Hysterectomy
Although fewer hysterectomies are being carried out than before, hysterectomy
remains one of the commonest major operations carried out on women.
For instance, each year more than 550,000 women undergo
hysterectomy in the USA, 100,000 in the
United
Kingdom, 60,000 in France, and 30,000 in Australia; in the USA, 20% of women
will have had a hysterectomy by the age of 40, increasing
to 33% by the age of 65 and 43% by the age of
85.
Indications for hysterectomy include fibroids, excessive menstrual bleeding, chronic pelvic pain (whether caused by endometriosis, pelvic inflammatory disease, pelvic congestion syndrome or when there is no obvious aetiology), and prolapse. Hysterectomy is also done in some cases of pre-cancer, and cancer involving the cervix, uterus, fallopian tubes or ovaries.
Historically, the earliest hysterectomies were performed via the vagina. However, abdominal hysterectomy has been the predominant route of surgery since it was first described in the mid-1800's unless done for utero-vaginal prolapse. Laparoscopic hysterectomy was introduced in 1989, and indirectly, has led to a resurgence of interest in vaginal hysterectomy for indications other than prolapse. In terms of operating time, major complications, post-operative discomfort, recovery and return to normal activities, several studies have now shown that vaginal hysterectomy is the optimal route of surgery for removing the uterus. However, vaginal hysterectomy is not possible in everyone.
Apart for the deciding the most appropriate route of surgery, the other decisions that have to be made are (a) whether to carry out a total or subtotal hysterectomy (to conserve the cervix or not), and (b) whether to combine hysterectomy with oophorectomy/salpingo-oophorectomy (to remove the ovaries at the same time or not). In many ways this is a personal decision and depends on circumstances. For instance, if you are relatively young, removing the ovaries would render you prematurely menopausal, which is generally not a good idea. Conversely, if you are have gone through the menopause and have a family history of ovarian cancer, than removing the ovaries along with the uterus seems a good idea as it will reduce your risk of developing ovarian cancer in the future.
Please click on the links below for further information about specific procedures:
Vaginal hysterectomy
Laparoscopic hysterectomy
Abdominal hysterectomy
Possible complications