Hysterectomy – Vaginal

VAGINAL HYSTERECTOMY & ANTERIOR/POSTERIOR COLPORRHAPHY

Removal of the uterus, including cervix, through an incision made in the deepest recesses of the vagina. This surgery is frequently accompanied by reconstructive surgery (colporrhaphy) to repair bladder muscles and rectal muscles.

REASONS FOR PROCEDURE

  • Cancer or suspected cancer of the uterus.
  • Fibroid tumors.
  • Chronic bleeding from the uterus.
  • Chronic pelvic infection.
  • Endometriosis.
  • Prolapsed (dropped) uterus.
  • Voluntary sterilization.
  • Strengthening of the bladder muscles, rectal muscles and pelvic ligaments.
  • Cystocele (dropped bladder) repair.

RISK INCREASES WITH

  • Obesity.
  • Smoking.
  • Conditions resulting in excessive estrogen exposure such as estrogen drugs, delayed childbirth, chronic anovulation (failure to release eggs from the ovary each month).
  • Iron-deficiency anemia; heart or lung disease; or diabetes mellitus.
  • Use of drugs such as: cortisone; antihypertensives; diuretics; or beta-adrenergic blockers.
  • Use of mind-altering drugs.

DESCRIPTION OF PROCEDURE

  • A general or regional anesthetic is administered.
  • The urinary bladder may be drained by catheter.
  • The vaginal walls are carefully separated from the bladder and rectal muscles.
  • The deepest recesses of the vagina are opened. The uterus and cervix are cut free and removed. The rear part of the vagina is closed with sutures.
  • The bladder muscles and rectal muscles are sewn into their proper position.
  • A small catheter (Foley) may be left in the bladder for a few days.

EXPECTED OUTCOME

  • Relief of symptoms caused by disorder being treated.
  • The vagina will be shortened somewhat after surgery. This should cause no lasting problem. Expect permanent sterility. Allow about 6 weeks for recovery from surgery.

POSSIBLE COMPLICATIONS
· Excessive bleeding; surgical-wound infection.
· Rectal, ureter or bladder damage.
· Muscles supporting bladder and rectum may require a second repair.
· Urinary retention.

POSTPROCEDURE CARE
GENERAL MEASURES

  • Hospital stay may be 1 to 3 days (occasionally longer).
  • Once home, someone should be available to help care for you for the first few days.
  • Use an electric heating pad, a heat lamp or a warm compress to relieve any discomfort.
  • Shower as usual.
  • Use a sanitary napkins-not tampons-to absorb blood or drainage (discharge is normal, but has an unpleasant odor).
  • Aftereffects of surgery may include constipation, urinary symptoms, fatigue and weight gain.
  • The psychological aftermath of a hysterectomy will depend on the individual. Some women feel only relief, others experience frequent and unexpected crying episodes (may be due to hormonal changes), and a few suffer from depression. Seek help and support from family and friends.

MEDICATION

  • After surgery, medicines for pain, gas, nausea or constipation may be prescribed.
  • Antibiotics if infection develops.
  • Continuation of supplemental hormones is recommended unless there are reasons why they should not be taken. Most patients will not require them until symptoms of menopause develop.

ACTIVITY

  • To help recovery and aid your well-being, resume daily activities, including work, as soon as you are able. Recovery at home may take 1 to 3 weeks, with full activities resumed in 6 to 8 weeks.
  • Resume driving 2 weeks after returning home.
  • Sexual relations may be resumed in 4 to 6 weeks (or when advised). Most women experience no change in sexual function; some report improvement, while others have a worsening sexual function; especially libido (sexual desire).

DIET

Clear liquid diet until the gastrointestinal tract functions again. Then eat a well-balanced diet to promote healing.