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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 Vaginal Hysterectomy. We would like to take the time to briefly discuss the process of undergoing Vaginal Hysterectomy. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Vaginal 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 Vaginal Hysterectomy?

During a Vaginal Hysterectomy, the womb and cervix are removed through a cut that is made in the top of the vagina. Specialised surgical instruments are inserted into the vagina to separate the womb from the ligaments that hold it in place.

After the womb and cervix have been removed, the cut will be stitched up.

A Vaginal Hysterectomy can be performed either using:

  • General anaesthetic - where you will be unconscious during the procedure or
  • Spinal anaesthetic - where you will be numb from the waist down
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:

  • Abdominal Hysterectomy - Having the uterus removed through a cut in the abdomen
  • Laparoscopic Hysterectomy through key hole incisions made in the abdomen
  • Robotic Hysterectomy through key hole incisions made in the abdomen
  • 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 will have chosen the method of hysterectomy that is appropriate for your medical condition. Some techniques will not suit your medical condition.

How do I prepare for Vaginal 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 Xray 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 consultant'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 a Vaginal Hysterectomy?

After-effects of general anaesthesia

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

Catheter

You may have a catheter in your bladder to allow drainage of your urine. This is usually for up to 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have difficulties passing urine, you may need to have a catheter for a few more days.

Scars

A Vaginal Hysterectomy is performed through your vagina so the scar will be out of sight. However, if you have keyhole surgery as part of your operation, you will have between two and four small scars on different parts of your abdomen. The scar will be anywhere between 0.5 cm and 1 cm long.

Stitches and dressings

Removal of the stitches in your vagina is not required as they are dissolvable. You may notice a stitch, or part of a stitch, coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about. If you have keyhole surgery, your cuts may be closed by stitches or glue. Glue and some stitches dissolve by themselves. Other stitches may need to be removed, you will be given information about this. Your cuts will initially be covered with a dressing.

Packs

You may have a pack in your vagina after the surgery to reduce the risk of bleeding. A nurse will remove this after your operation while you are still in the hospital.

Vaginal bleeding

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

Pain and discomfort

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

Trapped wind

Post-surgery your bowel may slow down for the time being, causing air or 'wind' to be trapped. This can cause some discomfort until it is passed. Getting out of bed and walking around will help. Once your bowels start to move, the trapped wind will ease.

Starting to eat and drink

After the surgery, you may have a drip in your arm to provide fluids. When you are able to drink again, the drip will be removed. You will be offered water or 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:

  • Start walking/moving about as soon as you can after your operation.
  • Perform 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 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 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.

Recovery from a hysterectomy if can be longer if:

  • You had health complications before your operation; for example, women with diabetes may heal at a slower pace and may be more prone to infection.
  • You are overweight - Patients can take a longer duration to recuperate from the effects of the anaesthetic and there is also a higher risk of complications such as infection and thrombosis.
  • There were any other complications during your surgery.

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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