Hysterectomy, total, partial or radical. Consequences and convalescence

When this intervention may prove necessary

Hysterectomy is usually used in the presence of certain female health problems such as, for example, when you are in the presence of,

• fibroids of the uterus (one of the most common reasons for hysterectomy);
• endometriosis (an abnormal accumulation of endometrial cells outside the uterus);
• pelvic support problems (such as uterine prolapse);
• abnormal uterine bleeding;
• chronic pelvic pain;
• gynecological cancer (a neoplasm that mainly affects the uterus).

In some cases, before performing a hysterectomy, you can try to use specific medicines or even try to get pregnant.

In fact, some women prefer to wait to have a hysterectomy only after they have “enlarged” their family.

Types of bottleneck intervention

There are different types of interventions for the removal of the uterus. The main distinction is between,

• A total hysterectomy: the entire uterus, including the cervix, is removed.
• a subtotal (partial) hysterectomy: the upper part of the uterus is removed, but the cervix remains intact; This type of hysterectomy can only be performed by laparoscopy.
• a radical hysterectomy: this type of total hysterectomy also includes the removal of surrounding structures; It is usually recommended when you suspect or are facing a diagnosis of cancer.

How it is performed

Hysterectomy can be done in several ways:

through the vagina

• The uterus is removed through the vagina, so no abdominal incision is made.
• However, this type of hysterectomy cannot be performed on all women. For example, those who have adhesions due to a previous operation, or who have a particularly large uterus, cannot undergo this type of surgery.
• Vaginal hysterectomy generally causes fewer complications than laparoscopic or abdominal hysterectomy.
• The healing time should be shorter, with a faster return of the patient to the activities of daily living.
• Whenever possible, this is always advisable as the first option.

through the abdomen

• The uterus is removed through an incision made in the lower part of the abdomen: in this way the surgeon will have a clear view of the pelvic organs.
• Abdominal hysterectomy can also be performed if adhesions are present, or when the uterus is large.
• However, this type of hysterectomy is associated with an increased risk of developing complications, such as an infection of the wound, bleeding, blood clots, tissue or nerve damage.
• Usually, it requires hospitalization and a longer healing time.

by laparoscopy

• It only needs the execution of some small incisions (about one centimeter) in the abdomen.
• A laparoscope is then inserted into one of the incisions, so that the surgeon can observe the pelvic organs.
• The surgeon then uses special instruments, inserted through another incision, for the actual removal of the organ.
• The uterus can then be removed by dividing it into smaller parts, and is extracted via a larger incision in the abdomen, or through the vagina (vaginal laparoscopic hysterectomy).
• This type of laparoscopy can also be assisted by a robot controlled by the surgeon, but (in general) it is not proven that this type of surgery is better than that performed manually.
• Compared to abdominal hysterectomy, laparoscopic surgery is less painful; has a lower risk of infection, and requires a shorter hospitalization time, so the patient soon returns to her normal life.
• However, laparoscopic surgery also presents risks: the operation can be particularly long, especially if performed by a robot; In addition, there is a higher risk of damage to the urinary tract and other organs.

The choice of the type of intervention depends on the reason why the patient is undergoing the operation, and other factors.

Sometimes, the surgeon makes the decision after the start of the operation in order to better assess any problems present.

In addition to the cervix and uterus, there are other organs that can be removed during a total hysterectomy: if they are abnormal – for example if they are affected by endometriosis – one or both ovaries and fallopian tubes can be removed.

These procedures are defined,

• salpingo-oophorectomy – when removing both the tubes and ovaries;
• salpingectomy – when only the fallopian tubes are removed;
• oophorectomy – when only the ovaries are removed.

The surgeon may not know until the time of surgery whether or not it will be necessary to remove the tubes and ovaries.

Women at risk of ovarian cancer or breast cancer – in order to reduce the risk – may decide to have their ovaries removed even if they are healthy. In this case we speak of selective salpingo-oophorectomy.

The consequences and possible complications

If the ovaries are removed before menopause, the patient will immediately develop signs and symptoms of end of childbearing age, and may also be at a higher risk of developing osteoporosis.

To limit the onset of these symptoms, your doctor may decide to prescribe hormone replacement therapy, while also limiting the risk of osteoporosis. Hormone therapy should be started immediately after surgery.

If the patient is particularly at risk, other osteoporosis medicines may also be prescribed.

Complications are more frequent after an abdominal hysterectomy. Some women are more likely to have complications than others: for example, if the patient has other health problems, she may be at greater risk for anesthesia-related problems.

Convalescence after surgery

It takes time to recover from a hysterectomy.

In the first few days the patient will feel pain, but it is possible to limit it thanks to pain medications.

You may need to stay in the hospital for a few days after the surgery. The length of your hospital stay will depend on the type of hysterectomy and how it was performed.

After the surgery, the woman will be asked to start walking again as soon as possible, as walking helps prevent blood clots from forming in the legs.

You may also be prescribed medication or other treatment to help prevent this.

As already mentioned, the first days after surgery are the most painful: for this reason, medications are usually administered to relieve pain.

The patient will notice bleeding and fluid from the vagina for several weeks, so after surgery it is advisable to use sanitary pads.

After most hysterectomies, constipation is common. Some women also have temporary problems with emptying their bladder after a hysterectomy.

Other effects resulting from these interventions can also be of a psychological nature: in fact, it is not uncommon for the patient to have an emotional response to the hysterectomy.

Indeed, it is possible that women feel depressed for no longer being able to bear children or – on the contrary – that they feel relieved that the previous symptoms have disappeared.

However, the patient must rest but, at the same time, must try to move as much as possible. It is important to take small walks, and every day try to lengthen the distance covered.

You should not lift heavy objects until your doctor allows you to.

It is not possible to insert anything inside the vagina during the first six weeks (eg no sexual intercourse, no tampons, etc.).

After recovery, continue to see your doctor for routine gynecological exams and general health care.

Depending on the reason for the hysterectomy, the patient may still need to perform other pelvic exams and screening.