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PATIENT INFORMATION GUIDE

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The doctors and staff at Apollo hospitals are pleased that you are considering us for your Abdominal Hysterectomy. We would like to take the time to briefly discuss the process of undergoing Abdominal Hysterectomy. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Abdominal Hysterectomy. This information is designed to offer additional information on your preparation before surgery, the surgery itself, and the road to recovery after your procedure.

What is Abdominal Hysterectomy?

An Abdominal Hysterectomy is a procedure in which the uterus is removed through a cut in the abdomen. The uterus is the muscular organ at the top of the vagina. Babies develop inside the uterus, and menstrual bleeding [periods] also occurs from the uterus.

There are many forms of Abdominal Hysterectomy.

  • Total Hysterectomy, where the uterus and cervix (neck of the womb) are removed
  • Subtotal Hysterectomy, where just the uterus is removed and not the cervix
  • Hysterectomy with Salpingooophorectomy where one or both or the ovaries and fallopian tubes are removed
  • Hysterectomy with Bilateral Salpingectomy where the uterus and both the fallopian tubes are removed.

What kind of Hysterectomy you are having, will depend your medical condition and your gynaecologist will have a discussion with you before surgery.

You will need an anaesthetic for an Abdominal Hysterectomy. This will be a general or a regional anaesthetic (spinal or epidural).

Hysterectomy
Uterus with ovaries and fallopian tubes

When is a Hysterectomy performed?

There are many reasons why the uterus would need to be removed. Some of the disorders that may be treated with a Hysterectomy are:

  • Constant heavy bleeding that has not been controlled by medicines or Dilatation and Curettage (D&C)
  • Endometriosis that causes pain or bleeding and does not respond to other treatments
  • Chronic pelvic pain
  • Prolapse uterus - a fallen (sagging) uterus
  • Precancerous or cancerous cells or tissue present in the uterus
  • Tumours in the uterus

Other ways in which the uterus may be removed are:

  • Vaginal Hysterectomy - Having the uterus removed through the vagina
  • Laparoscopic Hysterectomy through key hole incisions made in the abdomen
  • Robotic Hysterectomy
  • Hysteroscopy, Laparoscopy, Robotic Surgery may be used to:
    • Remove an area of endometriosis without removing the uterus
    • Remove tumours (fibroids) without removing the uterus

You should ask your doctor about these choices but you will find that your doctor would have chosen the method of Hysterectomy that is most appropriate for your medical condition. Please note that some techniques will not be the best option for your medical condition.

How do I prepare for Abdominal Hysterectomy?

  • Plan for your care and recovery after the operation, especially if you are to have general anaesthesia. Ask at work for time to rest. Try to find other people to help you with your day-to-day duties.
  • If you are taking daily aspirin for a medical condition, ask your doctor if you need to stop taking it before your surgery.
  • Be sure to tell your doctor what medicines you are taking.
  • You may be asked to undergo Pre Anaesthetic investigations such as blood tests, ECG, Chest X-ray and also be evaluated by the anaesthetic team to assess your fitness for anaesthesia.
  • Follow all pre-surgery instructions that your doctor gives you.
  • It may usually be recommended that you eat a light meal, the night before the procedure. Do not drink coffee, tea, water or any fluid after the time that the doctor asked you to stop fluids.
  • You may be given a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens after the procedure?

The IV and catheter are removed 1 or 2 days after the surgery. You may stay in the hospital about 3 to 5 days.

After you go home, get plenty of rest. Do not do any heavy lifting or otherwise strain the abdomen muscles for 4 to 6 weeks.

Follow your doctor's instructions for dealing with pain and preventing constipation.

If you were having menstrual periods before the surgery, you will no longer have them after the operation. You also cannot become pregnant. If your ovaries were removed, menopause starts right away and your doctor may prescribe hormone therapy. Be sure to discuss any concerns you have about these effects and treatment with your doctor before the surgery.

What can I expect after an Abdominal Hysterectomy?

Repercussions of general anaesthesia

Most modern anaesthetics are short lasting. You should not have, or suffer from, any after- effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired.

Catheter

You may be recommended to have a catheter (tube) in your bladder to allow drainage of your urine. This is usually for upto 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have trouble passing urine, you may need to have a catheter for a few days.

Scar

An Abdominal Hysterectomy is generally carried out through a cut that is roughly 10 cm long. This is usually made across the top of your pubic hairline, but sometimes it may run down from your belly button to your pubic hairline instead.

Stitches and dressings

Your cut will be sealed by stitches, staples, clips or glue. Glue and some stitches dissolve by themselves. Other stitches, clips or staples need to be removed. You will be given detailed information about this. Any stitches in your vagina do not require to be removed, as they are dissolvable.

Drain

Sometimes, a small tube is inserted through your lower abdominal wall to drain off any excess blood or fluid that may collect post your operation. This will be removed by a nurse after your surgery while you are still in the hospital.

Vaginal bleeding

You can anticipate some vaginal bleeding for one to two weeks after your operation. This is like a light period and is red or brown in colour. Some women have little or no bleeding at first, and then have a sudden flow of old blood or fluid about 10 days later. This usually stops immediately and during this period you should use sanitary towels rather than tampons as using tampons could increase the risk of infection.

Pain and discomfort

You can expect pain and uneasiness in your lower abdomen for at least the first few days after your operation. When leaving hospital, you will be provided with painkillers for the pain you are experiencing.

Trapped wind

Following your operation your bowel may slow down for a brief time, causing air or 'wind' to be trapped. This can cause some pain or uneasiness until it is passed. Getting out of bed and walking around will provide some relief. Once bowel movements start, the trapped wind will ease.

Starting to eat and drink

After your operation, you may have a IV drip in your arm to administer fluids. When you are able to drink again, the drip will be removed. You will be offered water or a cup of tea and something light to eat.

Formation of blood clots - how to reduce the risk

There is a small possibility of formation of blood clots in the veins in your legs and pelvis (deep vein thrombosis) after any surgery. These clots can travel to the lungs (pulmonary embolism), which could be fatal. You can reduce the risk of clots by:

  • Starting to walk/moving about as soon as you can after your operation.
  • Performing exercises while you are resting, for example: pump each foot up and down briskly for 30 seconds by moving your ankle or move each foot in a circular motion for 30 seconds and bend and straighten your legs - one leg at a time, three times for each leg.

You may also be advised other methods to reduce the risk of a clot formation, particularly if you are overweight or have other health issues.

Physiotherapy

You will be given guidance and information about exercises to help you recover fast and ways to gain mobility without difficulty.

Tiredness and feeling emotional

You may feel tired than normal post-surgery as your body is using a lot of energy to heal itself. You may need to take a nap during the day for the first few days. A Hysterectomy can also be emotionally traumatic and many women during this stage feel tearful and emotional.

What are the risks associated with this procedure?

  • The cut in your abdomen (incision) may have to be reopened to stop any bleeding
  • Your bladder or the tubes leading to it may be injured and need surgical repair
  • You may develop an infection or bleeding
  • The incision may open
  • You may develop a hernia in the incision

Ask your doctor how these risks apply to you

Get in touch with the hospital and your medical team or call 1066 if:

  • You develop a fever over 100 degree F
  • You have nausea and vomiting
  • You have chest pain or become short of breath
  • You have bleeding from the vagina
  • You have leakage from the incision or the incision opens up
  • You have pain where you urinate
  • You have swelling, redness or pain in your leg

About this information

You should go through this information along with any other information you have received about your choices and the surgery itself. This information gives general advice. Every woman has different needs and recovers in different ways. Your own recovery will depend on:

  • How fit you are before your operation
  • The reason you are having a Hysterectomy
  • The exact type of Hysterectomy that you have
  • How smoothly the surgery goes and whether there are any complications.

 

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