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Hysterectomy

hysterectomy TO REMOVE FIBROIDS

A hysterectomy is a surgery for the removal of fibroid(s) with removal of the uterus and cervix. The surgery can be done through a traditional incision in the abdomen, a small incision in the belly button, or vaginally. A hysterectomy is not the removal of the ovaries. This is done when a women has medically problematic fibroids that can not be removed through a hysteroscopy or a myomectomy. It is done in the hospital and the most common type of anesthesia used during a hysterectomy is a general anesthesia, which will result in you going all the way to sleep.

The Benefits for having this procedure done are to have the fibroid(s) removed and the uterus, together, to fix the problems AND to prevent the fibroids from growing back. There is a 100% chance of fixing the bleeding with hysterectomy. The benefit is to achieve the goal because medicines can not fix, or have not fixed things. Sometimes surgery is a better fix than long term use of medication.

Types of Hysterectomy Surgeries

Vaginal Hysterectomy: This is a hysterectomy done all through the vagina. The advantage of vaginal surgery is less time in the hospital and quicker recovery, as compared to abdominal surgery.  Most patients need fewer pain pills, and are able to return to “normal” activity/work sooner than if they had surgery through an abdominal incision.

Laparoscopic Hysterectomy: This is a hysterectomy done through a small incision in your belly button. The advantage of laparoscopic surgery is less time in the hospital and quicker recovery, as compared to abdominal surgery.  Most patients need fewer pain pills, and are able to return to “normal” activity/work sooner than if they had surgery through an abdominal incision.

Abdominal Hysterectomy: This is a hysterectomy done through a regular incision in your abdomen, similar to a cesarean section incision. Recovery takes a little longer and may require more pain medication.

What About the Ovaries

The plan on what to do with the ovaries will be discussed before your surgery. If we find one or both of your ovaries is abnormal enough at the time of surgery we will need to remove it/them. Your age and your preference are factors in our decision to remove one or both of the ovaries. What to do with the ovaries is a separate discussion and decision from the why take out the uterus discussions.

Alternatives to Surgery

In situations like this, the alternative is to do nothing or use medicine to manage the problem if that is an option. Fibroids are not necessarily dangerous. They can be left alone if a patient prefers. We would remove the fibroids because of symptoms/problems that they may cause. There are alternative surgeries and interventions for the management of fibroid bleeding. The limitation is that only hysterectomy is a 100% cure of the bleeding. The alternative interventions for symptomatic fibroids include:

Abdominal Myomectomy: To remove the fibroid(s) only and leave behind the uterus, cervix and ovaries. This procedure will be done through a regular operation with an incision in your abdomen…[read more]

Laparoscopic Myomectomy: Some fibroids can be removed in minimally invasive surgery with only the telescope in the belly button depending on size and location…[read more]

Hysteroscopic Myomectomy: Some fibroids are mostly inside the uterine cavity, and can be removed with minimally invasive surgery done through the vagina, into the cervix, and then into the uterine cavity…[read more]

Embolization, Uterine Artery, or Uterine Fibroid: Some women want to preserve their uterus AND avoid surgery. Certain fibroids can be treated with a procedure which blocks the blood flow to the uterus and fibroids. As a result, the fibroids shrink.

Limitations

Once the uterus is removed you can no longer get pregnant. Also, hysterectomy is 100% curative of bleeding, but it may not resolve all of your pain or cramping. Fibroids almost never grow back after hysterectomy. Rarely a fibroid will grow near, but not actually on the uterus, even when the uterus is gone.

Risks

The following information is very detailed, and is simply meant to be complete. This is a VERY safe surgery. The topic is complicated. All surgery has the risk of bleeding, infection and damage to internal organs. Anything that is damaged during the procedure will be fixed either by the doctor performing the operation, or by a specialist, if necessary. This is rare. Complications can extend the time you need to stay in the hospital OR slow your recovery.

Recovery

Typical Time in Hospital: Most women go home within 2-3 days for a laparoscopic or abdominal hysterectomy and Next Day for a vaginal hysterectomy. By the time you go home you are taking pills for pain, and you can take care of yourself: eat, walk, get out of bed, shower, go up and down the stairs, and do other things necessary to go about your daily life.

Recovery at Home: Recovery is marked more by fatigue than pain. You may be tired for 4-6 weeks after the surgery. This usually means you find yourself needing a nap at 2-3 pm each day.

Back to Regular Activity/Work: Most patients are ready in 6 weeks with an abdominal hysterectomy, 4 weeks with a laparoscopic hysterectomy, and 3 weeks for a vaginal hysterectomy. Paperwork for an employer will say to return to work 6 weeks after surgery.  If you feel ready to return to work earlier I can write you a letter OR modify/re-do the paperwork.

Bladder function after surgery: Bladder function is different for everyone. Some women are NOT able to urinate on their own after this surgery. The bladder may go on strike while it is recovering from the surgery that “moved things around.” The inability to urinate is usually limited to one week. If you can not empty your bladder completely by the time it is time for discharge from the hospital you will go home with a catheter in your bladder AND a leg bag. The nurses will teach you how to care for yourself and the catheter. You will then come to the office approximately 5-7 days after surgery to have the catheter removed. We will make sure you can completely empty your bladder at that time.

Bladder function 1-2 months after surgery: You can expect an increase in the sensation of urinating after this surgery. The bladder has been “leaning” on the uterus and fibroids, for a long time and has been “pushed” into a smaller space than it would ordinarily use. When the uterus and fibroids are removed the bladder will expand into that space. When you urinate, you can expect to feel your bladder contracting to empty. This will be a new and very strange sensation. Many women feel as if they have a bladder infection; it is not an infection. It is just the new feeling of the bladder contracting during urination.