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Operations: Hysterectomy and removal of uterine adnexae for ovarian malignancy.

Insurance code: Q0880

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: This operation is used to remove the uterus, ovaries, fallopian tubes and any other structures directly involved with ovarian malignancy to try and obtain a surgical cure, to accurately stage the condition or to remove as much diseased tissue as possible to help chemotherapy work effectively.

Description of procedure: The operation is similar to a standard hysterectomy as below but the operation is normally carried out through a long mid-line abdominal incision to provide excellent access. The omentum which is a large fat pad in the upper abdominal cavity is removed as part of the staging procedure. Part of the bowel is sometimes removed if it is directly involved in the main tumour mass. A typical standard hysterectomy involves the following: A catheter is placed in the bladder to drain off all the urine and protect the bladder from surgical damage. The uterus and ovaries are 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 stapled with fine metal clips which are removed on the sixth post-operative day.

Anaesthetic These operations are usually carried out under general anaesthetic.

Length of stay A five night stay is typical although an extra night is sometimes require..

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
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 six week post-operative consultation is usually made. When the pathology results are back a consultation is also made with Dr Marcia Hall (oncologist) or her team to discuss the results and start considering whether any additional chemotherapy is sensible or necessary.

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.

Relevant websites:


Information on ovarian cancer