Hysterectomy
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Introduction

Three types of operation:

Abdominal – TAH – Total Abdominal Hysterectomy

  • This is the most common form of surgery performed in the UK

Vaginal – VH – Vaginal Hyesterectomy
Laparoscopic – LAVH – Laparoscopically assisted Vaginal Hysterectomy

  • This is becoming more popular, and allows for a shorter inpatient hospital stay after the operation
It may/may not be accompanied by oophorectomy (removal of the ovaries). Removal of the ovaries predisposes to early menopause, but even in those where the ovaries remain, there is still an increased risk of early menopause.
  • Bilateral oophorectomy (aka Surgical Menopuase) – causes an immediate menopause, which is often highly symptomatic. The risks of early menopause include cardiovascular disease and osteoporosis.

Indications

  • Uterine or adenexal (literally means appendage – in this case refers to ovaries and fallopian tubes) disease

Considerations

  • Does the woman still wish to have children?!

Complications

Peri-operative – occur in 3.5% of patients
Post-operative – occur in 9% of patients

  • Fever
    • TAH – 30%
    • VH – 15%
  • General bowel symptoms
  •  Bowel damage
    • TAH – 0.3%
    • VH – 0.6%
  • General urinary symptoms
  • Urinary Tract Damage
    • TAH – 0.3%
    • VH – 1.4%
  • Significant bleeding
    • TAH – 2.3%
    • 5% of TAH patients require blood transfusion
    • VH – 1.9%
    • LAVH – 4.2%
  • Sexual Dysfunction – around 40% of cases
    • Controversial – some studies suggest sub-total hysterectomy improves sexual outcome, whilst other suggest that hysterectomy in general has no negative sexual effects.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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