If you and your doctor decide that you should have a hysterectomy (removal of the uterus), you may have an abdominal hysterectomy (removal of the uterus through a cut in the abdomen) or a vaginal hysterectomy (removal of the uterus through the vagina). A vaginal hysterectomy is often preferable if possible, because you don't need a large abdominal opening made, which speeds recovery.
There are a lot of different reasons that women choose to have a hysterectomy performed, including:
  • excessive menstrual bleeding (another option for fixing this problem is endometrial ablation)
  • fibroids (non-cancerous uterine growths) which are causing abnormal bleeding
  • pelvic organ prolapse, which means that weakening muscles and ligaments are allowing the uterus to fall into the vagina
  • cervical or uterine precancer or cancer, or to avoid getting cancer if you are high-risk for these cancers
  • chronic pelvic pain due to endometriosis and/or scarring involving the uterus
There also may be reasons to also remove the ovaries and fallopian tubes during a hysterectomy, but this is not always done.
In a traditional abdominal hysterectomy (laparotomy), a relatively large opening must be made in the abdomen to remove the uterus.
In a purely vaginal hysterectomy, the uterus and other reproductive organs are removed through the vagina, which eliminates the need for a large abdominal opening and speeds recovery time.
In a laparoscopically assisted vaginal hysterectomy, the uterus is removed through the vagina, but additionally a few small incisions are made in the abdomen for a laparoscope and the surgical instruments used to help remove the uterus and other organs.
In a strictly laproscopic hysterectomy, your doctor will use laparoscopic instruments to cut up your uterus (and potentially other reproductive organs) into smaller pieces so that they can be removed through the small slits cut into your abdomen, rather than through the vagina.
You will usually be under a general anesthetic for any type of hysterectomy. The surgeon will make a relatively large opening in your abdomen. If the entire uterus is removed, the procedure is specifically called a total hysterectomy.
In a vaginal hysterectomy, theorgans are removed through an incision made in the top of the vagina. In both types of hysterectomy, sometimes the cervix of the uterus is left behind, and this is called a partial or supracervical hysterectomy.
Once a vaginal procedure has begun, the doctor might decide to perform an abdominal hysterectomy instead of a vaginal hysterectomy. A common reason for this is if the doctor discovers lots of scar tissue in the abdomen (which can be caused by multiple past cesarean sections, for example, which makes the organs too difficult to remove through the vagina. You will not know if this has happened until you wake up from general anesthesia after the operation.
After any hysterectomy, you will usually need to stay in the hospital for at least one night. The complete recovery time is usually 3-4 weeks for a vaginal hysterectomy, compared to six weeks or more for an abdominal hysterectomy. Be sure to follow your doctor's instructions about how much activity you can resume, and when. You will have a follow-up appointment with your doctors about two weeks after the surgery.
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