Abdominal Hysterectomy: Everything You Need to Know

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Chapters

0:00 Introduction
0:46 Why is it required?
1:33 Types of Hysterectomy
2:18 How is it performed?
3:05 Risks of Abdominal Hysterectomy



Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.

Usually performed by a gynecologist, a hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States.[1] Nearly 68 percent were performed for benign conditions such as endometriosis, irregular bleeding, and uterine fibroids.[1] It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.[2]
Hysterectomy is a major surgical procedure that has risks and benefits. It affects the hormonal balance and overall health of patients. Because of this, hysterectomy is normally recommended as a last resort after pharmaceutical or other surgical options have been exhausted to remedy certain intractable and severe uterine/reproductive system conditions. There may be other reasons for a hysterectomy to be requested. Such conditions and/or indications include, but are not limited to:[3]

Endometriosis: growth of the uterine lining outside the uterine cavity. This inappropriate tissue growth can lead to pain and bleeding.
Adenomyosis: a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature. This can thicken the uterine walls and also contribute to pain and bleeding.
Heavy menstrual bleeding: irregular or excessive menstrual bleeding for greater than a week. It can disturb regular quality of life and may be indicative of a more serious condition.
Uterine fibroids: benign growths on the uterus wall. These muscular noncancerous tumors can grow in single form or in clusters and can cause extreme pain and bleeding.
Uterine prolapse: when the uterus sags down due to weakened or stretched pelvic floor muscles potentially causing the uterus to protrude out of the vagina in more severe cases.
Reproductive system cancer prevention: especially if there is a strong family history of reproductive system cancers (especially breast cancer in conjunction with BRCA1 or BRCA2 mutation), or as part of recovery from such cancers.
Gynecologic cancer: depending on the type of hysterectomy, can aid in treatment of cancer or precancer of the endometrium, cervix, or uterus. In order to protect against or treat cancer of the ovaries, would need an oophorectomy.
Transgender (trans) male affirmation: aids in gender dysphoria, prevention of future gynecologic problems, and transition to obtaining new legal gender documentation.[4]
Severe developmental disabilities: this treatment is controversial at best. In the United States, specific cases of sterilization due to developmental disabilities have been found by state-level Supreme Courts to violate the patient's constitutional and common-law rights.[5]
Postpartum: to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical haemorrhage.[6]
Chronic pelvic pain: should try to obtain pain etiology, although may have no known cause.

Risks and adverse effects

In 1995, the short-term mortality (within 40 days of surgery) was reported at 0.38 cases per 1000 when performed for benign causes. Risks for surgical complications were presence of fibroids, younger age (vascular pelvis with higher bleeding risk and larger uterus), dysfunctional uterine bleeding and parity.[7]

The mortality rate is several times higher when performed in patients who are pregnant, have cancer or other complications.[8]

Long-term effect on all case mortality is relatively small. Women under the age of 45 years have a significantly increased long-term mortality that is believed to be caused by the hormonal side effects of hysterectomy and prophylactic oophorectomy.[9][10] This effect is not limited to pre-menopausal women; even women who have already entered menopause were shown to have experienced a decrease in long-term survivability post-oophorectomy.[11]