Total Abdominal Hysterectomy: Types, Indications, Procedures, Complications, Recovery

Total Abdominal hysterectomy (TAH) is the removal of uterus along with cervix by making an incision in the lower abdomen. In partial hysterectomy, there is no removal of cervix, only uterus is removed. If the ovaries along with Fallopian tubes are also removed it is called total hysterectomy along with salphinooophorectomy. If both sides’ ovaries are removed, then it is called bilateral salphingooophorectomy.

Total hysterectomy: Removal of uterus and cervix.

Subtotal Hysterectomy: Removal of main part of the uterus and leaving cervix intact.

Total Hysterectomy with Bilateral Salphingo-Oophorectomy: Removal of uterus along with fallopian tubes and ovaries

Radical Hysterectomy: Removal of uterus, cervix, fallopian tubes, part of vagina, ovaries, lymph glands, fatty tissue.

Total Abdominal hysterectomy is mainly indicated in elderly women and is rarely indicated in younger women of child bearing age. In younger women mostly conservative approach is used but if the condition present is cancerous, then total abdominal hysterectomy is performed mainly to save the patient. The drawback of performing total abdominal hysterectomy surgery in younger women is she will not be able to bear children and will be emotionally depressed throughout her lifetime.

Total abdominal hysterectomy is done if the patient has:

• Fibroids in uterus
• Endometriosis
• Adenomyosis
• Menorrhagia
• Prolapse of Vagina
• Cancer of Cervix, ovaries, fallopian tubes, or uterus.
• Pelvic inflammatory diseases

In Vaginal Hysterectomy, removal of uterus and cervix is done through the incision made on top of vagina. The duration of this surgery lasts for half an hour and can be done under local, spinal or general anesthesia. It is usually preferred as it is less invasive and it involves speedy recovery.

In Abdominal Hysterectomy, removal of uterus and cervix is done through an incision on the abdomen.

Laparoscopic Hysterectomy is also known as keyhole surgery. A laparoscope is inserted and tiny video camera will be inserted through another hole made on the abdomen to view the insides of the abdomen. These are carried out under general anesthesia. The instruments are inserted through either abdomen or vagina to remove the uterus, cervix and any other part of the reproductive organs.

The complete medical history is recorded by the doctor and the following investigations are advised to know the condition of reproductive organs of the subject.

1. Complete pelvic examination: This is done to check all the internal organs in the pelvis.
2. PAP smear: This is done to rule out any conditions of the cervix.
3. Pelvic ultrasound/Pelvic MRI: This gives a clear picture of the internal organs of the pelvis.
4. Complete blood count: This is done to check the health condition of the patient.

The following preparations to be done by the subject before undergoing this surgery:

1. Stop smoking
2. Follow a balanced diet
3. Maintain a healthy lifestyle
4. Exercise regularly
5. Keep weight under control
6. Inform the doctor of any concomitant medications and illness.

The surgical procedure of total abdominal hysterectomy is explained to the subject and informed consent taken. Total abdominal hysterectomy is performed under general anesthesia. This can be done by either horizontal incision along the bikini line or vertical incision from the umbilicus to the bikini line. The uterus removal along with cervix is done. The wound is stitched up and it takes about half an hour to perform total abdominal hysterectomy procedure.

Total abdominal hysterectomy is advised if the uterus is very large and difficult to remove by vaginal or laparoscopically. During this surgery even the other internal organs can be checked for any cancerous/ precancerous growths and can be removed to provide pain relief to the subject and is done in the best interest and wellbeing of the subject.

1. Infections
2. Venous thromboembolism
3. Emotional disturbances
4. Gastrointestinal tract injury.
5. Bleeding from the internal organs
6. Nerve injury
7. Vaginal cuff dehiscence
8. Bowel and bladder disturbances
9. Vaginal discharge
10. Menopausal symptoms

• Take adequate rest and do not lift any heavy objects
• Take a short walk at the earliest
• Painkillers to ease the pain
• Exercises to increase mobility
• Eat healthy and sleep well

The recovery time depends on the age of the subject and the general health before Total abdominal hysterectomy surgery. The subject will be in the hospital for about 4-5 days before discharge. The follow-up will be scheduled 4-6 weeks, sometimes even more follow-up is required if complications are present. It takes around 8 weeks to completely heal following Total abdominal hysterectomy and adequate rest is advised during this time. Wound care to be done regularly and inform the doctor if any complications are seen during this period.

The normal activities like driving, exercise, lifting heavy objects, sex, returning to work following Total abdominal hysterectomy can be done after the wound is healed completely which takes about 8-10 weeks after surgery. There is no need to bother about contraception but usage of condoms is advised to prevent infections from sexually transmitted diseases from the partner.

Also Read:

• 4 Types of Hysterectomy, its Procedure & Recovery Time
• Does Hysterectomy Cause Weight Gain, Know the Causes of Weight Gain After Hysterectomy & How to Prevent It?
• Pap Smear After Hysterectomy: Is it Necessary?

References

1. www.nhs.uk
2. www.news-medical.net
3. Obstet Gynecol 2013 Mar;121 (3): 654-73.doi:10.1097/AOG.ob013e3182841594