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Gynaecology

Vaginal Hysterectomy and Repair

The uterus (also known as the womb) is a pear shaped organ that sits between the bladder and the rectum (back passage). 

From puberty, every 26 to 30 days the uterus begins a menstrual cycle, during which time the uterus prepares itself to receive and nourish a fertilised egg (ovum). If the egg is not fertilised, then the thickened lining of the uterus sheds as a period (menstrual bleeding). If the egg is fertilised, then the cycle changes. Periods stop and the uterus grows to provide nourishment and support for the growing baby until birth.

The uterus, tubes and ovaries

The most common conditions of the uterus, for having a hysterectomy are:

• Uterine disease.

• Diseases of tubes and ovaries.

• As part of the treatment for a prolapse.

• Bleeding not controlled by conservative treatment.

The operation

Vaginal Hysterectomy

Removal of the uterus through the vagina. The vagina is stitched from below and there is no cut in the abdomen.

Sometimes, a laparoscope (telescope type of instrument) is also used. The surgeon will discuss this with you.

The surgeon will discuss with you the best surgery for your condition. You may need removal of one or both ovaries, but this depends on the reason for your hysterectomy, your age and their condition in relation to disease.

Vaginal Repair

There are many different techniques used for management of female incontinence. Ask your doctor to describe which operation you are having and the risks and outcomes of those risk

Benefits of having the surgery

The decision to have a hysterectomy depends on the type of problems you are having and how bad they are. It also depends on whether you need major surgery to make your life better or, if you have a life threatening illness, to prolong your life. You need to discuss this with your surgeon.

Risks of not having the procedure

This depends on the reason for the surgery:

For prolonged bleeding, you may develop anaemia, which may need blood transfusions, and continued problems with heavy and irregular periods.

If you have a prolapse, the uterus can drop down into the vagina and even outside the vagina where it can develop ulcers and cause considerable pain and discomfort.

If you have a suspected tumour, then possible spread of tumour may result.

Condition And Procedure

The doctor has explained that I have the following condition: (Doctor to document in patient’s own words)

The following procedure will be performed:

Removal of the uterus (womb) through the vagina and repair of any prolapse.

This involves a cut in the vagina in its top part and/or front and back walls.

A catheter is usually put into the bladder after the operation to drain the urine until healing has taken place. A pack may also be used.

Anaesthetic

See “About your anaesthetic” information sheet for information about the anaesthetic and the risks involved. If you have any concerns, talk these over with your anaesthetist.

If you have not been given an information sheet, please ask for one.

General Risks Of A Procedure

They include:

• Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and

physiotherapy.

• Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be

fatal.

• A heart attack because of strain on the heart or a stroke. − Death is possible but very rare due to the procedure.

Risks Of This Procedure

Below are listed some risks/ complications. See patient information sheet- “Hysterectomy” for more information about the consequences and frequency of the risks.

If you have not been given an information sheet, please ask for one.

• Severe bleeding from large blood vessels about the uterus.

• Collection of blood clot at top of vagina (haematoma).

• Infection in the operation site or pelvis or urinary tract.

• Injury to other organs such as the ureter(s) (tube leading from kidney to bladder) bladder or bowel.

• A connection (fistula) may develop between the vagina and other organs (bladder, bowel).

• Bowel blockage after the operation.

• Pain in the perineum, which can last for weeks after surgery.

• Failure after vaginal repair ie. vaginal repair may not be successful, in the short or long term and may need later

corrective surgery. This results in recurrence of the prolapse.

• Occurrence of pain during sexual intercourse or altered sexual function after vaginal repair.

• Change in bladder and bowel habits.

• Feelings of depression and anxiety.

• Onset of menopause in pre- menopausal women if both ovaries are removed.

• Increased risk in obese people of wound infection, chest infection, heart and lung

complications and thrombosis.

• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

 

 

Hysterectomy: Removal of the Uterus