An abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen.
Hysterectomy is used to treat a number of conditions, including heavy or painful periods, fibroids and prolapse. The operation may be performed through the abdomen or the vagina.
After a hysterectomy, you'll no longer have periods or be able to get pregnant.
WHAT IS HYSTERECTOMY ?
Hysterectomy is the surgical removal of the womb (uterus), with or without the cervix. The operation may also be with or without the removal of the ovaries and the fallopian tubes.
The uterus is a muscular organ of the female body, shaped like an upside-down pear. The lining of the uterus (the endometrium) thickens and, after ovulation, is ready to receive a fertilised ovum (egg).
If the ovum is unfertilised, the lining comes away as bleeding. This is known as menstruation (period). If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy.
If a woman has a hysterectomy, she will no longer have menstrual periods or be able to have a child, and will not need to use contraception.
IN WHICH CASES HYSTERECTOMY IS PERFORMED ?
There are different reasons for this. There are various causes ranging from fibroids to cancer diseases. In addition, although the cause cannot be found, it may be possible to remove the uterus in the tables caused by severe bleeding. Generally, the most common cause of removal of the uterus worldwide is myoma. Because fibroids cannot be treated with medication under normal conditions. Therefore, it is possible to get rid of fibroids by removing the uterus. Apart from this, it can be taken together with the uterus during surgery in patients with uterine cancer or over the age of 45 who have a problem in their ovaries after the reproductive function ends.
Adenomyosis (Chocolate cyst in the uterus),
In cases showing symptoms such as low back pain, constipation problems, inability to urinate, frequent urination or urinary incontinence due to myoma or the pressure it has created.
In cases of severe bleeding or breakthrough bleeding. Severe bleeding or breakthrough bleeding may be caused by fibroids.
In cases such as uterine prolapse to protrude from the vagina, removal of the uterus may be required.
HOW IS HYSTERECTOMY
Uterine removal surgery can be performed open or closed (laparoscopically). The incisions made in closed surgery are much smaller than in open surgery. It is preferred because it is more advantageous than aesthetic surgery, but some situations are restrictive for closed surgery. Open surgery can be done in two ways. The uterus can be removed through an incision made in the abdomen, or it can be removed from the vagina. When the vaginal route is preferred, no incision is made in the abdomen. In cases such as cancer, chocolate cyst, it is preferable to remove the uterus with an incision made from the abdomen, and today, due to the development of laparoscopic methods, an operation can be performed as a door. In case of uterine prolapse, it may be preferred to remove the uterus from the vagina and, if necessary, add procedures to prevent sagging of other intra-abdominal organs.
At the same time, there are hysterectomy procedures, which are called differently according to which parts of the uterine tissue will be removed with the hysterectomy procedure or which organs other than the uterus will be included in the removal process:
• Partial hysterectomy refers to a hysterectomy procedure in which the body of the uterus is removed but the neck, fallopian tubes, and ovaries are left in place.
• Total hysterectomy, on the other hand, is the process of removing the uterus completely without interfering with other reproductive organs.
• The procedure called radical hysterectomy, on the other hand, is the term expressing the removal of the vagina tissue close to this region, supporting tissues and sometimes the fallopian tube, ovaries and lymph nodes in that region, in addition to the complete removal of the uterus.
Before the uterus removal surgery, some tests may be requested from the patient.
In addition to blood analysis, urinalysis, chest X-ray, and EKG examinations, the doctor may also request different tests depending on the patient's condition.
Patients may need an enema the night before the uterus removal surgery.
If there is no special situation regarding the patient, 8 hours of fasting is sufficient before the operation.
Hysterectomy is especially important in patients with uterine or ovarian cancer, as it contributes to survival. Complaints that occur due to the large number of fibroids formed in the uterus may also disappear after hysterectomy surgery.
Hysterectomy is considered among major surgical operations and the duration of this procedure can vary between 1-3 hours. Depending on the surgical method applied, the length of hospital stay and recovery period may also differ. The time to return to daily activities after surgery may take 3 to 6 weeks.
The most common problems after uterus removal operation are vaginal discharge and bleeding and uncomfortable feelings, especially pain at the surgical incision site. Vaginal discharge and bleeding is not as much as bleeding during menstrual periods. It may take up to 6 weeks for improvement. If there is excessive discharge or bleeding, accompanied by a strong foul odor, and blood clots form, a doctor should be consulted.
If the ovaries are removed along with the uterus, the patient may experience symptoms such as hot flashes, vaginal dryness, loss of libido (decreased sexual desire), difficulty sleeping (insomnia), anxiety and sweating, which are symptoms similar to menopause with onset. “Hormone Replacement Therapy (HRT)” can be given if menopause-like symptoms make daily life difficult. Hormone Replacement Therapy begins to show its effect after a week. In order to reduce these complaints in patients who do not want to use HRT, it should be noted that low-fat herbal diet and consumption of soybean (and its products) may reduce complaints. Exercise after the recovery period is also very useful in controlling menopausal complaints.
It is known that some antidepressant drugs can also be effective in reducing the effects of menopause complaints. There may be changes in the bowel habits of the patient after the operation. Some women may experience urinary tract infection or constipation after surgery. Both conditions are easily treatable. After the operation, the patient may leak urine. Women who have had a hysterectomy face a 60% increased risk of urinary incontinence during their lifetime compared to women who have not had surgery. This cannot always be prevented, however, pre-operative examination detects existing leaks that can be treated with surgery, and if necessary procedures are added during hysterectomy, this rate can be reduced a little more. It is repaired during surgery. In most cases, it does not cause any long-term problems.
FREQUENTLY ASKED QUESTIONS
What are the Risks of Hysterectomy?
As with any surgery, there are certain risks for hysterectomy surgery. Although surgical application gives anxiety to patients, it should be known that this surgery is the most frequently performed surgery by doctors all over the world. In other words, it is one of the fields where doctors are most experienced. The current risks are very low. infection, development of clots in the lungs or veins, bleeding, injury to nearby organs such as the urinary tract and intestine, menopause and intestinal laziness can be counted among the general risks. If the ovaries are not removed, there is no risk of menopause.
These risks are minimized by preoperative examinations, choosing the right method for the patient, the medications given to the patient before the surgery, and the experience of the physician.
How Long Does the Pain Last After Uterine Surgery?
Depending on the age of the person and the operation performed, this period may vary, but in general, simple pain and discomfort up to 3 months after hysterectomy is considered normal. After the operation, the patient is given painkillers. If the patient's pain lasts longer than 3 months and has severe pain, he should consult a doctor.
When the Uterus is Removed, is Menopause Immediately Entered?
When the uterus is removed, menopause is not immediately entered. If your ovaries were not removed simultaneously during uterine removal surgery, you will enter menopause at your normal age. Menopause occurs when the ovaries are removed.
If the uterus needs to be removed at an early age, you will not experience hot flashes, sweating or other effects of menopause unless the ovaries are removed.
What is the Anesthesia in Uterus Removal Surgery (Hysterectomy)?
Uterine removal surgery is a surgical operation performed in the operating room environment and the patient is fully asleep.
Will There be any Scars After Uterus Removal Surgery (Hysterectomy)?
The scarring in the area where the surgical procedure was performed after the uterus removal surgery is related to the healing power of the person's tissue. However, in uterine removal surgeries performed with laparoscopic, that is, closed method, scarring is less than in open surgery.
Is Weight Gained After Uterine Surgery?
In some studies, it is stated that women have an increased risk of weight gain after hysterectomy. However, there are many factors that affect this and it is not valid for every woman. It has been shown that women who are overweight before the surgery, women whose ovaries are removed along with the uterus, women who have a longer recovery period and who are not active during this period are more likely to gain weight.
Will There be Bleeding After Removal of the Uterus (Hysterectomy)?
Bleeding after uterine removal surgery is in the form of stains. Spot-like bleeding may occur in the first week after surgery. Such bleeding is considered normal and is a temporary condition.
Sexuality After Uterine Removal
If you are wondering if removing the uterus will affect sexuality, you can have peace of mind. Although it is a cause for concern, sexuality is not adversely affected after removal of the uterus.
Diseases that cause removal of the uterus can actually make sexual intercourse painful. For example, uterine prolapse not only makes sexual intercourse painful, but also causes problems such as urinary incontinence and incontinence in women. Therefore, women may begin to avoid both sexual intercourse and social involvement. Again, irregular and excessive bleeding are conditions that negatively affect sexual life. Since all these problems will disappear after uterus removal surgery, it is common for women to have positive changes in their sexual life rather than negative ones. Although rare, women who have their ovaries removed may complain of dryness during sexual intercourse. This situation can be easily solved with drugs and lubricants.
There are prejudices in women that their partners will also be affected after hysterectomy. How does removal of the uterus affect men? If you think that, the answer to this can actually be given in two ways. The first is medical facts. There is no shape change in the vaginal area of the woman whose uterus was removed. Therefore, nothing physically changes for men.
Secondly, there may be unrealistic social judgments. A woman does not lose anything from her femininity and sexual life when her uterus is removed. Contrary to this rhetoric circulating in the society, men can also affect their partners when they have this surgery. The best way to prevent this is to inform the woman and man correctly about this issue. Both parties should know that this surgery will return the sexual life, which may have been adversely affected by the disease, to its old days, rather than negatively affecting the sexual life.