Abdominal and vaginal hysterectomy

Gynecological surgeries

Gynecological surgeries are performed when it is necessary to remove the uterus or ovaries because of the presence of benign tumors, uterine fibroids, endometriosis or other ovarian cystic formations.

ABDOMINAL HYSTERECTOMY (REMOVAL OF THE UTERUS)

An abdominal hysterectomy is performed under general anesthesia. Before the procedure, the bladder is emptied by introducing a urinary tube, called a catheter, through the urethra. The catheter usually remains in the bladder for 2 to 3 days. After washing and disinfecting the surgical field, the doctor opens the abdominal wall with an incision just above the pubic hair line. The uterus is separated from the neighboring organs and certain blood vessels are ligated. After that, the uterus is removed in its entirety, with or without ovaries, and sent for histopathological specimen examination.

VAGINAL HYSTERECTOMY (REMOVAL OF THE UTERUS THROUGH THE VAGINA)

A vaginal hysterectomy is a surgical procedure in which the uterus is removed through a cut in the vagina. Indications for a vaginal hysterectomy largely coincide with indications for an abdominal hysterectomy, but this procedure is technically more demanding. On the other hand, the patient's recovery and hospitalization are significantly shorter compared to the recovery of patients who undergo abdominal hysterectomy. The surgical procedure begins with a circular incision through which the cervical fascia is prepared and the urinary bladder is separated. The entry is made intraperitoneally through a posterior incision, after which the uterine ligaments are ligated, and then the uterus is removed. An additional advantage of this procedure is the possibility of providing a better solution to the issue of associated pelvic floor defects and static incontinence that may be present. At the end of the procedure, the wall of the uterus is additionally strengthened with the ends of the uterine ligaments in order to prevent a possible subsequent defect (cystocele, enterocele).

Patients must be aware that no medical procedure is completely risk-free. Despite the special attention paid to each patient and each surgical procedure, in some cases there is a possibility of complications during or after the surgical procedure. In most cases, complications can be noticed immediately and can be eliminated in a timely manner. However, bear in mind that the severity of certain surgical complications can be life-threatening for the patient. 

Possible complications during the surgery:

• Damage to neighboring organs - the risk is higher in cases where the patient has had a previous surgery, which results in possible adhesions or anatomic abnormalities. The above-mentioned damages are most often observed and treated during the procedure, but in rare cases, the manifestation of damages to neighboring organs is possible even after the procedure.
• Extremely heavy, uncontrolled bleeding that requires a blood transfusion.
• Postoperative complications: temporarily weakened bladder function - although this phenomenon usually does not require treatment, it can be treated with a temporary urinary catheter
• Infections - the urinary tract infections, wounds, pneumonia, peritonitis or sepsis, all of which are successfully treated with antibiotics. A possible postoperative hernia is solved by a repeated surgery.
• Intestinal obstruction or ileus - occurs very rarely, as a result of temporary paralysis of the intestine or adhesions inside the abdominal cavity. In these cases, it is necessary to establish a diagnosis, and in some cases repeat the surgery.
• Blood clots and blockage of vessels - occur exceptionally in cases of thrombosis or blockage of vessels, for example in the lungs due to the expansion of clots (pulmonary embolism, stroke). They can lead to organ damage due to poor blood supply. Prolonged bed rest increases the risk.
• Damage to the skin, soft tissues and nerves - these complications are also extremely rare and are caused by an injection before, during or after the surgery. Such injuries are usually temporary and disappear within a few weeks, and rarely cause long-term problems.
• A painful scar – the scar in the area of ​​the abdominal incision may become sensitive or painful.