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What is Hysterectomy?

A hysterectomy is the surgical removal of the uterus and in certain cases also the cervix. The uterus plays a pivotal role in reproduction as it moderates menstruation and also houses the fetus. Therefore, women who get a hysterectomy do not get periods and cannot get pregnant.

When should you get a Hysterectomy?

• Heavy Periods: This doesn’t just mean bleeding more, but can also include a period lasting much longer than a week. Not only are they very disruptive, but can also lead to problems like iron deficiency. Although other treatment options are also available, certain women are left with no choice but surgery.
• Chronic pelvic pain: The uterus is the reason behind chronic pelvic pain for many women and removing it is the only way to treat this pain.
• Fibroids: Fibroids are non-cancerous growths on or around the womb. Symptoms of this condition include heavy periods, pelvic and lower back ache, pain during sex, constipation and discomfort during urination. Fibroids, in certain cases, are only treated through surgical removal of the uterus.
• Cancer: Ovarian, cervical, uterine cancers might also pave the need for getting a hysterectomy done.
• Pelvic inflammatory disease: PID is the infection of the female reproductive organs, that results in pain the abdomen, fever, painful sex and urination, vaginal discharge, fatigue and irregular bleeding. Surgery is resorted to when the bacteria does not respond to medicine, abscess ruptures or the doctor fears that the abscess will rupture. As this condition can also be lethal, therefore, treatment is imperative.
• Endometriosis: In this condition, uterine lining grows outside of the uterus as well, leading to formation of scar tissues, cysts and painful periods. In severe cases, doctors have to remove the uterus.
• Adenomyosis: Similar to endometriosis, in this condition, the inner lining of the uterus grows into the uterus, meriting an ultimate removal of the uterus.
• Uterine Prolapse: This occurs when the muscles of the uterus collapse, falling through the cervix and thus protruding from out of the vagina.

Possible Complications of Hysterectomy?

No surgery is easy on the body, hysterectomy is no exception. Hysterectomy complications include:

• Surgical complications: Some people are allergic to anesthesia, which obviously poses a problem for the patient. Also, anesthesia can also lead to vomiting and nausea in patients. Moreover, many women get UTIs due to the use of a catheter during the operation.
• Complications due to the process: Hysterectomy risks also include infection at the sight of the wound. Moreover, there is also the fear of internal bleeding in this process. Similarly, internal scar tissue can also be formed on account of the surgery.

Blood can also pool beneath the stitches, in a condition known as hematoma. Blood clots can also be formed, leading to secondary complications like pulmonary embolism, that can be fatal in severe cases as well.

Vaginal prolapse can also occur on account of the surgery. In this condition, part of the vagina ends up coming out of the body. Some patients also suffer from chronic pain due to the surgery.

There is also the danger of damage to the bowels and bladder due to hysterectomy. Common complaints include urinary incontinence, a state in which patients have reduced or no bladder control.

In rare cases, patients can also suffer from a vaginal fistula, a state in which a hole is formed between the vaginal and rectal wall.

• Emotional & sexual problems: Moreover, hysterectomy side effects also impede emotional health. In cases where the road to recovery is hard, and life gravely disruptive, mental health also takes a turn for the worse.

Some women also have feelings of grief and loss, especially those who wished to get pregnant but cannot due to the operation.

Uterus removal side effects also include changed sex life. Due to the hormonal changes and the toll on the body on account of the surgery, some women suffer from decreased sexual desire as well.

What are the alternatives to hysterectomy?

It is very important to weigh hysterectomy risks and benefits before opting for the procedure. Other than inability to have children, hysterectomy also has impact on your sex life and self-image.

Some doctors are also less hesitant to perform the procedure and consider it only as the last resort as Hysterectomy surgery comes with its own plethora of problems. Medicine, waiting it out, exercise, hormone therapy, and other less intense surgical procedures like myomectomy are some of the alternatives to hysterectomy.

What are different types of hysterectomy?

• Partial Hysterectomy: In this type of hysterectomy, only a certain portion of the uterus is removed. Cervix is also generally left intact as well.
• Total Hysterectomy: In this case, the doctor removes the entire uterus and cervix.
• Hysterectomy and Salpingo-Oophorectomy: Alongside removal of the uterus, in this type of hysterectomy, one or both of the ovaries alongside fallopian tubes are removed.

What are the different surgical techniques for hysterectomy?

Surgical approaches to hysterectomy are contingent upon patient condition, any possible complication and surgeon experience. Surgical techniques utilized are:

• Open, abdominal hysterectomy: This is the usual approach to hysterectomy. In this type, the surgeon makes a 6-12 inches incision in the abdominal wall to remove the uterus. Recovery time with this surgery is greater as the incision size is significant. It also causes great inconvenience to the patient.
• Vaginal hysterectomy: In this technique, the uterus is removed via vagina through a tiny incision. There are no outward cuts and the operation itself is not very rigorous. Patient healing time and care is also lesser in this case, especially since they do not have to carry out the tedious task of wound care.
• Laparoscopic Hysterectomy: A Laparoscope is a thin and long tube that has a camera and high intensity light at the front. Doctor makes 3-4 tiny incisions, rather than one long cut, to insert the laparoscope. Doctor hence gets a visual from inside of the body, which they use to cut the uterus into pieces, removing one at a time.
• Laparoscopic-assisted vaginal hysterectomy: In this surgery, the laparoscope is inserted into the body via the belly, but the pieces of the uterus are removed from the incision made in the vagina.
• Robot-assisted radical total laparoscopic hysterectomy: This state-of-the-art technique uses a robot that the surgeons operate. This way, the incision made is very precise. Surgeons also have a better 3-dimension view of the surrounding tissue as well. In the robot assisted radical hysterectomy, there are other benefits for the patient as well. Bleeding is significantly less and there is also less scarring. Moreover, the complications are lesser in such surgeries as well, and the patient also has to endure less pain. These factors therefore help in patients having a shorter stay at the hospital. They can also return to their normal life quicker as well then.

What is the recovery time for Hysterectomy?

Being a major operation, naturally hysterectomy recovery is also significant. A patient has to stay in the hospital for around 2-5 days in the hospital during which their vitals are kept track of to avoid any complications.

Patients have to take it easy on themselves, but that does not mean they have to be sedentary. Walking for a few is imperative to prevent the formation of clots.

In case of vaginal hysterectomy, the patient's vagina is bandaged and gauzed to control the bleeding. Even though gauze gets removed after a few days, the bleeding can continue for at least 10 days. It is recommended for the patients to wear sanitary pads during this time.

After coming home, patients should still take it easy. They should continue with walking, but rigorous exercise is still off-limits. Also, refrain from standing a point too long, soon after the surgery. You will get better over time, so be patient.

Avoid activities like driving for at least 2 weeks after the surgery. Make lifestyle changes that optimize your rest and hence recovery time.

They should also refrain from pushing objects, lifting heavy items and bending. Moreover, patients also are not allowed to have sex, until okayed by the doctor.

Due to the surgery, women might also get constipated. It is important to drink plenty of fluids and eat a diet rich in fiber. You can also ask your doctor about taking stool softeners.

Also, be diligent about taking your medication. Some patients are prescribed antibiotics, and it is vital to complete the course. Patients should expect full recovery in 3-4 weeks, ideally.

What kind of doctors perform Hysterectomy?

An OB-GYN (obstetrician and gynecologist) generally performs hysterectomy, but choosing the correct doctor is also contingent on the type of the surgery being performed.

Not every OB-GYN is well-versed in the latest hysterectomy techniques that are not only less invasive, but also offer better patient prognosis.

Therefore, be sure to visit the best OB-GYN with sufficient surgical experience. You can book an appointment with the best 0B-GYN in Pakistan easily through Oladoc. Not only are the listings comprehensive, but pertinent information like experience, reviews, the consultation fee is also available for the doctor profiles.

What is the Hysterectomy Cost in Pakistan?

The Cost of the procedure is contingent on various factors like the type of surgery being performed, the type of hysterectomy, patient stay at the hospital etc. On average, hysterectomy cost can be somewhere from Rs.61000 to Rs.36600.