Vaginal Hysterectomy Procedure
What Is Vaginal Hysterectomy?
Vaginal hysterectomy or removal of the uterus through the vaginal canal is a surgical technique used by many obstetricians when medical treatment for certain disorders of the uterus is not suitable. It is also an option against doing an abdominal hysterectomy, whereby the uterus is removed by a longer incision on the lower abdomen. During the procedure the fallopian tubes and ovaries may or may not be removed with the uterus, depending on the indications or need for such.
A vaginal hysterectomy may be done in women with abnormal uterine bleeding, fibroids in the uterus, uterine prolapse, cancer of the uterus, chronic pelvic pain and endometriosis. The vaginal route is usually the best option when the uterus is not too enlarged and can easily pass through the elastic walls of the vaginal canal. Compared to abdominal hysterectomy it results in less surgical trauma and complications thereby enabling a patient to have a shorter hospital stay and faster recovery. Risks are minimal except if the patient is diabetic, obese and suffering from other health problems. Complications that may arise from this procedure are similar to other surgeries such as bleeding, pain, infection and blood clots. Internal organs like the ureters and urinary bladder may be injured but this is not very common.
Vaginal Hysterectomy Procedure
A patient is asked to fast for several hours before the procedure. She may need to take some medications and be sedated prior to the operation.
In the operating room the patient is given either general or regional anesthesia. The patient is then positioned lying down with her legs supported by stirrups as in a pelvic exam. Her pelvic area is cleansed with a sterile solution and a urinary catheter is inserted into her bladder.
The surgeon, usually an obstetrician, makes incisions in the vagina to access the uterus. The uterus is then isolated and detached from its blood supply and ligaments with the use of long instruments. If the fallopian tubes and ovaries are also removed, these, too are isolated from their connective tissues and blood supply. These organs then pass through and are removed through the vaginal canal.
Occasionally the surgeon may encounter problems with visualization and may need laparoscopic assistance. Or, if the uterus turns out to be too large or is adherent to the pelvis an abdominal incision may be necessitated. The surgeon then makes sure the bleeding from the incisions is controlled and clears the operative field of gauzes and instruments.
The patient is then allowed to recover from anesthesia in the recovery room and transferred to her suite thereafter. She is encouraged to get up and walk as soon as she can to avoid gastrointestinal bloating and leg vein clotting. Usual length of hospital stay if there are no complications is two or three days.
What to Expect After Hysterectomy
After the procedure the patient is advised that:
- She may take medications for pain which should last a few days
- She will experience vaginal bleeding and discharge for a few weeks. She may use sanitary napkins for this purpose.
- She has to take a rest from stressful duties or housework and avoid lifting heavy objects for a few weeks.
- She must abstain from vaginal intercourse for about six weeks.
- If the ovaries and tubes were removed she may experience symptoms of menopause, including hot flashes and vaginal dryness.
- Emotional distress from a sense of loss is possible, especially for young women who are in their reproductive years. However, in many women who are relieved of chronic pain or bleeding a sense of satisfaction and improvement in mood are experienced.
- Any symptoms of prolonged pain, fever and uncontrolled bleeding must prompt her to seek medical consultation.
- Gynecologic, pelvic exams and follow-up consultations are advised for preventive and health maintenance.
Hysterectomy is a major surgical procedure done for a gynecologic problem not amenable to medical treatment. Although it is generally safe, vaginal hysterectomy carries with it some risks. Good surgeon-patient communication can help prepare a woman for a vaginal hysterectomy procedure and obtain good results.
References
ACOG, “Hysterectomy”, https://www.acog.org/publications/patient_education/bp008.cfm?printerFriendly=yes
Mayo Clinic, “Vaginal Hysterectomy”, https://www.mayoclinic.com/health/vaginal-hysterectomy/MY00099/DSECTION=what-you-can-expect
