An abdominal hysterectomy involves the removal of the womb via an incision in the abdomen. Depending on various factors including the reason for the operation and your age, you may be advised to have your ovaries removed at the same time.
How is the operation performed?
Under general anaesthetic an incision, usually transverse (bikini line) but sometime midline vertical incision, is made in the abdominal wall. The uterus, and ovaries if they are to be removed, are then identified and structures close by are dissected away to allow the womb to be removed, Those structures include the bladder, ureters (tubes from the kidney to the bladder) and bowel. The blood vessels to the womb are then clamped and cut and the womb is cut away from the top of the vagina. The top of the vagina is then stitched closed and the abdominal incision closed.
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. 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 and pulmonary embolism (blood clot on the lung). To help reduce the risk of DVT / PE you will be asked to wear compression stocking 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.
Abdominal hysterectomy should only be required if you are not suitable for vaginal or laparoscopic hysterectomy. The reasons for this include the size of the womb or the reason for the operation but the majority of hysterectomies can be done vaginally or, if the gynaecologist has adequate training, laparoscopically (keyhole surgery).
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.
You may also have a pump called a Patient Controlled Analgesia (PCA) connected to the drip in your arm. This contains morphine, or a morphine like substance that you can administer to your self for pain relief as you need it.
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.
Over the next couple of days the catheter, drip and PCA will be removed
You will need to inform the nursing staff each time you pass urine so this can be measured.
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.
HRT - If you were pre menopausal and have had your ovaries removed you will probably require HRT. This will be provided, usually as a daily tablet, for you to take home. Your GP will continue this medication when your supply runs out.
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 can gradually increase your activity as the pain allows but do not undertake strenuous activity for at least six weeks (three months if you have had a vertical incision)
Lifting / Exercise – avoid heavy lifting and aerobic workouts or strenuous exercise for at least 6 weeks. You may start again gently when you feel comfortable.
Hygiene – you may shower but do not soak in a bath until a week post operatively. Ensure that your incision is clean and dry after showering or bathing.
Stitch - the stitch used usually requires removal five day's after the operation (7-10 days if the incision is vertical)
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 for 2 – 4 days after your anaesthetic, and you should 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. If you have had a sub-total hysterectomy and your cervix is still present you may resume normal sexual activity when you feel comfortable.
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 if you have had a total hysterectomy. If you have had a sub-total hysterectomy it will still be necessary to continue with regular smear tests as advised by your G.P. surgery
You will usually be seen for follow up around three months after the procedure.