In general, a hysterectomy is used to treat many female health conditions, including:
- Uterine fibroids (most commonly)
- Pelvic support problems, such as uterine prolapse
- Abnormal uterine bleeding
- Chronic pelvic pain
- Gynecologic cancer (uterine, cervical)
Although the vast majority of hysterectomies performed through a large abdominal incision, there is a trend towards either vaginal or laparoscopic-oriented procedures which are less invasive and thus, result in a shorter recovery time. Patients who have LAVH done typically have smaller fibroids they are trying to treat and a smaller uterus, who have not undergone a Caesarean section.
Patients in need of a hysterectomy who have large fibroids that would interfere with surgery or if you have a large uterus that obstructs the surgeon’s visibility around the uterus are not candidates for a laparoscopic hysterectomy.
After deciding on the type of hysterectomy you will have, you should have a pre-operative health/risk assessment. Any blood thinners such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of bleeding. If you can, quit smoking, as this will also reduce your risk of excessive bleeding. Review informed consent guidelines with your physician, including ovarian cancer risk, whether to remove the fallopian tubes (salpingectomy) or the ovaries (oophorectomy), and sexual function outcomes after surgery.
Your doctor will likely have you stop eating and drinking the night before surgery. Immediately before the procedure and before undergoing general anesthesia, prophylactic antibiotics are used to prevent infection.
Patients should expect to take pain relievers after the surgery, and use an IV and a urinary catheter. Patients are encouraged to walk to reduce the risk of blood clots in the legs. Most women who have a laparoscopic or vaginal hysterectomy return home after 3 to 4 days, and may take up to 2 weeks to return to light desk work.
During this time, vaginal bleeding is normal. However, during the first few (up to 6) weeks, patients should not use tampons or put anything into the vagina, including douching or engaging in sexual intercourse. Sanitary napkins and pads are fine. A follow-up with your physician should help you assess when it is okay to return to work and resume sexual activity.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Infection is the minor complication with the highest prevalence in hysterectomies. A proper assessment of every patient, along with complete lab work, will help to prevent postoperative complications. A postoperative course of antibiotics can reduce the risk of infection. After healing, scars are handled with special treatments to minimize their appearance.
Long term, both partial and total hysterectomy can lead to hormonal shifts similar to natural menopause, and sexual function will be changed. For women who have not yet undergone menopause, this will be more severe, and will be accompanied by complete loss of fertility. These may impact long-term quality of life and should be assessed prior to having the procedure done.
Risks of hysterectomy in particular include heavy blood loss, bladder injury, and bowel injury. Laparoscopic procedures have been shown to have similar complication rates to other methods of hysterectomy, but do take longer to perform, increasing the risk of being under general anaesthesia.
$10,000-20,000+ (depending on if cancer involved, total vs. partial)