A hysterectomy is a surgical procedure that involves the removal of a woman's uterus. It is often performed to treat various medical conditions such as uterine fibroids, endometriosis, chronic pelvic pain, and certain types of cancer. Understanding the reasons behind a hysterectomy, the procedure itself, and the recovery process is crucial for those considering this surgery.

What is a Hysterectomy?

A hysterectomy is a surgical procedure in which a woman's uterus is removed. This surgery may involve the removal of other reproductive organs, such as the cervix, ovaries, and fallopian tubes, depending on the patient's condition and the type of hysterectomy performed. 

Hysterectomies are generally classified into three types:

• Open surgery hysterectomy: removal of the uterus and cervix.
• Laparoscopic hysterectomy: removal of the upper part of the uterus while leaving the cervix intact.
• Radical hysterectomy: removal of the uterus, cervix, part of the vagina, and surrounding tissues, often including the lymph nodes. This type is typically performed for cancer treatment.

What’s The Purpose of Hysterectomy?

Hysterectomy is performed for several medical reasons, including:

• Uterine Fibroids: These non-cancerous growths in the uterus can cause severe pain, heavy bleeding, and other symptoms that interfere with daily life.
• Endometriosis: A condition where tissue similar to the lining inside the uterus grows outside of it, causing pain and potentially leading to fertility issues.
• Chronic Pelvic Pain: Persistent pain in the pelvic region that has not responded to other treatments may be alleviated through hysterectomy.
• Uterine Prolapse: A condition where the uterus descends into the vaginal canal due to weakened pelvic muscles, leading to urinary issues, pelvic pressure, and other symptoms.
• Cancer: Hysterectomy is a crucial treatment for cancers of the uterus, cervix, ovaries, and endometrium.
• Adenomyosis: A condition where the inner lining of the uterus breaks through the muscle wall of the uterus, causing pain and heavy periods.

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What Happens Before Hysterectomy?

Preparing for a hysterectomy involves several important steps to ensure the surgery goes smoothly and to promote a quicker, safer recovery. Key steps in preparation include:

• Medical Evaluation: Comprehensive medical assessments, including physical examinations, blood tests, and imaging studies, are essential to determine the patient's fitness for surgery.
• Medication Review: Patients should inform their healthcare provider of all medications, supplements, and herbal remedies you are taking. Certain medications may need to be adjusted or discontinued before surgery.
• Pre-Surgical Instructions: Patients will receive specific instructions regarding fasting, medication adjustments, and bowel preparation before surgery.
• Lifestyle Adjustments: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can improve surgical outcomes and recovery. Smoking cessation is particularly important as it can affect healing.
• Mental Preparation: Understanding the procedure, potential outcomes, and having a support system in place can help patients mentally prepare for the surgery and recovery process.

Hysterectomy Procedure

The hysterectomy procedure can be performed using different surgical approaches:

Open surgery hysterectomy

An incision (cut) in your belly is used by a surgeon to perform an abdominal, or open, hysterectomy. Depending on the magnitude of the pathology and the indication for surgery, the incision might be vertical and extend up to or past the belly button, or horizontal and low on your belly, just above your pubic bone.

For an abdominal hysterectomy, you will be placed under general anesthesia to ensure they are unconscious and pain-free throughout the procedure. 

Laparoscopic hysterectomy

Minimally invasive procedures can be used to perform a hysterectomy in several circumstances. A laparoscopic hysterectomy is accomplished through multiple smaller ones.

A surgeon will insert an endoscope, which is a tiny video camera, through a single incision. The laparoscope gives the surgeon a video monitor view of your pelvic organs. Gas is inflated in the abdomen. Your uterus can be removed in pieces or whole using tiny surgical instruments through the other incisions.

Vaginal hysterectomy

For the removal of the uterus, the least invasive method is a hysteroscopic (vaginal) hysterectomy. You don't have any abdominal wounds since the uterus is removed through an incision at the top of the vagina.

Your eligibility for a vaginal hysterectomy may depend on a number of factors, such as the need to remove your fallopian tubes and/or ovaries, adhesions (scar tissue), uterine fibroid, severe endometriosis, lack of uterine descent, or the surgeon's preference or experience.

How Long Does a Hysterectomy Take?

The duration of a hysterectomy varies depending on the type of procedure, the complexity of the case, and the patient's individual circumstances. On average, the surgery takes between 1 to 3 hours. 

Factors that can influence the length of the surgery include:

• Type of hysterectomy: open surgery hysterectomies typically take longer than vaginal or laparoscopic procedures.
• Patient's health: pre-existing conditions, such as obesity or previous open surgeries, can impact the complexity and duration of the surgery.
• Extent of surgery: procedures that involve the removal of additional organs, such as the ovaries or fallopian tubes, may require more time.

What Are the Risks of Hysterectomy?

Like any surgical procedure, hysterectomy carries potential side effects and risks. Common side effects include:

• Pain and discomfort: pain at the incision site, abdominal cramping, and pelvic discomfort are common in the initial recovery period.
• Bleeding and infection: postoperative bleeding and the risk of infection at the incision site or internally are potential complications.
• Hormonal changes: removal of the ovaries during a hysterectomy induces surgical menopause, leading to symptoms such as hot flashes, night sweats, and mood changes.
• Emotional impact: some women may experience emotional effects due to the loss of fertility and changes in hormone levels.
• Adhesions and scar tissue: formation of internal scar tissue can lead to adhesions, causing pain or bowel obstruction in rare cases.

Patients should discuss these potential side effects with their healthcare provider and have a plan in place to manage them.

What Happens After Hysterectomy?

The length of stay in the hospital after a hysterectomy varies according to the type of procedure you underwent.

Depending on the type of hysterectomy, patients may stay in the hospital for 1 to 3 days. Minimally invasive procedures often result in shorter hospital stays.

In order to be sure there are no indications of difficulties, your healthcare professional might wish to keep an eye on you.

Pain relief is typically managed with medications. Patients should follow their doctor's instructions for pain control. In order to avoid blood clots in your legs following surgery, you will be walking around as soon as feasible.

Patients are advised to avoid heavy lifting, strenuous activities, and sexual intercourse for several weeks to allow for proper healing.

Regular follow-up visits with the healthcare provider are essential to monitor healing and address any concerns. For patients who have had their ovaries removed, hormone replacement therapy may be recommended to manage menopausal symptoms.

How Much Hysterectomy in Indonesia?

The cost of hysterectomy in Indonesia starts from IDR 5,000,000 to more than IDR 25,000,000.

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References:

Hoffman, M. (2010, January 26). The Different Types of Hysterectomy and Their Benefits. WebMD; WebMD. https://www.webmd.com/women/hysterectomy

Hysterectomy. (2022, November 16). Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hysterectomy

NHS Choices. (2024). Overview - Hysterectomy. https://www.nhs.uk/conditions/hysterectomy/

Clinic, C. (2024). Hysterectomy: Surgery, Types, Side Effects & Recovery. Cleveland Clinic. https://my.clevelandclinic.org/health/procedures/hysterectomy