Q: I have been advised to have a hysterectomy for complex hyperplasia. I understand that this is the safest course of action from a cancer viewpoint and I am going to go ahead but I am really worried about after effects like prolapse and so on. I have finished my family so fertility is not a concern. Could you advise me as to possible after effects and their likelihood? I am 41 years old.
A: It is tough to be told at 41 years old that you need to have total removal of the womb (hysterectomy) in order to prevent endometrial cancer (cancer of the womb). But it seems that you are mentally (and hopefully physically) strong enough to get through this without suffering any long-term complications.
The first laparoscopy hysterectomy was performed over 30 years ago and is now the most common type of hysterectomy. The benefits of laparoscopic hysterectomy include decreased morbidity, shorter hospital stay and faster return to normal activities compared to the traditional abdominal approach.
There are several subtypes including Total Laparoscopic Hysterectomy (TLH) when the uterus (womb) and cervix are removed, Laparoscopic Subtotal Hysterectomy (LSH) when the cervix is left in place and Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) when surgery to the ovaries and fallopian tubes is performed through the laparoscopic ports in the abdomen but the remainder of the surgery is performed vaginally.
You have not mentioned the need for removal of your ovaries and fallopian tubes. For pre-menopausal women (and I assume you are pre-menopause at 41 years old), the decision to remove the ovaries (or not) is based on your doctor’s advice and your own preference. By removing the ovaries and fallopian tubes you may reduce your risk of developing an ovarian cancer in the future but it will plunge you into the menopause.
One important factor in determining who may have a better outcome post hysterectomy is your weight. Ideally you are not in the obese category for BMI (Body Mass Index) ≥30 kg/m2 as this is associated with longer operative time, increased blood loss, increased complication rates, and greater likelihood of conversion to the more traditional open surgical route.
The procedure will be performed under general anaesthetic, with antibiotic medication as well as antithrombotic (to prevent blood clots) medication given during and typically for a few days after the hysterectomy.
If the planned operative site has a lot of hair, shaving the hair with razors should be avoided as it is associated with increased risk of surgical site infection. It is best to use depilatory (hair removal) cream if needed. Hair removal should be performed just prior (or close as possible) to the time of surgical incision. You will have a catheter inserted into your bladder.
When it comes to complications of the procedure, the risk of conversion to open laparotomy is approximately 4pc which means you will have a larger surgical wound on your abdomen and longer healing time. The next most common risk is the possibility of catching a urinary tract infection which can happen in up to 3pc of cases. This is easily treated with antibiotics.
There is a very small risk of vaginal cuff dehiscence (splitting or opening of a surgical wound) which can occur in about 1pc of cases. This will cause a delay in tissue healing of the vaginal walls following surgery. Lastly, in less than 1pc of cases there can be an accidental bowel/urinary tract injury during the surgery or possible haemorrhage (bleed) post procedure.
Following discharge from hospital you will be advised to avoid heavy lifting or straining for a few weeks. It generally takes anything from two to eight weeks before you can get back to the majority of daily activities, and avoidance of sexual intercourse is typically recommended for six to eight weeks after total hysterectomy.
Dr Jennifer Grant is a GP with Beacon HealthCheck