About abdominal hysterectomy
A hysterectomy is a treatment option for a number of conditions including:
- heavy and/or very painful periods
- endometriosis - a condition in which the lining of the womb grows somewhere else inside the abdomen, such as on the ovaries, behind the womb or on the bowels or bladder
- fibroids - non-cancerous growths of the womb
- prolapse - where the womb drops into the vagina
- cancer of the womb, cervix (neck of the womb) or ovaries
After a hysterectomy you won't have any more periods or be able to become pregnant
What is an abdominal hysterectomy?
This is an operation to remove the womb through an incision in your abdomen while you are under a general anaesthetic. Usually the cervix (neck of the womb) is also removed during this procedure. If it is left then this is called a sub total hysterectomy. We’ll also discuss whether your ovaries should also be removed during the operation. This is called an oophorectomy.
What are the alternatives to a hysterectomy?
The operation is usually only recommended when other treatments are considered unsuitable or haven't been effective. There may be medicines you can try or alternative types of surgery. Your doctor or surgeon should have already discussed these options with you and offered them to you before recommending surgery.
Preparing for your operation
You will be invited to a pre-operation talk, this will enable you to find out about your stay in hospital and what to expect after your operation.
Your surgeon and anaesthetist will usually visit you before the operation. This is a good time to ask any questions. If you have any particular concerns, write them down so that you don't forget them or contact your doctor about them before going into hospital. Your surgeon will ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and give your permission for it to go ahead.
Your nurse will prepare you for theatre. You will be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
What happens during an abdominal hysterectomy
The operation usually takes about an hour. Once the anaesthetic has taken effect, your surgeon will make a cut across your lower abdomen just below your bikini line. If you have large fibroids in your womb, your surgeon may need to make a cut from your belly button down to your bikini line instead. If this is likely to happen, your surgeon should discuss this with you before the operation.
Your womb will be taken out through the cut in your abdomen. Stitches (which may be dissolvable) will be used to close the cut on your abdomen and the area will be covered with a dressing.
What to expect afterwards
You will have a catheter (a thin tube) to drain urine from your bladder into a bag for around 24 hours. In-addition you may have a fine plastic tube (also known as a drain) may be left in your abdomen for up to 48 hours afterwards. This will allow any blood and fluids to drain into a bag and reduces the risk of infection. The catheter and drain tubes will be removed as your recovery progresses and you become more mobile.
You will be given pain relief to help with any discomfort as the anaesthetic wears off. You may be offered patient controlled analgesia (PCA). This is a pump connected to a drip in your arm that allows you to control how much pain medicine you receive.
Your nurse will give you advice about getting out of bed, bathing and your diet. You may be able to see a physiotherapist who can explain some exercises that you can do to help speed up your recovery. You will usually be in hospital for 2-4 days.
The clips or stitches will usually be taken out once you are home by your practice nurse between day 5 and 10. The nurse will give you advice on caring for your wound once you are home.
Recovering from an abdominal hysterectomy
Your total recovery time will depend on your body but its generally between 6-8 weeks. If you need a sick note for work we can give you one for 6 weeks when you are discharged. Your own GP will give you a note after this if you are still not fit for work. If you have any problems at all after you have gone home you can call the hospital ward nurse for advice or seek help from your GP. You are advised not to drive for 4-6 weeks.
What risks or complications can occur?
Abdominal hysterectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. During the operation your safety is our top priority but every procedure has its own risks and potential complications. Below is a list of those most relevant to abdominal hysterectomies:
- Complications of anaesthesia
Problems associated with an anaesthetic. Your anaesthetist will discuss these with you prior to your operation.
This occurs with every operation but you will be given medication to control the pain both in hospital and to take home with you. Immediately after your operation the pain will be controlled by strong painkillers, which are gradually reduced as you recover.
There will be bleeding during the procedure. It is rare for major bleeding to occur and require a blood transfusion. This risk is 3 in 200 patients.
There may be small amount of bleeding from the wound site, and vaginal bleeding is normal due to the wound up inside the vagina. Tampons should not be used.
- Damage to other internal organs
Other organs such as the bladder, ureters or bowel may be damaged during the procedure because they are all close to the womb. If any damage occurs this will usually be repaired at the time and will rarely cause any long term problems. A bladder or ureter injury will occur in 3 out of every 400 hysterectomies performed. The risk of bowel injury is less at 4 in 10,000 cases. A repair of the bowel requires additional treatment and a longer recovery time is usually needed.
This can occur with any operation and can usually be treated with antibiotics. An infection can develop within the pelvis or at the wound site. The risk of postoperative infection is 2 in 100. As a precaution we give all patients having a hysterectomy one dose of antibiotics prior to theatre.
Blood clots (thrombosis) in the legs can occur due to not moving while in theatre or after your operation. Sometimes these clots can move through the blood stream to the lungs (embolus) causing difficulty breathing. The risk of a clot forming is 4 in 1000.
To prevent clots occurring you will be given special stockings to wear during your hospital stay and for 6 weeks after. These stockings will improve the circulation. You will also be encouraged to get out of bed the day following your operation. An injection is given to thin the blood and stop it from clotting – your doctor will decide if this is necessary.
You will need to tell us if you have had blood clots before or have clotting problems. A blood clot in your legs or lungs is a serious problem and will need hospital treatment and blood thinning drugs.
If your wound doesn’t heal properly we may need to insert some stitches. This may happen in approximately 6 per 1000 operations and may involve another anaesthetic. Some people have skin which scars badly and this cannot be avoided.
There is no conclusive evidence that having a hysterectomy will induce an early menopause. If both ovaries are removed at the same time then menopause will occur. Some women may experience problems, which are usually, but not always short-lived.
All operations carry some risk of death (approximately 1 in 4000). This risk will depend upon your general health and will be discussed by your doctor.