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Hysterectomy is an operation to remove the uterus, most often used in the treatment of neoplastic diseases, but also in the case of uterine prolapse and fibroids of this organ. It is possible to have a total hysterectomy involving the removal of the ovaries and fallopian tubes in addition to the uterus and the endometrium, and radical hysterectomy, where apart from the complete removal of the uterus and its body, the upper part of the vagina and the surrounding lymph nodes are also removed.
Indications for hysterectomy surgery
Hysterectomy, that is, removal of the uterus, is performed in the following cases:
- if your gynecologist finds numerous fibroids in your uterus, which are enlarging and give symptoms such as long, painful and heavy periods,
- in elderly women in whom the gynecologist has found a significant decrease, and sometimes even prolapse of the uterus due to the relaxation and weakening of the pelvic floor muscles, numerous births and hard physical work,
- if you are diagnosed with cancer of the endometrium (lining of the womb) or endometrial cancer and if you have cancer of the cervix when it is suspected that it has metastasized into the womb.
Sometimes during surgery histerectomy the cervix is left behind, which has mainly psychological indications (it slightly improves the patient’s well-being), but may result in the development of a cancer of this organ at a later stage. Most gynecologists recommend removal during surgery histerectomy also the cervix.
How is hysterectomy surgery performed?
Hysterectomy the traditional method is performed under general or lumbar anesthesia (the patient is conscious but does not feel pain). The surgeon-gynecologist opens the abdominal wall and removes the uterus and – if necessary – the appendages, i.e. the ovaries, fallopian tubes, the cervix, as well as the upper part of the vagina and the surrounding lymph nodes. Sometimes it is only during the operation that it becomes clear what its course will be, i.e. whether it is necessary to remove only the uterus or the appendages. For women under 45, if an ultrasound finds cysts on the ovaries, the “healthier” ovary is often left to provide a source of hormones. For older patients, it is usually removed during histerectomy both the uterus and the appendages to prevent the risk of developing cancer. After the surgery histerectomy there is a need for a few or more than a dozen days of hospitalization.
During the operation, material is collected for histopathological examination.
Hysterectomy can also be performed by laparoscopy. This operation requires general anesthesia. Through a small incision at the navel, the doctor inserts a laparoscope, i.e. a speculum, which allows you to observe the inside of the abdominal cavity on the monitor. Through another small incision, micro-tools are inserted into the abdominal cavity, which cut the uterus from the ligaments that support it and the vagina or cervix. The uterus is then divided into small pieces and taken out through an incision in the abdominal wall (if the uterus was large) or through the vagina (if it was small). Laparoscopic method histerectomy is used in cases where radical surgery to remove the uterus and appendages is not necessary. It is a less invasive operation than the traditional method, but the patient should stay in the hospital for at least 5 days.
Therapy after hysterectomy surgery: convalescence and hormone replacement therapy
Hysterectomy it is a radical interference in the female body. Removal of the uterus in many patients is associated with severe stress and uterine discomfort (patients are afraid of losing their “femininity”). If during histerectomy Only the uterus has been removed and the patient was premenopausal, the ovaries still produce sex hormones, so all you need is recovery and rest. If your ovaries are also removed during surgery, this causes the woman to go through a rush of menopause and a drop in the level of her sex hormones (estrogen). In this case, hormone replacement therapy may be necessary, unless hysterectomy it is performed in a woman after the menopause – in this case, the ovarian functions have stopped spontaneously.
Po histerectomy you should conserve your body for at least half a year – that is, do not lift more than 5 kg or perform heavy physical work.
In the case of histerectomy your cancer may require further treatment such as chemo- or radiotherapy.