Vaginal Hysterectomy +/- Repair

A vaginal hysterectomy involves the removal of the womb via the vagina. If a prolapse repair is undertaken this involves replacing the bladder / bowel, via the vagina back to its original position.

How is the operation performed?
Vaginal Hysterectomy
Under general or spinal anaesthetic the cervix (neck of the womb) is incised to release it from the vagina. The bladder is then dissected off at the front and the bowel dissected off the back of the womb. The blood vessels to the womb are then clamped and cut and the remaining attachments to the womb divided. The womb is then removed and the top of the vagina stitched closed. A catheter is then usually placed in the bladder and a pack (roll of bandage) placed in the vagina.
Repair Procedures
Depending on if the prolapse is from the front or back of the vagina the skin over the area is incised vertically. The bladder or bowel is then carefully dissected off the back of the vaginal skin. Two layers of supporting stitches are then placed to hold the bladder / bowel in position, following which the excess vaginal skin is removed and the edges of the vagina stitched back together. A catheter is then usually placed in the bladder and a pack (roll of bandage) placed in the vagina.

Complications
Injury to surrounding structures / organs
There is a small risk of accidental injury to the bowel, blood vessels, the bladder or the ureters (the tubes from the kidney to the bladder). If such complications were recognised to have occurred at the time of the procedure they would be repaired. This may involve making an incision in your abdomen to allow repair of the injured organ. Sometimes however, the injury is not apparent at the time and comes to light after the operation is finished. In this case a further operation is usually required to treat this. In around 5% of ladies a collection of blood occurs at the top of the vagina (vault haematoma). This can cause the vaginal bleeding to last longer than expected and this may also be rather smelly, as the blood drains. In most cases this simply requires antibiotics and patience until it settles but occasionally it can be necessary to have a further minor operation (from down below) to drain the collection.

General Surgical Risks
As with all surgery there is a risk of infection, bleeding, deep vein thrombosis, pulmonary embolism (blood clot on the lung). Should significant bleeding occur in the operation that could not be controlled through the vagina it would become necessary to make an incision in your abdomen to gain access to bleeding area. To help reduce the risk of DVT / PE you will be asked to wear compression stockings and will be given a daily injection to decrease the risk of clotting. These risks are increased by, amongst other things, length of stay in hospital and prolonged reduced mobility.

Specific post-operative care

From theatre you will be taken to the recovery room where staff will monitor your pulse, blood pressure, pain, sickness and wound site.
You will have an intravenous drip in your arm and a catheter in the bladder.
If you experience some nausea (sickness) this can be controlled with medications.
Around half an hour later you will return to the ward.
On the ward you will receive regular pain killers and any anti-sickness medication you require
You will be able to drink and eat as you feel able and to gradually increase what you are able to tolerate.
You may have some vaginal bleeding, so a sanitary pad will be provided. 
The next day the catheter, pack and drip will be removed.
You will need to inform the nursing staff each time you pass urine so this can be measured as it is quite common to have difficulty passing urine to start with, especially if you have had an anterior repair.


Specific discharge information

Pain Killers - you will need to take regular pain killers at home to it is best to ensure you have a good supply of paracetamol and ibruprofen (if you can take these) at home.

Activity - You may feel tired and lethargic after your operation and this may continue for a few weeks.  This is quite normal and you should take short periods of rest during the day. It is important however to keep mobile. You may gradually increase your activity as the pain allows but do not undertake strenuous activity for at least four weeks if you have had a vaginal hysterectomy (not for prolapse). If you have had your operation for prolapse, and have had a repair you should not undertake strenuous activity for three months, to allow body's own tissue to reach full strength.

Lifting / Exercise – avoid heavy lifting and aerobic workouts for at least four weeks if you have had a vaginal hysterectomy (not for prolapse). If you have had your operation for prolapse, and have had a repair you should not undertake strenuous activity for three months, to allow body's own tissue to reach full strength.

Hygiene – you may shower but do not soak in a bath until a week post operatively. 

Stitches - the stitches used are dissolvable and you will probably not be aware of them. Occasionally some of the stitches used to hold the prolapsed organ in place become a little spiky and you may notice these. These stitches however also dissolve with time.

Vaginal loss - Some vaginal bleeding / discharge is normal after surgery which should decrease over time. You may well notice an increase in loss 10-14 days after the operation, as the stitches at the top of the vagina dissolve, this is quite normal. You may also notice these stitches on your pad. If your loss becomes heavy or offensive please contact Mr Carpenter’s Secretary or your GP.

Urine – if you experience any discomfort i.e. burning or stinging when passing urine please contact Mr Carpenters Secretary or your GP

Diet - Try to eat a healthy well balanced diet, including plenty of fibre and drink sufficient water to avoid constipation. 

Driving – you must not drive until you feel comfortable and are able to undertake an emergency stop. In most cases this is around 4-6 weeks.

Sexual activity – refrain from penetrative sex for 4 - 6 weeks to allow the internal wounds to heal. 

Work – you usually require at least 6 weeks off work.  Please ask for a sickness certificate before you leave hospital.

Cervical smear tests – will no longer be necessary.

Follow Up
You will usually be seen for follow up around three months after the procedure.