Vaginal Hysterectomy for Fibroids
Uterine Fibroid Symptoms
Uterine fibroid is a benign growth of the uterus that often occurs during childbearing years. Almost 75 percent of women develop uterine fibroid throughout their lives, but the majority do not experience symptoms. The most common symptoms associated with uterine fibroid are heavy menstrual bleeding and prolonged menstrual periods. The less common complaints are abdominal pain (when the fibroid outgrows its blood supply), infertility (when the fibroid grows into the uterine cavity) constipation and bladder symptoms (when the fibroid compresses the bladder or rectum).
Vaginal Hysterectomy Procedure to Relieve Fibroid Symptoms
During the vaginal hysterectomy for fibroids procedure, choice of anaesthesia is usually regional, which can be either spinal or epidural anaesthesia that blocks the sensation of the lower half of body. Patient’s preparation and steps of vaginal hysterectomy includes:
i) Cleaning and shaving the vaginal area.
ii) Setting up intravenous line (IV) for medicine and blood transfusion if needed.
iii) Placing a urinary catheter to empty the bladder.
iv) Accessing the uterus via an incision made inside the vagina
v) Cutting and clamping the uterine blood vessels, separating the uterus from the connective tissues, ovaries and fallopian tubes.
vi) Absorbable suture material is used and placed in the deep layer which will heal within weeks after surgery.
vii) Uterus is removed via vaginal opening and vagina is closed at the top.
This procedure may take up to 90 minutes and can be longer if ovaries and tubes are removed.
Benefits of Vaginal Hysterectomy
Total vaginal hysterectomy when compared to total abdominal hysterectomy tends to have faster postoperative recovery, assessed as time in hospital or time to return to work. This is attributed to the smaller incision made during vaginal hysterectomy. Laparoscopic assisted vaginal hysterectomy allows the operating doctor to visualize the pelvic organs on the screen using a laparoscope. It is the choice of surgery for patients with previous pelvic surgery and adhesions. The greatest benefit of laparoscopic assisted vaginal hysterectomy is its potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy.
Risks of Vaginal Hysterectomy
As stated by Garry R, et al. (2004) in The eVALuate study, the most common risk for both vaginal and abdominal hysterectomy is massive blood loss requiring blood transfusion. Uterine fibroid is a very vascular growth and blood loss during the surgery should always be anticipated.
There is a one percent chance of injury to the bowel or bladder and blood clot in lungs following abdominal hysterectomy, which is slightly higher than with a vaginal hysterectomy. The risk of organ injury is greater if large uterine fibroids, severe endometriosis with adhesion or cancer is obstructing the view or otherwise makes the surgery difficult.
A patient’s medical conditions like high blood pressure, diabetes and obesity should be taken into account while preparing for vaginal hysterectomy for fibroids.
Expected Recovery
After the surgery, patients are given pain relief medication and antibiotics to prevent infection. It is normal to experience bloody vaginal discharge following the surgery for a few days.
Recovering from a vaginal hysterectomy is more pleasant, less painful and shorter than after an abdominal hysterectomy. Most of the patients can be discharged within one week and resume work within two weeks following surgery. Quality of life is greatly improved without those disturbing menstrual problems and associated symptoms of anemia.
Women are encouraged not to carry anything more than 20 pounds and avoid vaginal intercourse until six weeks after surgery.
References
- Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF.
- Garry R, et al. (2004). The eVALuate study: Two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ, 328(7432): 129.
