Hysterectomy at Exeter Hospital

Why might you need a hysterectomy?

A hysterectomy is an operation that can treat several gynaecological conditions (conditions that affect your reproductive system).

Hysterectomies are performed for a variety of reasons, including treating cancer of the uterus, ovaries, cervix, vagina or fallopian tubes, endometriosis, adenomyosis, excessive bleeding which doesn't respond to hormone therapy, severe persistent pelvic pain, prolapsed uterus, fibroids, or relaxation of the uterus.

There is more than one method of removing the uterus, and in some cases, it may be possible to carry out the surgery without leaving a visible scar.

Main types of hysterectomy

Total Hysterectomy

Both the body (uterus) and the neck of the womb (cervix) are removed.

Subtotal Hysterectomy

Only the body of the womb (uterus) is removed and not the cervix. If a subtotal hysterectomy is performed, it is recommended that cervical smears are done regularly. If the result of the smear test is normal, it should be repeated every three years till the age of 50 and every 5 years till the age of 64 years.

Radical Hysterectomy

The womb (uterus), the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue are removed.

Removal of the ovaries and the fallopian tubes along with the womb is called a hysterectomy with bilateral salpingo-oophorectomy.

Hysterectomy and bilateral salpingo-oophorectomy

The ovaries and the fallopian tubes along with the womb (uterus) are removed.

What happens during hysterectomy surgery?

A hysterectomy involves the surgical removal of a woman's uterus. Sometimes, the fallopian tubes and ovaries are removed at the same time. There are several procedures available. Your consultant will advise you on the right procedure for you.

Vaginal hysterectomy

• Your surgeon may recommend a vaginal hysterectomy if your uterus and cervix are being removed
• A vaginal hysterectomy is usually performed using general anaesthetic (you'll be asleep) and takes about one hour
• Your surgeon will access your uterus through a hole in the wall of your vagina
• Your uterus and cervix will be pulled forward and using special instruments they will remove your uterus and the ligaments that hold it in place along with your cervix
• The wound will be closed using dissolvable stitches
• You may have a gauze dressing in your vagina to help control any bleeding
• You may have a catheter (a tube to help you pass urine from your bladder) in place - this is usually removed the day after your surgery

Abdominal hysterectomy

• An abdominal hysterectomy is usually performed using general anaesthetic (you'll be asleep)
• The length of your surgery will depend on why you are having your hysterectomy
• Your surgeon will make an incision (cut) in your abdomen (stomach)
• The incision may be horizontal along your bikini line or vertical from your navel (belly button) to your bikini line
• They will remove your uterus and any other reproductive organs that may be causing symptoms
• Your wound will be closed using stitches or staples
• There may be a drainage tube in your wound that will be removed before you leave the hospital
• Dressings may be used to cover and protect your wound
• You may also have a catheter (a tube that drains urine from your bladder) in place that will be removed the day after surgery

Laparoscopic (keyhole) hysterectomy

• A laparoscopic hysterectomy is usually performed under general anaesthetic and takes from 60 - 90 minutes
• Your surgeon will make several small incisions (cuts) in your abdomen (stomach)
• So your surgeon has room to work, your abdomen will be inflated with carbon dioxide gas
• Surgical instruments and a long, thin tube connected to a light and camera will be inserted into the incisions in your abdomen
• Your surgeon will also make a small incision around your cervix and use instruments to remove your womb and cervix through your vagina
• Your wounds will be closed with stitches or staples

How long does it take to recover from a hysterectomy?

• Most women make a good recovery from a hysterectomy in 6 - 8 weeks
• Your length of stay in hospital and recovery time will depend on your own situation and the type of hysterectomy you have
• You may need to stay in hospital for a few nights
• We will encourage you to get out of bed and take short walks as soon as possible following your surgery
• You will be given pain relief medication but be sure to let us know if you are still experiencing any discomfort
• Once we discharge you, somebody will need to take you home
• You may be sore and suffer some bruising, which is perfectly normal
• Wait until you have fully healed before having sex
• You should rest and limit your activity. Avoid strenuous activity and any heavy lifting
• Take any pain relief medications as prescribed
• Move around at home a few times a day to avoid the formation of blood clots
• Be sure and discuss any return to work with your consultant

Are there any risks?

Complications are rare but possible. Rest assured that your consultant will weigh up the risks and advantages with you when deciding if they recommend surgery. Your consultant will also discuss any additional risks that apply to your situation at your initial consultation.

You could experience:

• heavy bleeding
• a wound or urine infection
• damage to some of the blood vessels or organs in your abdomen – including your bowel, bladder and ureters

Making the right decision

Hysterectomy is a major operation and it's important you understand the effects it will have on your body. In many cases, a hysterectomy has life-changing effects on your body.

What happens to your body after a hysterectomy?

• After a hysterectomy, you won’t be able to have children
• If you have your ovaries taken out as well as your womb, you’ll start to go through menopause immediately
• A hysterectomy may cause the feeling of a loss of femininity, so it's important to understand the emotional changes you might experience