An abdominal hysterectomy is a surgery that involves making a cut on the skin of the abdomen in order to remove the whole uterus. The uterus is either removed alone, or together with one or both ovaries (called Oophorectomy) and Fallopian tubes (called Salpingectomy). An abdominal hysteroscopy can also be total – removal of the entire uterus, or partial – removal of the upper part of the uterus while leaving the lower part of the uterus and the cervix intact.
Common reasons for having an abdominal hysterectomy done include – large uterine fibroids, cancer or suspected cancer of the uterus, endometrium and cervix, abnormal uterine bleeding, endometriosis, adenomyosis, and uterine prolapse.
Before the surgery, some tests will be done to check your blood level, heart and kidney functions, blood group, and blood clotting function. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery. If your blood level is low, you will be placed some tablets or injections to raise the blood level, or to prevent you from having another period, so that your blood level doesn’t drop. Once everything is satisfactory, a date can be fixed.
For this surgery, you will have the choice of either being put to sleep (general anaesthesia), or being numbed from the waist down (spinal anaesthesia), as long as there are no other medical contraindications involved.
The cut on the skin is usually made on the lower abdomen; below the bikini line. The good thing about this is that the scar formed on this part of the skin is smaller and less obvious. However, a cut can also be made from the umbilicus down to the lower abdomen if the uterus is very big (for example if there are large fibroids), if there is a strong suspicion or confirmation of a cancer (to be better able to view other surrounding organs), or if the person already has a scar there from a previous surgery. The uterus is carefully detached from the ovaries and Fallopian tubes (if they aren’t also being removed), the supporting structures, and the blood vessels that supply it. In a partial hysterectomy, the lower part of the uterus and the cervix are not removed.
The procedure lasts for an average of two to three hours, and the challenges faced postoperatively include pain and abdominal discomfort.
Women who are premenopausal and have the ovaries also removed automatically become menopausal after the surgery. With a partial hysterectomy, because the cervix is left intact there is still a risk of cervical cancer, so routine cervical smears must be continued. Having a total abdominal hysterectomy alone (without the ovaries being removed) does not negatively affect sexual drive. Sometimes, there is a feeling of a sense of loss after the procedure.
You will be on admission for about four days, after which recuperation continues at home, and your next visit is scheduled for two to four weeks after discharge.