Hysterectomy

Hysterectomy

A total hysterectomy involves removing the uterus and the cervix. This procedure is performed for many conditions other than can-cer, including dysfunctional uterine bleeding, endometriosis, non-malignant growths, pelvic relaxation and prolapse, and previous injury to the uterus. Malignant conditions often require a total ab-dominal hysterectomy and bilateral salpingo-oophorectomy (re-moval of fallopian tubes and ovaries).

Laparoscopically assisted hysterectomy is performed by some physicians with excellent results and rapid recovery. This method is most often used for vaginal hysterectomy and is performed as a short-stay procedure or ambulatory surgery in carefully selected patients. Patients have a short hospital stay and a low incidence of postoperative infection.

The number of hysterectomies in the United States per year has stabilized at 600,000, despite an increase in the number of baby-boomers who have reached the age when this procedure is likely to be performed. The rate may be stabilizing because women often seek second opinions, and the number of therapeutic options (ie, laser therapy, endometrial ablation, and medications to shrink fibroid tumors) has increased.

PREOPERATIVE MANAGEMENT

The physical preparation of a patient undergoing a hysterec-tomy differs little from that of a patient undergoing a laparo-tomy. The lower half of the abdomen and the pubic and perineal regions may be shaved, and these areas are cleaned with soap and water (some surgeons do not require that the patient be shaved). The intestinal tract and the bladder need to be empty before the patient is taken to the operating room to pre-vent contamination and injury to the bladder or intestinal tract. An enema and antiseptic douche may be prescribed the evening before surgery, and the patient may be instructed to administer these treatments at home. Preoperative medications adminis-tered before surgery may help the patient relax.

POSTOPERATIVE MANAGEMENT

The principles of general postoperative care for abdominal surgery apply, with particular attention given to peripheral circulation to prevent thrombophlebitis and deep vein thrombosis (noting vari-cosities, promoting circulation with leg exercises, and using elastic compression stockings). Major risks are infection and hemorrhage. In addition, because the surgical site is close to the bladder, voiding problems may occur, particularly after a vaginal hysterectomy.

Edema or nerve trauma may cause temporary loss of bladder tone (bladder atony), and an indwelling catheter may be inserted. During surgery, the handling of the bowel may cause paralytic ileus and interfere with bowel functioning.