Hysterectomy can be done in different ways, including total hysterectomy, partial hysterectomy, and radical hysterectomy. This procedure is usually performed for women who have completed their family.

Anatomy and Physiology of Uterus

The uterus is a female reproductive organ located in the lower abdomen, between the bladder and the rectum. It is a pear-shaped, muscular organ with thick walls and is responsible for hosting a developing fetus during pregnancy.

The upper part of the uterus, called the fundus, is connected to the fallopian tubes, while the lower part, called the cervix, extends into the vagina.

The walls of the uterus consist of three layers:

1. The innermost layer is the endometrium, which is shed during menstruation and is where a fertilized egg implants and develops into a fetus.
2. The middle layer is the myometrium, made up of smooth muscle and responsible for the uterus contractions during labour.
3. The outermost layer is the perimetrium, a thin layer of connective tissue covering the uterus's surface.

A gynaecologist may advise having a  hysterectomy if a woman is experiencing one or more of the following symptoms:

1. Heavy or painful vaginal bleeding even after menopause (medically termed dysfunctional uterine bleeding).     
2. Fibroid: non-cancerous and benign tumours present in the uterus.
3. Endometriosis leading to severe abdominal pain.     
4. A shift of the uterus from its normal position or causing prolapse.
5. Chronic pelvic pain (persistent pain in the lower belly).
6. Any cancers of the uterus or surrounding organs.

Hysterectomy is performed through various methods, depending on the patient's condition and other factors. The most common methods include:

1. Abdominal Hysterectomy: In this method, the surgeon makes a large incision in the lower abdomen to remove the uterus.
2. Vaginal Hysterectomy: In this method, the surgeon removes the uterus through the vagina, without making any incisions in the abdomen.
3. Laparoscopic Hysterectomy: In this method, the surgeon makes a few small incisions in the abdomen and inserts a laparoscope (a thin, lighted tube with a camera) and other instruments to remove the uterus.
4. Robotic Hysterectomy: This method is similar to laparoscopic hysterectomy, but the surgeon uses a robotic system to control the instruments.

The method chosen will depend on various factors, including the patient's medical history, the size of the uterus, the reason for the surgery, and the surgeon's expertise. Each method has its own benefits and risks, and patients should discuss the options with their doctor to determine which method is best for them.

Hysterectomy is a major surgical procedure that involves the removal of the uterus.

Before the Hysterectomy

Before the procedure, the doctor will perform a physical exam, review the medical history and perform some tests, including blood tests, a pelvic exam, and imaging tests, such as ultrasound or MRI.

On the day of the Hysterectomy

On the day of the surgery,

1. The patient will be asked to arrive at the hospital or clinic several hours before the procedure.
2. The healthcare provider will ask the patient to sign the consent form.
3. The patient will be asked to change their clothes and wear the hospital gown as provided.
4. The patient will need to fast for a certain period before the surgery and may be given medication to help relax.
5. General anaesthesia will be administered before the surgery so the patient won’t feel any pain during the procedure.
6. Vitals will be monitored.
7. The patient will then be shifted to the operation theatre.

After the hysterectomy, doctors advise staying in the hospital for up to seven days. Even after discharge from the hospital, it will take six to eight weeks for you to recover completely. The time required for the patient to return to their routine will also depend on the type of hysterectomy done.

The recovery process in the hospital

Any patient who has a hysterectomy undergoes surgical menopause right after it. It is common to experience menopausal symptoms like mood swings, vaginal dryness, or hot flashes post-surgery. In some cases where the ovaries were not removed, you may experience mild bleeding, and menopause will occur within five years.

1. After the surgery, the patient will be taken to a recovery room where she will be closely monitored.
2. The doctor might prescribe hormones that the body cannot produce post-surgery.

Recovery process/expectation after hospital discharge

The patient may experience some pain, constipation, or trouble passing urine which is a temporary effect and subsides within a few days. After the patient is discharged, ensure that she follows these precautions:

1. Rest for a longer time so that your body can recover
2. Avoid lifting any heavy objects till the surgeon gives you a green signal

First follow-up appointment

1. The first follow-up appointment after a hysterectomy usually occurs about 4-6 weeks after the surgery.
2. During this appointment, the healthcare provider will assess the patient's healing and recovery progress.
3. They will examine the incision site, check for any signs of infection or complications, and ensure that the patient is healing properly.
4. The healthcare provider will also discuss any restrictions on physical activity, such as lifting heavy objects or engaging in strenuous exercise, and provide instructions on gradually resuming normal activities.
5. They may also discuss hormone replacement therapy if the patient had their ovaries removed during the hysterectomy.

Hysterectomy is a safe procedure and has the following benefits.

1. Stopping abnormal, heavy bleeding.
2. Relieving chronic pain.
3. Restoring pain-free sex.
4. Preventing cancer.
5. Removing cancerous tissue.
6. Improving quality of life.

Hysterectomy is a surgical procedure to remove a woman's uterus. As with any surgery, there are potential risks and complications that may occur. Some of these risks include:

1. Infection: Infection is a common risk with any surgery, and it can occur after a hysterectomy. Symptoms of infection include fever, redness, and tenderness at the incision site.
2. Bleeding: Some bleeding is normal after a hysterectomy, but excessive bleeding can occur in some cases and may require a blood transfusion.
3. Blood clots: Blood clots can form in the legs or lungs after a hysterectomy, which can be life-threatening in severe cases.
4. Damage to nearby organs: During a hysterectomy, there is a risk of damage to nearby organs, such as the bladder or rectum.
5. Urinary incontinence: Hysterectomy can increase the risk of urinary incontinence, involuntary leakage of urine.
6. Sexual dysfunction: Hysterectomy may affect sexual function, including reduced libido, vaginal dryness, and painful intercourse.

When is consultation with the doctor needed?

Consultation with the doctor after hysterectomy may be needed if the patient experiences any of the following symptoms:

1. Heavy bleeding or vaginal discharge
2. Severe pain in the abdominal area
3. Fever or chills
4. Nausea or vomiting
5. Difficulty urinating or pain while urinating
6. Swelling or redness in the incision area
7. Persistent cough or shortness of breath
8. Signs of infection, such as increased redness, warmth, or tenderness in the incision area.

The risks of delaying a hysterectomy can vary depending on the underlying condition that necessitates the surgery.

If a woman has been diagnosed with cancer and needs a hysterectomy, delaying the procedure could allow cancer to progress and spread to other body parts. This can lead to a more advanced cancer stage, which may require more extensive treatment and have a worse prognosis.

In cases where a woman has uterine fibroids, delaying a hysterectomy could result in the fibroids growing larger and causing more severe symptoms, such as heavy bleeding and pelvic pain. The fibroids may sometimes grow outside the uterus and cause other complications.

The cost of hysterectomy surgery ranges from ₹55,000 to ₹1,30,000. The cost varies based on the following factors:

1. Technique and equipment used
2. Age of the patient
3. Other medical conditions that the patient may have
4. The type of hospital facility availed - individual room or shared