Hysterectomy

Last updated 20.09.12

 

Index

 

Definition

-  Surgical removal of uterus w/wo ovaries, vagina &/or fallopian tubes

 

Rationale

-  Must consider conservative Mx first

-  Indications

-  Used to treat excessive menstrual bleeding

-  Cancer of the endometrium, ovary or cervix

-  Fibroids

-  Endometriosis

-  Uterine prolapse

-  PID

 

Approaches

-  Abdominal Hysterectomy

-  Transverse incision superior to pubic symphysis: laparotomy

-  Typically indicated when large fibroids or Ca present

-  Vaginal Hysterectomy

-  Performed through a small incision in vagina

-  Typically w laparoscopy

-  Preferred due to reduced scarring

 

Classification

-  Total Hysterectomy

-  Entire uterus & cervix removed, ovaries spared

-  Subtotal (Partial) Hysterectomy

-  Uterus removed, cervix retained

-  Radical Hysterectomy

-  Removal of uterus, fallopian tubes, ovaries, upper vagina & pelvic ligaments & nodes

-  Hysterectomy & Bilateral Salpingo-oopherectomy

-  Uterus, ovaries & fallopian tubes removed

 

Complications

-  No uterus = no periods, no children

-  Vaginal vault prolapse

-  Injury to bladder, bowel or ureters

-  Fistula: vesicovaginal, recto/colo/enterovaginal

-  Sudden menopause