Hysterectomy—Open Surgery Overview

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Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant. The surgery may be done through the abdomen or the vagina. This is a common surgery in the United States.

This type of surgery can be:

• Partial or subtotal hysterectomy—removal of the uterus (without removing the cervix)
• Total, complete, or simple hysterectomy—removal of the uterus and cervix (the opening of the uterus leading to the vagina)
• Radical hysterectomy—removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
• Salpingo-oophorectomy —removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

Prior to Procedure

Your doctor may do the following:

• Blood and urine tests
• X-ray of abdomen and kidneys—a test that uses radiation to take a picture of structures inside the body, especially bones
• Pelvic ultrasound —a test that uses sound waves to visualize organs in the abdomen
• Dilation and curettage (D&C)—surgical removal of tissue from the lining of the uterus
• Ask you to take enemas to clean out your intestines

You should do the following:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as warfarin (Coumadin)
• clopidogrel (Plavix)
• If instructed, take antibiotics.
• Arrange for a ride home and for help at home.
• Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

Most of the time, general anesthesia is used—blocks pain and keeps you asleep through the surgery; given through an IV in your hand or arm

Description of the Procedure

There are two different methods that are described here.

Open Abdominal Hysterectomy

The doctor will make a cut in your lower abdomen. This is to expose the tissue and blood vessels that surround the uterus. The tissue will then be cut. The blood vessels will be tied off. The uterus will be removed. Next, the doctor will sew the tissue back together and close the skin with stitches or staples. If the cervix is taken out with the uterus, you will also have stitches put in the back of your vagina.

Abdominal Hysterectomy © 2009 Nucleus Medical Media, Inc.

Vaginal Hysterectomy

This method will not involve any outside incisions. The doctor will stretch the vagina and keep it open with special tools. He will then cut free the uterus and cervix. The connecting blood vessels will be tied off. Next, the doctor will remove the uterus and cervix through the vagina. Lastly, the doctor will close the area in the back of the vagina with stitches.

Vaginal Hysterectomy © 2009 Nucleus Medical Media, Inc.

With each procedure, a vaginal "packing" is placed in the vagina. This will be removed after 1-2 days.

Immediately After Procedure

If you have other medical problems, the doctor may need to remove or repair other organs or tissue.

Your doctor will send tissue samples to the lab to be analyzed. In the recovery room, you will have IV fluids and medicines.

How Long Will It Take?

1-3 hours

Will It Hurt?

You will likely have pain, fullness, bloating, and vaginal bleeding or discharge during the first few days. Your doctor will give you pain medicine.

Average Hospital Stay

• Open Abdominal hysterectomy: 3-5 days

• Vaginal hysterectomy: 1-2 days

Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

• On the first night, you may be instructed to sit up in bed and walk a short distance.
• During the next morning, the IV will probably be removed if you are eating and drinking well.
• You may need to wear special socks or boots to help prevent blood clots.
• You may have a foley catheter for a short time to help you urinate.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Follow your doctor's instructions .
• Take proper care of the incision site. This will help to prevent an infection.
• Take showers instead of baths. However, baths are allowed.
• During the first two weeks, rest and avoid lifting.
• Slowly increase your activities. Begin with light chores and short walks. Depending on your job, you may be able to return to work.
• Check with your doctor to see when it is safe to drive again.
• To promote healing, eat a diet rich in fruits and vegetables . Ask your doctor if you need to take iron .
• Try to avoid constipation by:

• Eating high-fiber foods
• Drinking plenty of water
• Using stool softeners if needed
• Ask your doctor when you can use tampons. Also ask about Kegel exercises .
• Wait six weeks before resuming sexual activity.
• If you still have a cervix, you will still need regular Pap smears .

Recovery from open abdominal hysterectomy usually takes 6-8 weeks. Recovery time will be quicker for other methods (eg, laparoscopic surgery ).

RESOURCES:

National Uterine Fibroids Foundation
http://www.nuff.org/

Women's Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed September 8, 2009.

Bren L. Alternatives to hysterectomy: new technologies, more options. US Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2001/601_tech.html . Accessed February 20, 2008.

Hysterectomy. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org . Published March 2006. Accessed September 8, 2009.

Hysterectomy: frequently asked questions. Women's Health.gov website. Available at: http://www.4woman.gov/faq/hysterectomy.htm . Updated July 2006. Accessed September 8, 2009.

Women's reproductive health: hysterectomy. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/reproductivehealth/WomensRH/Hysterectomy.htm .Updated January 2008. Accessed February 20, 2008.