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What is Hysterectomy?
A hysterectomy is a gynecological surgical operation that effects the removal of the uterus. The procedure is used both to prevent and to mitigate the spread of cancer cervical, and treat other problems such as:
- Uterine fibroid (tumor formed from muscle tissue);
- Pelvic pain;
- Abnormal uterine bleeding;
- Endometriosis (an abnormality in which there is the presence of the mucosa that lines the inner face of the uterus outside the uterine cavity);
- Uterine prolapse (condition in which the uterus moves into the vagina due to the weakening of the muscles that support it);
- Depending on the case, it may also include removal of the uterine attachments (adjacent tubes and ovary), especially in situations of severe endometriosis and advanced cancer.
There is no specific ICD for hysterectomy, as it is not a disease. But the ICD for diseases that lead to the need for a hysterectomy are N99.3 for post-hysterectomy dome prolapse, and O82.2 for cesarean delivery for hysterectomy.
The price of the operation varies a lot because it has several types and ways to be performed. In general, the value of laparoscopic and robotic hysterectomy is higher. Abdominal hysterectomy costs, on average, R $ 10 thousand and assisted video hysteroscopy , R $ 18 thousand.
What is the difference between hysterectomy and tubal ligation?
The ligation or tubal ligation, it is a voluntary female sterilization surgery. It consists of cutting or tying / burning the uterine tubes, procedures that can be performed in several ways, such as by placing plastic rings, titanium clips, sutures, among others, preventing eggs and sperm from fertilizing.
The operation requires anesthesia and its recovery time varies according to the patient and the type of anesthesia used. The practice of heavy activity within 48 hours after surgery should not be performed. Tubal ligation is not a contraceptive method, but a definitive one (it can be reversible in some cases), and it does not prevent sexually transmitted diseases.
Thus, while hysterectomy aims to treat diseases and other symptoms that affect the quality of life in women, sterilization is specifically to sterilize women.
Types of Hysterectomy
The types of hysterectomy are defined according to which organs will have to be removed which is decided by the doctor based on each specific case.
The types of hysterectomy are:
Partial hysterectomy (subtotal hysterectomy)
Only the body of the uterus is removed. In this case, in which the cervix is not removed, it is still necessary to have a Pap smear regularly.
Total hysterectomy
The body and cervix are removed.
Radical hysterectomy
Also called enlarged total hysterectomy, total hysterectomy with unilateral or bilateral annexectomy or Wertheim-Meigs surgery, in this type of hysterectomy there is the removal of both the body and the cervix, the ligaments of the organ or fallopian tubes (salpingectomy), the ovaries (oophorectomy) and tissue of the vagina around the cervix. It is usually performed when there is an advanced malignancy (cancer).
This classification plays a decisive role in the way in which the surgery will be performed.
How the surgery is performed
The gynecological surgeon is the one who performs the operation, but medical surgeons are also qualified. In cases where hysterectomy is necessary for cancer (cancer), the operation is usually performed by cancer surgeons.
All types of surgery are medium or large, and must be performed in the operating rooms of hospitals. These surgeries last, on average, 2 hours, but vary according to the severity of the complications.
The ways to perform the procedure are:
Vaginal hysterectomy
The surgeon separates the uterus from its attachments and then removes it through the vagina. The condition for surgery to be performed in this way is that the uterus does not vary in size. The discomfort, in this case, is less and the recovery is faster. The length of stay is 1 to 2 days and the recovery time is 2 to 3 weeks.
Laparoscopic hysterectomy
Small cuts of 5 to 10 mm are made in the abdominal region or in the vagina (laparoscopic vaginal hysterectomy). The doctor who performs the procedure uses long, thin instruments through these cuts, and has the help of a camera attached to a telescope. The uterus is then removed, also through the vagina, in smaller pieces (morcelamento), as well as in vaginal hysterectomy. The length of stay is 1 to 2 days and the recovery time is 2 to 3 weeks.
Robotic hysterectomy
3D technology, high definition vision and robotic arms are used that provide high precision in the procedure. It differs from laparoscopic hysterectomy in that it is these “robots” that perform the operation, while the surgeon assists with a monitor. The length of stay is 1 to 2 days and the recovery time is 2 to 3 weeks.
Abdominal hysterectomy
The uterus is removed through a vertical or horizontal incision in the abdomen. Although it causes more discomfort and pain and requires more recovery time, this method is inevitable when the uterine volume is larger due to tumors and polyps. The hospital stay is 4 days and the recovery time is 6 weeks.
Attention!
In some cases, the doctor may find it necessary to switch from vaginal hysterectomy to abdominal hysterectomy. The most widely used surgery is abdominal surgery, as it facilitates the visualization of the area by the surgeon, better identifying the affected tissues and organs.
What symptoms and pathologies may require a hysterectomy?
It is estimated that 16% of hysterectomies are considered unnecessary. Therefore, it should be the last possible option, that is, it should only be performed when other treatments are not effective and there was no other less invasive and cheaper option.
It is indicated for women who have complications in the pelvic region, such as:
- Cancer of the uterus or ovary (or as a preventive);
- Cervical dysplasia (abnormal tissue development);
- Uterine leiomyoma or fibroid (appearance of non-cancerous tumors in the uterus);
- Abnormal bleeding or uncontrollable bleeding;
- Non-malignant growth of the uterus and appendages;
- Chronic pelvic pain;
- Pelvic prolapse (failure to support the pelvic organs);
- Severe pelvic infection;
- Percrete placenta (deep implantation of the placenta in the uterine wall);
- Adenomyosis or other severe endometriosis;
- Sexual adequacy surgery (female to male);
- Some other irreparable damage to the uterus.
When it comes to malignant conditions, the hysterectomy will usually be total or radical.
Care before Hysterectomy
It is very important that the patient is informed about the surgery to which she will be submitted. Knowing more, she will feel more secure and this can help her emotionally at the time of the operation.
During hospitalization and in the preoperative period, some procedures must be performed with the patient. The responsible nursing professional must qualify the patient for surgery and prepare her for physical and laboratory exams.
The most common procedures are:
- Check surgical clothing;
- Trichotomy (shaving of the hair in the area where there will be intervention);
- Antissepsis of the skin (prevents the surgical wound from becoming infected);
- Absolute fasting for a few hours before hysterectomy;
- Possible use of antibiotics or laxatives (intestinal preparation);
- Bloodtests;
- Urine tests;
- Biopsy of the endometrium (mucosa that covers the inner face of the uterus);
- Insertion of a urinary catheter in the urethra to empty the bladder;
- Depending on the anesthesia used, other precautions can be taken.
During the performance of these processes, the patient’s vital signs should always be checked.
Psychological monitoring
This operation can affect the woman’s psychological balance, as it involves the removal of what most women have as the representation of their femininity, as it is associated with their reproductive role. That is, despite the relief of treating cancer or any other implication that led her to need a hysterectomy, she may feel less of a woman and even lose her sexual appetite. In women who have no children, the impact of infertility can be even greater. Thus, this condition can affect your self-esteem , your sexual and marital relationship and your recovery.
So it is important that, if the woman has a partner, he is very understanding of this situation, and also that she has, along with the pre and post-operative process, the support of a psychologist.
Hysterectomy recovery care
The recovery time from surgery depends on the type of procedure performed, but can vary from two to eight weeks. In cases of more radical operations, complete recovery can reach 12 months. The doctor responsible for the case is the one who will decide when the patient can return to her daily activities. During rehabilitation, some care must be taken. Look:
Walk
Staying in bed all the time favors the clotting of the veins ( thrombosis ), which is why short walks at home during the day are indicated, an activity that also speeds up healing.
Dressings
The cut region must be cleaned regularly, with water and mild soap or coconut. After bathing, it should be dried with a clean, dry towel. The dressing is usually changed from 12h to 12h, but it can vary according to the prescription of the head nurse.
Diet
There are no feeding restrictions after hysterectomy, except when the doctor considers it necessary.
Sexual intercourse
Each body has an individual response after being introduced to interventions like this. Therefore, it is necessary to have medical guidance to know when it is possible to have sex again without impairing healing. Initially, there should be no intimate contact with the partner and relationships should generally be avoided for a period of six to eight weeks after the operation.
When the hysterectomy is partial, there is not so much hormonal change, so the libido (sexual desire) and vaginal lubrication are maintained. However, removal of the ovaries and cervix causes a large hormonal gap, decreased lubrication and there may be less sexual appetite.
For this, in addition to the replacement of hormones, it is also recommended to use lubricants during sexual intercourse. Pleasure may indeed diminish, but it is especially related to the stimulation of the clitoris and the vaginal canal, which do not undergo intervention. On the other hand, it is also common for pleasure to increase, since after hysterectomy there are no more symptoms that led the woman to undergo surgery, such as pain and hemorrhage.
Physical effort
Rest is essential, especially in the first days after surgery. Avoid making sudden movements, physical activities and, mainly, lifting weight for at least 3 months.
Pap
Also known as cytology, it is an exam to detect diseases such as cervical and endometrial cancer, vaginal infections and sexually transmitted diseases. This preventive examination should continue to be performed after partial hysterectomy, as the cervix is also at risk of developing cancer.
Side Effects of Hysterectomy
Some difficulties will have to be faced after the operation. Are they:
- Hysterectomy prevents pregnancy, however, women between 40 and 60 years of age are the ones who perform this operation the most, that is, women who have already gone through the reproductive phase and have had the opportunity to have children;
- If only the uterus is removed, despite menstruation breaking, the cramps will remain due to ovulation of the ovaries. If there is also the removal of the ovaries, which are responsible for the secretion of estrogen, hormonal replacement and even prescription medications are needed to reduce the characteristic symptoms of menopause, such as hot flashes, sweating, mood swings and disturbed sleep. Women who cannot undergo replacement therapy will experience early menopause and increase their risk of osteoporosis and myocardial infarction;
- Even if the ovaries are not removed, they can fail a few years after surgery due to the lack of blood supply from the uterus;
- In the first few days, there may be vaginal bleeding and abdominal cramps. The gynecologist will recommend painkillers, anti-inflammatory drugs and antibiotics to relieve pain and prevent infections;
- Complications for urination may arise;
- Risks related to drugs used in anesthesia. The most serious include nerve damage, allergic reactions and death;
- The uterus produces a substance called prostacyclin, which is responsible for inhibiting the formation of blood clots. Thus, removal of the uterus can increase a woman’s chances of having thrombosis, and may also increase the risk of heart attacks;
- Constipation is another frequent complication, which can be resolved through medication, hydration and a diet rich in fiber;
- Fatigue;
- Joint pain;
- Depression;
- Anxiety;
- Palpitations;
- Development of benign ovarian cysts;
- Insomnia;
- Irritability;
- Shortened vagina.
Some complications can appear after the procedure and are considered less common:
- Persistent fever;
- Frequent vomiting;
- Abdominal pain even after the prescribed medication;
- Vaginal bleeding greater than menstruation;
- Swelling, redness, foul odor, presence of pus or bleeding in the cut;
- Infections;
- Lesions in the intestine (leakage of fecal material and infections) and bladder (urinary incontinence), which are organs neighboring the uterus;
- Vaginal prolapse
About 35% of women who undergo hysterectomy undergo another related surgery within 2 years. The greatest risks for performing the procedure are women with later cancer and pregnant women. Mortality ranges from 1 to 6 women per 1000 operations.
Cases of hysterectomy due to uterine neoplasia may require further treatment with chemotherapy or radiation therapy.
Does hysterectomy get fat?
There is no proven explanation of why, nor that hysterectomy actually causes weight gain, but there are many reports of women who gained weight after surgery.
Even so, there are theories that relate the procedure to weight gain, such as the impossibility of practicing physical exercises for a long time, the increase in the production of progesterone and the decrease in the levels of estrogen, factors that intensify and fluid retention by the body. .
Prevention
When a doctor realizes that it is necessary to perform a hysterectomy, it is important to consult other specialists in the gynecological area so as not to run the risk of performing the procedure unnecessarily. After all, there are many dangers and disadvantages to removing uteri and attachments, so as long as possible, it should be treated in a less invasive manner. However, if the other opinions are also important, it means that there is a risk if the surgery is not performed.
Therefore, there are no ways to prevent hysterectomy. When it is considered necessary, it must be done. What can be done is to prevent factors that lead to the inevitability of the procedure, such as:
- Perform preventive gynecological exams regularly: identify cervical cancer in advance;
- Having sex with a condom, taking the HPV vaccine between 9 and 26 years of age, avoiding the use of cigarettes and avoiding having multiple sexual partners: minimize the chances of having cervical dysplasia (or cervical dysplasia) and pelvic infections;
- Exercise and maintain your ideal weight: help prevent uterine prolapse.
Hysterectomy, surgery to remove the uterus and its attachments, is necessary when there is some complication in the female pelvic region. However, many of these complications could have been prevented or treated in a less invasive manner had they been previously diagnosed.
Therefore, share this text so that more women know about the subject and can practice attitudes that avoid this operation.
