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Operation: Total abdominal hysterectomy

Insurance code: Q0740

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation Abdominal hysterectomy is carried out to remove the uterus. This operation is still sometimes carried out as a final solution for heavy periods or pelvic pain and is also carried out to remove a large fibroid uterus for relief of pressure symptoms and to try and cure endometrial, cervical or ovarian cancer.

Description of procedure
A catheter is placed in the bladder to drain off all the urine and protect the bladder from surgical damage. The abdominal cavity is opened through a transverse supra-pubic (bikini line) or midline vertical abdominal incision. The uterus is removed with a series of stitches to secure the blood vessels which supply the uterus. Once the uterus is safely removed the abdominal cavity is closed with strong stitches and the skin stitched with fine stitches which are left in place to be removed five days later.

Anaesthetic These operations are usually carried out under general anaesthetic.

Length of stay A ‘bikini’ line incision normally allows for a four night stay and a vertical midline incision normally requires a five night stay.

Post-operative management The catheter is normally removed the following day. The IV fluid line is left in place until oral fluids are tolerated. The painkilling pump is kept in place until it is no longer required. Stitches or skin staples are normally removed the days of discharge from hospital.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as bladder and bowel. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Infection in the vaginal skin is common because of proximity to the bowel and anti-biotics are given at the time of surgery to reduce risk of infection. If offensive discharge, increasing pain or unusual bleeding are noted during the post-operative phase a course of anti-biotics may be necessary.

Post-operative consultation
A routine appointment is normally booked for six weeks to ensure the vagina is well healed although other appointments may be necessary to ensure the post-operative course goes smoothly.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This may take up to nine weeks. Heavy lifting is best avoided for three months to prevent stitches giving way but light lifting is not a problem. Driving short distances is practical once comfortable and strong sedative pain killers are no longer being taken.

Other websites to review:

Information about endometrial ablation

Some information about heavy periods, fibroids and hysterectomy

Some information about hysterectomy