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
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy