Abdominal Hysterectomy: Procedure & Complications

Contents

In this article we will look at:

• What is abdominal hysterectomy?
• How is abdominal hysterectomy performed?
• Am I eligible for an abdominal hysterectomy?
• What risks will I face while undergoing the abdominal hysterectomy procedure?
• What are the disadvantages of abdominal hysterectomy? 
• What are the complications of abdominal hysterectomy? 
• What are the side effects of undergoing an abdominal hysterectomy?
• How will I benefit from undergoing an abdominal hysterectomy procedure?
• What are my alternatives to abdominal hysterectomy?
• What are the pre-procedure guidelines I should follow for an abdominal hysterectomy? 
• What are post-operative guidelines I need to follow after undergoing an abdominal hysterectomy procedure?
• What is the recovery period after undergoing an abdominal hysterectomy procedure? 
• Are the results of abdominal hysterectomy permanent? 
• How do I know if the abdominal hysterectomy procedure I underwent is a success? 
• More Hysterectomy Related Topics 
• In the Spotlight- Latest News on Hysterectomy
• References

You can click on any of the links above to navigate to the section of your interest.
 

What is abdominal hysterectomy?

Abdominal hysterectomy is an invasive surgical procedure in which the uterus is removed, sometimes with the cervix, ovaries, ligaments and the fallopian tubes through a horizontal incision made in the lower abdomen or the bikini line (similar to the incision for a Cesarean Section) which is 6 to 8 inches long. The opening in the abdomen gives the surgeon easy access of the pelvic organs. In some cases, however, if the uterus is too large or bulky, a vertical incision may be made, providing the surgeon a greater access to the abdominal cavity. 

Abdominal hysterectomy is performed under general anesthesia and depending on the type of hysterectomy can take from 60 minutes to 2 hours. 

How is abdominal hysterectomy performed?

The following steps are involved in the abdominal hysterectomy procedure:

1. At the outset, anesthesia is administered by an anesthetist to keep you asleep and free from pain during surgery.
   
   
2. Once the anesthesia takes effect, the surgeon makes an incision (cut) on your abdomen of about 6 to 8 inches long. The cut may be a vertical one depending on the requirement and may start below your belly button and go down, or it may be a horizontal one made across your lower abdomen, just below your belly button.
   
   
3. Depending on your particular health condition, the surgeon will decide the type of hysterectomy to perform. At times, the decision is made while the surgery is in progress, i.e., once the surgeon cuts through the fat and muscle in the abdomen and able to see what are the problems present in the different parts within. Based on the decision, it can be a:
   
   
   • Partial hysterectomy: where the surgeon removes the upper portion of the uterus leaving the cervix intact.
   • Total hysterectomy: where the surgeon removes the entire uterus along with the cervix.
   • Radical Hysterectomy: where the surgeon removes the uterus, cervix, ovaries, fallopian tubes, upper vagina, some surrounding tissue, and the pelvic lymph nodes.

4. Once the appropriate type of hysterectomy is performed, the surgeon sutures the incision and covers it with a bandage. Bandages soaked with medicines may also be placed on your vaginal area.

Am I eligible for an abdominal hysterectomy?

You are eligible for an abdominal hysterectomy if you:

• Have a larger than normal uterus
• Suffer from cancer of the ovaries and uterus
• Suffer from endometriosis
• Suffer from large uterine fibroids
• Suffer from chronic uterine infection
• Suffer from severe pain associated with menopause

Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depends on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure. 

What risks will I face while undergoing the abdominal hysterectomy procedure?

The risks of abdominal hysterectomy include:

• Blood clots
• Infection
• Excessive bleeding
• Adverse reaction to anesthesia
• Damage to your urinary tract, bladder, rectum or other pelvic structures during surgery, which may require further surgical repair
• Early onset of menopause even if the ovaries aren't removed
• Rarely, death

What are the disadvantages of abdominal hysterectomy? 

The disadvantages of abdominal hysterectomy include:

• Longer recovery period for the patient.
• Tends to lead to more pain during recovery.
• Leaves a visible scar on the abdomen. A bikini-line incision may be possible.

What are the complications of abdominal hysterectomy? 

Complications of abdominal hysterectomy include:

• Infection
• Hemorrhaging (blood loss)
• Formation of blood clots
• Adverse reactions to anesthesia
• Accidental damage to pelvic and/or abdominal organs

What are the side effects of undergoing an abdominal hysterectomy?

The side-effects of undergoing an abdominal hysterectomy may include:

• Injuries caused during surgery procedure
• Fever
• Infection
• Early onset of menopause even if the ovaries aren't removed.
• You’ll no longer have menstrual periods.
• Occasional spotting or pink discharge for up to about 6 weeks after the surgery.
• You will never be pregnant since your uterus will be removed.
• Relief from the symptoms you suffered from prior to the surgery.
• If your cervix remains in place, you're still at risk of cervical cancer, and therefore, will need regular Pap tests to screen for cervical cancer.
• Some women experience a better sex life after hysterectomy, as their painful symptoms subside after the surgery. While some others experience a drop in testosterone levels and thus possible sexual dysfunction.
• Underweight women who undergo abdominal hysterectomy are more prone to suffer from complications after the procedure.
• Overweight women who undergo abdominal hysterectomy for non-cancerous conditions face a greater risk of bleeding and infection compared to women of normal weight.
• Some women experience psychological effects after undergoing hysterectomy, such as depression, since not being able to bear children or not menstruating anymore may make them feel as if they are not a ‘whole’ or a ‘real’ woman anymore. This may also occur if the woman loses her sex drive post the surgery. Such women need to undergo counseling to counteract the feelings of depression and uncertainty.

How will I benefit from undergoing an abdominal hysterectomy procedure?

Abdominal hysterectomy:

• Provides the surgeon good visibility and easy access to the pelvic organs. The surgeon is able to quickly detect the problems present.
• Enables removal of a very large uterus or large areas of endometriosis, adenomyosis, or scar tissue (adhesions)
• Enables the surgeon to take an on-the-spot decision, based on the patient’s condition to retain or remove the cervix.
• Requires less time under anesthesia and in surgery than a laparoscopic hysterectomy.

What are my alternatives to abdominal hysterectomy?

The alternatives to abdominal hysterectomy include:

• Medical/hormonal management
• Hysteroscopy
• Laparoscopy
• Myomectomy
• Endometrial Ablation
• MRI–guided focused ultrasound (MRgFUS)
• Uterine artery embolization (UAE)
• Vaginal Hysterectomy

What are the pre-procedure guidelines I should follow for an abdominal hysterectomy? 

Preparation for an abdominal hysterectomy typically involves several steps:

• Physical examination to determine the overall health condition
• Pelvic exam
• Blood and urine tests
• Complete medical history discussion with your surgeon
• You will be advised to quit smoking, if you smoke, for at least 6 weeks prior to the surgery since smoking can cause problems during the operation and can also delay the healing process
• You will be advised to not drink and eat anything at least 12 hours prior to the procedure.
• Your doctor may prescribe an enema or a laxative to empty your bowels thoroughly before the surgery
• The doctor may prescribe some medicines prior to the surgery, which can reduce the risk of heavy bleeding during the surgery

What are post-operative guidelines I need to follow after undergoing an abdominal hysterectomy procedure?

The post-operative guidelines for abdominal hysterectomy include:

• Overnight stay at the hospital is required immediately after the hysterectomy procedure. In fact, after an abdominal hysterectomy procedure, a hospital stay from 3 to 5 days is generally required. You will be monitored for discomfort and be given medications to prevent pain and infection.
• Post the surgery you should avoid lifting heavy weights or any form of strenuous physical activity for at least the first 6 to 8 weeks.
• You need to avoid tub baths for at least 6 weeks after the surgery.
• Depending on your health condition, the doctor will advise you to abstain from sexual intercourse from 6 to 8 weeks after the surgery.
• You may need to use sanitary napkins since vaginal bleeding may occur after a hysterectomy procedure and last for a few weeks.
• After 6 weeks depending on the rate of your recovery, the doctor may advise you to return to work, perform light chores and drive short distances.
• After any surgery, constipation is a common problem due to the number of medicines and inactivity. Eating fruits and vegetables and drinking lots of fluids may help you avoid constipation. And if that is not helping the doctor may prescribe a stool softener or a laxative.

What is the recovery period after undergoing an abdominal hysterectomy procedure? 

The recovery period after an abdominal hysterectomy is 6 to 8 weeks depending on the overall health conditions.

Are the results of abdominal hysterectomy permanent? 

There is no definite answer to this question as the results of the surgery can vary from person to person. Some people may experience complete relief from their symptoms, while others may suffer from slight side-effects. It will be wise to discuss your complete medical history with the doctor and also get to know the risks involved for you personally before taking a decision to undergo the procedure. 

How do I know if the abdominal hysterectomy procedure I underwent is a success? 

Here again, the results vary from person to person. Ideally, if you are free from the earlier painful and discomforting symptoms, then quite obviously, the procedure has been a success for you. If you experience side effects after the procedure for prolonged periods, then you may need to consult with your doctor once again to understand the situation and opt for further treatments.

More Hysterectomy Related Topics 

People interested in this topic also read: 

Hysterectomy Procedures: Types, Costs, & Risks

Types of Hysterectomy

• Supracervical/Partial Hysterectomy: Procedure & Side Effects
• Total Hysterectomy Procedure: Side-effects & Recovery Time
• Radical Hysterectomy: Procedure, Side Effects, & Cost
• Hysterectomy with Bilateral Salpingo-Oophorectomy: Procedure & Side Effects

Methods/Techniques of Hysterectomy 

• Abdominal Hysterectomy: Procedure & Complications
• Vaginal Hysterectomy: Procedure & Complications
• Laparoscopy-Assisted Vaginal Hysterectomy: Meaning & Side Effects
• Laparoscopic Supracervical Hysterectomy: Procedure & Side Effects
  
  

Related Topic

Endometriosis: Symptoms, and Treatment

In the Spotlight- Latest News on Hysterectomy

 Here are some of the latest news on hysterectomy from India and around the world:

• Reports of private doctors performing hysterectomies on Indian women even when not required is disturbing
• Fibroid embolization: An alternative to hysterectomy?
• Doctor couple from Hyderabad has made ‘saving the womb’ a mission to save women from unnecessary hysterectomies
• Endometriosis: the cause, the complications and how to beat it

References

1. Higgs P, Janda M, Asher R, Gebski V, Forder P, Obermair A. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer. 2018. Available at: https://www.sciencedirect.com/science/article/pii/S0002937817328077. Accessed February 27, 2018.

2. Hanzal E. Total Abdominal Hysterectomy in Benign Conditions: Hysterectomy Techniques for the Normal-Sized and Small Uterus. 2018. Available at: https://link.springer.com/chapter/10.1007/978-3-319-22497-8_89. Accessed February 27, 2018. 

3. Blackwell R, Kirshenbaum E, Shah A, Kuo P, Gupta G, Turk T. Complications of Recognized and Unrecognized Iatrogenic Ureteral Injury at Time of Hysterectomy: A Population-Based Analysis. The Journal of Urology. 2018. Available at: http://www.jurology.com/article/S0022-5347(18)30150-2/abstract. Accessed February 27, 2018.