stephenquinn

Obstetrician and Gynaecologist

Abdominal Hysterectomy

Abdominal hysterectomy Information for patients, relatives and carers


What is a hysterectomy?

Hysterectomy is a general term for surgical removal of the uterus (womb) that is done while you are asleep under a general anaesthetic. However, there are variations of the basic operation used to treat different medical conditions:

  • Total abdominal hysterectomy (TAH) The womb and the cervix (neck of womb) are removed.
  • Bilateral salpingo-oophrectomy (BSO) Both the fallopian tubes and ovaries are removed. This may be done with TAH (see above).
  • Sub-total hysterectomy The womb is removed, but not the neck of the womb.
  • Vaginal hysterectomy The womb and (sometimes the ovaries as well) are removed via the vagina. This operation is sometimes done to treat prolapse of the womb.
  • Laparoscopic hysterectomy This operation is the surgical removal of the womb through three or four very small incisions (cuts) in your abdomen (tummy). One of these wounds will be in your umbilicus (belly button).



Are there any risks associated with total abdominal hysterectomy?

As with any operation, there are risks. Specific to this operation, there is a risk of:

  • Infection
  • Wound breakdown, i.e. when the wound does not heal well. This is temporary
  • Wound haematoma (bruising under the skin)
  • Haemorrhage (internal bleeding)
  • Injury to the bladder or ureter (the tube that connects your kidney's to your bladder)
  • Deep vein thrombosis (DVT), also known as blood clots
  • Pulmonary embolism (blood clot on the lungs)
  • Injury to the bowel

We take many steps to keep the risks we have described to a minimum. For example:

We give you antibiotics to prevent infection and the procedure is carried out in sterile conditions

We ask you to wear special support stockings and to take medication to thin the blood, as this helps to prevent the formation of blood clots

Your anaesthetist (a specialised doctor) will see you before the operation to check that you are fit for the operation and the anaesthetic


Are there any alternatives to this treatment?

This will depend on your existing medical condition. Your hospital doctor will discuss the options with you if appropriate.


Will there be a scar?


Yes. The surgeon will either make a pfannenstiel incision (also called a ‘bikini line’ incision), just above the pubic hair, or a midline incision (also known as an ‘up and down line’) on your tummy. The wound will be closed together after the operation using sutures (stitches).


What about losing my fertility?


If both ovaries and the womb are removed, this will result in loss of fertility. At any age, having to have your ovaries removed can affect the way a woman feels about herself, particularly if this occurs at a young age. The loss of fertility can have a huge impact if you planned to have children and you have an operation that takes this choice away.


Depending on the extent of your surgery, you may want to make sure that you have explored all your options. It is important that you have the opportunity to discuss this with the hospital doctor or if appropriate with the gynaecological specialist nurse (also known as your key worker) before your operation. If appropriate, advice is also available from our specialist fertility team and premature menopause team (see contact details further below). If you wish, we can also refer you to other support organisations, as well as to a counsellor.


Will I need hormone replacement therapy (HRT)?


You may be offered HRT if you have both your ovaries removed and you have not already been through the menopause. HRT is available in many forms – as an implant, patches (similar to nicotine replacement patches), tablets, gels, sprays and vaginal creams. Potential symptoms can also be managed using ‘alternative’ remedies.

Please discuss the options available to you either with the gynaecology team before you are discharged from hospital or with your GP.


What happens before my operation?


Yes. Make sure that all your questions have been answered to your satisfaction and that you fully understand what is going to happen to you. You are more than welcome to visit the ward during visiting times and meet the staff before you are admitted to hospital. Just ask your clinic nurse or your gynaecological specialist nurse/key worker to arrange this for you.

An enhanced recovery programme (ERP) has been established at Imperial College Healthcare NHS Trust for patients undergoing surgery. It aims to reduce complications and length of hospital stay. An important part of this programme of care is your understanding of how you, and possibly your family and friends, can play an active part in your recovery.

An appointment at the pre-admission assessment clinic will be arranged with you a week before your operation date. The pre-admission assessment appointment is an opportunity to ensure that you are medically fit for the anaesthetic and the operation. This will involve taking a full medical history and ordering any tests that you may require to prepare you for your operation, such as a blood test, chest x-ray or ECG (recording of your heart).

If you take blood-thinning medications (such as warfarin or aspirin) and/or you are allergic to any medications, please tell the doctor or nurses at your pre-admission assessment appointment.

If you are a smoker, it would benefit you greatly to stop smoking or cut down before you have surgery. This will reduce the risk of chest problems as smoking makes your lungs sensitive to the anaesthetic.

You should also eat a balanced diet and if you feel well enough, take some gentle exercise before the operation as this will help your recovery afterwards. Your GP, his/her practice nurse or the doctors and nurses at the hospital will be able to give you further advice about this. You may be referred to a dietitian if you are having problems eating or maintaining your weight.

Before you come into hospital for your operation, try to organise things ready for when you return home. If you have a freezer, stock it with easy to prepare food. Arrange for relatives and friends to do your heavy work (such as housework, changing your bed sheets, vacuuming, gardening and shopping) and to look after your children if necessary.

You may wish to discuss this further with your gynaecological specialist nurse/key worker if this is a problem. A social services assessment may be suggested if you feel you need further support at home to recover from the operation.


Consent


You will be asked for your consent before your treatment begins. Your doctor and/or gynaecological nurse specialist/key worker will carefully explain the procedure involved. Details will vary according to each individual case. No medical treatment can be given without your written consent.

If you do not understand what you have been told, let the staff know straight away so they can explain again. You may also find it useful to write a list of questions before your appointment and to have a relative or friend with you to help you remember the discussion when the treatment is explained.

All clinical communications copied to your GP may also be sent to you, at your request. 


What happens on the day of the operation?


On the day of your admission, please bring all the medication that you take regularly. You will be admitted to hospital on the day of your surgery, unless your hospital doctor recommends that you should be admitted the day before due to a medical reason (such as diabetes, heart problems etc).

Your temperature, pulse, blood pressure, breathing rate, height, weight and urine will be measured. A blood sample will be taken to check that you are not anaemic.

The anaesthetist who will be putting you to sleep for the operation will also come to see you. He/she may prescribe a ‘pre-med’ for you to take one hour before surgery to help you relax and make you sleepy.

We will give you special stockings to wear and start you on heparin injections to prevent blood clots (DVT) from forming in your legs following surgery. This will be discussed with you by your hospital doctor.

The physiotherapists will also show you some useful exercises to do after surgery.

You may be given an enema (a small sachet of medication) or suppository to help you empty your bowels. We will ask you not to eat or drink anything for at least six hours before your operation is scheduled to take place. This will be discussed further at the pre-admission assessment clinic.

We will ask you to have a shower or bath before going to the operating theatre. All make-up, nail varnish, jewellery (except wedding rings, which can be taped onto the finger), body piercings and dentures must be removed. One of the nurses will then take you to the operating theatre.


What happens after the operation?


You will wake up in the recovery room before you are taken back to the ward. You may have trouble opening your bowels for the first few days after the operation. This is temporary and we can give you laxatives if you need them.

You may feel light-headed or sleepy after the operation. This is due to the anaesthetic and may continue until the next morning. You may have a ‘drip’ attached to your arm to provide you with fluids to prevent dehydration until you are able to drink. It is important that you start to drink and eat after your operation as soon as it is recommended by your doctor. We will encourage you to walk to the ward dining room for all meals. There is no restriction on the type of food you can have. You will also have protein or milk drinks every day until you are ready to go home to help you recover and your wound heal better.

A temporary catheter (tube) will be inside your bladder for 1 to 2 days to drain urine away and allow you to rest more easily.

You will have a dressing on your wound, which will be removed the day after surgery. Any stitches or clips will need to be removed five to ten days after your operation, or they may dissolve when the wound has fully healed. If you have stitches to be removed and you are no longer in hospital, we will ask you either to come back to the ward or go to your GP to have this done.

You may have some vaginal bleeding, but this does not usually last for more than a few days. You may also have a blood-stained discharge, which may last for up to two weeks.

You may have a sore throat for two or three days after having a general anaesthetic. This sometimes happens because the anaesthetist has to pass a tube down your windpipe to give you the anaesthetic gases that keep you asleep during the operation.

We will encourage you to do gentle leg and breathing exercises to help with circulation and prevent chest infections. The physiotherapist will help and advise you with this. He/she will also encourage you to get out of bed and start moving around as soon as possible, as this will help with your recovery.


Pain 


Please tell us if you are in pain or feel sick. There are several ways to help you control your pain and these will be discussed with you by the anaesthetist. You may have a device which you use to control pain yourself. This is known as a ‘PCA’ (patient-controlled analgesia) pump, and you will be shown how to use it. The anaesthetist may also discuss the use of an ‘epidural’ as an option. This is a method of pain relief commonly used during childbirth and also for people with back pain, and is an injection in the back.

The anaesthetist may also discuss with you the use of TAP block (transversus abdominis plane block). This method is to spread pain relief across the abdomen, and it may last for up to two days.

We also have tablets/injections that we can give you as and when required so that you remain comfortable.


Is it normal to feel weepy or low in mood afterwards?


Yes. It is a common reaction to the operation and to being away from your family and friends. The advice and support of your friends, family, GP, gynaecological specialist nurse/key worker or support groups may be able to help you. If these feeling persist, please speak with your nurse who can put you in touch with a counsellor or other relevant services. 


When can I go home?


You will be discharged from hospital about two to three days after your operation. You will be supplied with anti-clotting injections to take home with you and will be shown how to inject yourself before you leave. Please discuss this with the nurse if you are unsure.

Please arrange for someone to come and collect you by car or accompany you in a taxi on the day of your discharge home, as you will not be able to drive yourself or travel on public transport.

If you have been prescribed medication during your stay in hospital, the nursing staff will give you a supply of this to take home with you.


Is there anything I need to watch out for at home?


Please contact your GP, gynaecological specialist nurse/key worker or go to your nearest accident & emergency (A&E) department if you have:

  • excessive redness or discharge around the wound site
  • a high temperature or fever (38°c or above)
  • heavy vaginal bleeding
  • a smelly discharge from the vagina or wound
  • pain or swelling in your calves or the veins in your legs
  • difficulty in breathing
  • difficulty opening your bowels or passing urine


What happens when I leave the hospital?


It is normal to feel tired when you go home. However, your energy levels and what you feel able to do will increase with time. This is individual, so you should listen to your body’s reaction and rest when you need to. This way, you will not cause yourself any harm.

Avoid lifting or carrying anything heavy (including children and shopping) for about four to six weeks after your operation. Vacuuming and spring cleaning should also be avoided until you have had your check-up at the hospital.


You should avoid aerobic exercise, jogging and swimming until advised otherwise, but should continue with the exercises that the physiotherapist showed you. Walking is an important part of the recovery process.

Try to eat a balanced diet and rest as much as possible, accepting all help that is offered to you. Continue with gentle activities, such as making drinks, light dusting and washing up, gradually increasing your level of activity. Gentle exercise such as walking is an important part of your recovery after surgery.


When can I start driving again?


You are advised not to drive for about four weeks after your operation. However, this will depend upon the extent of the surgery you have had and your individual recovery. 

Do not drive until your strength and speed of movement are back to normal, as you must be able to do an emergency stop. It is important to inform your insurance company that you have had an operation to ensure that you are covered in the event of an accident. You should also make sure that you are not drowsy from any painkillers and that your concentration is good.


When can I return to work?


Most women feel able to return to work after four to eight weeks, but this will depend on the type of hysterectomy you have had. It will also depend on the type of work you do, how well you are recovering and how you feel physically and emotionally.


When can I have sex?


After surgery you may not feel physically or emotionally ready to start having sex again for at least four weeks while your body is healing from the surgery. It can take two to three months or longer to physically recover from the operation and even longer for energy level and sexual desire to return to how it was before your operation. During this time, it may feel important for you and your partner to maintain intimacy (such as kissing, stroking etc), despite refraining from sexual intercourse.

Some couples are both physically and emotionally ready to resume having sex much sooner and this can feel like a positive step. If you or your partner has any queries or concerns about this, please do discuss them with your hospital doctor, GP or gynaecological nurse specialist/key worker. Your specialist nurse can answer your questions and give you reassurance about all of these issues either before or at any point after your operation.


Will I need to visit the hospital again?


Yes, for a check-up in the outpatient clinic about one to six weeks after your operation. 


Routine cervical smear tests are usually not necessary after the hysterectomy operation as the cervix has been removed.

It is important that you make a list of all medicines you are taking and bring it with you to all your clinic appointments. If you have any questions at all, it may help to write them down as you think of them. It may also help to bring someone with you when you attend your outpatient appointments.