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