VAGINAL HYSTERECTOMY

COMMON CONDITIONS REQUIRING

HYSTERECTOMY

ABNORMAL UTERINE BLEEDING

UTERINE  FIBROIDS

UTERINE  PROLAPSE

CHRONIC  BLADDER  LEAKING

PRE-CANCEROUS LESIONS OF THE UTERUS

CERVICAL CANCER

UTERINE CANCER

        What is a vaginal hysterectomy?

           A vaginal hysterectomy is performed to treat one of the above conditions
           or abnormalities of the uterus. Your uterus is removed (hysterectomy) through
           the vagina, and this helps solve the health problem. This is done through an
           incision in the vagina (a vaginal hysterectomy). At the same time, if the ovaries
           (the small glands that produce the eggs) are diseased, they can be taken out
           as well, with the Fallopian tubes (which connect the ovaries with the womb).
          This is called a salpingo-oophorectomy. Rarely, the operation cannot be safely
          finished through the vagina. This may be because the uterus is too large, or
          fixed to other organs, or bleeding occurs. It is then necessary to make an
          incision in the stomach remove it out from above.

           The Operation

          You will have a general anesthetic and will be completely asleep. An incision 
           is made in the upper part of the vagina. This will not leave any visible scar.
           The uterus is removed. If the ovaries are diseased, they will need to be
           removed as well. The top of the vagina is closed and suspended by
           special sutures placed in the surrounding tissue. All tissue is sent to
           the laboratory to be examined under the microscope. You will be in
           hospital from 1 – 3 days. If both ovaries are taken out, you may have
           menopausal problems such as hot flushes. You can stop them by taking
           hormone replacement therapy (HRT). This can be started at the time of the
           hysterectomy.

            Any Alternatives

          An alternate of hysterectomy is using keyhole surgery to free off the body
          of the uterus and cervix and bringing both out through the vagina. This
          procedure is called an LAVH – laparoscopically assisted vaginal hysterectomy.
         The hospital stay is a little longer and the recovery time is longer also, as
          noted in the table above. Rarely, the tummy has to be opened as for an
          abdominal hysterectomy. We rarely use this procedure unless bleeding,
          very large masses or cancer is present.

          Before the operation stop smoking and get your weight down if you are
          overweight.  If you know that you have problems with your blood pressure,
          your heart, or your lungs, ask your family doctor to check that these are
          under control. Check the hospital's advice about taking the Pill or hormone
          replacement therapy (HRT). Check you have a relative or friend who can
          come with you to the hospital, take you home, and look after you for the
          first week after the operation. Sort out any tablets, medicines, inhalers that
          you are using. Keep them in their original boxes and packets. Bring them
          to hospital with you.

           In the hospital, you may be checked for past illnesses and may have
           special tests, ready for the operation. Please tell the doctors and nurses
           of any allergies to tablets, medicines or dressings. You will have the
           operation explained to you and will be asked to fill in an operation
           consent form. Many hospitals now run special preadmission clinics,
           where you visit for an hour or two, a few weeks or so before the operation
           for these checks.

            After - In Hospital

           You will have a small/thin plastic tube (a drip) in an arm vein. This gives
           you salt and sugar and water, and sometimes blood, for a day or so from
           a plastic bag on a stand. You may be given oxygen from a face mask for
           a few hours if you have had chest problems in the past.  You may have
           some backache. You may be given injections or tablets by the nurses
           for the pain.

            By the end of two days you should have little pain. A general anesthetic
            will make you slow, clumsy and forgetful for about 24 hours. Do not make  
            important decisions during that time. The nurses will help you with
            everything you need until you can do things for yourself. You will have
           some blood and urine tests in the first day after your operation. These
           will check you are not anemic and have no infection in the urine.

            You may have a fine tube (catheter) in the bladder to drain it for a day
            or so after the operation. There will be slight bleeding like the end of
            a period.  Use pads. Do not use tampons for six weeks. If the bleeding
            is heavy, call the office.

            You will be able to take a bath or shower as often as you wish. Do not
            soak in the bath for more than 10 minutes. Try to keep the wound area
           dry for a week. You will be given an appointment for an Out Patient check
           up about two weeks after you leave hospital. They will have the results of
           the tests. 

            After - At Home

           At home, you are likely to feel tired and need rest two or three times a day
           for one or more weeks. You will gradually improve. After three months, you
           should be able to return completely to your usual level of activity. You can
           drive as soon as you can make an emergency stop without discomfort,
           generally after one or two weeks. You will be able to start sexual relations
           before your six-week check, if you are comfortable and have no bleeding
           or discharge. You may be able to return to a light job after about one week.  

           Possible Complications

                  As with any operation under general anesthetic there is a very small
          risk of complications related to your heart or you lungs. The tests that you
          will have before the operation will make sure that you can have the operation
          in the safest possible way and will bring the risk for such complications
          very close to zero. 

           Most hysterectomies are without complication. Minor complications happen
           in up to 2% of cases. Chest infections may arise, particularly in smokers.
           Do not smoke. Occasionally the bladder is slow to start working again.
           This requires patience. You may need the catheter back in the bladder
           for a few days. Wound infection is sometimes seen. This settles down
           with antibiotics in a week or two. Aches and twinges may be felt in the
           wound for up to six months. Sometimes there are numb patches in the
           skin around the wound which get better after two to three months.
           Sometimes scarring in the vagina makes intercourse difficult or
           uncomfortable. This usually settles down with time.

           More serious complications happen very rarely and can include
           severe bleeding or damage to your bladder, bowel and vessels and
           may require another operation to fix them.

           General Advice

            We hope these notes will help you through your operation. They are a
            general guide. They do not cover everything. Also, all hospitals and
            surgeons vary a little. If you have any queries or problems, please ask
            the doctors or nurses.

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                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
              and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal
              Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
                                                                                 Aesthetic Services