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Sub-Total abdominal hysterectomy

Insurance code: Q0750

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 Sub-total abdominal hysterectomy is carried out to remove the uterus. In the subtotal procedure the cervix is retained rather than removed. The operation is otherwise similar to a standard abdominal hysterectomy. 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 I 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 day of discharge from hospital.

Potential complications Potential complications include bleeding at the time of surgery or bleeding during the post-operative period. This is evident by falling blood pressure and a high pulse rate so the nursing staff will monitor these vital signs closely during the post-operative period. Antibiotics are given at the time of surgery but high temperatures and malaise during the recovery are signs of infection. Thrombosis or DVT’s are common following pelvic surgery so stockings are fitted and heparin injections are given to thin the blood. Damage to structures such as the bladder or ureters are uncommon but important complications which would require repair work if recognised.

Post-operative consultation
It is good practice to meet about six weeks after the date of the operation to check both the abdominal and vaginal incisions. It usually takes about six weeks for energy levels to recover and for bowel and bladder function to return to normal. The pathology results on the uterus and cervix will be reviewed and further cervical smears will probably not be required. Employment ‘sick’ notes can be given. A final letter will be written to the GP.

Other websites to review:

General comments on heavy periods, fibroids and hysterectomy

Information on hysterectomy and sub-total hysterectomy