When is hysterectomy considered for treatment of fibroids?
Women over the age of 40 with completed family may choose to have a hysterectomy. This is obviously a 100% solution with guaranteed relief of symptoms and no risk of recurrence.
Is laparoscopic (key-hole) hysterectomy feasible for uterine fibroids?
Most hysterectomy operations are now performed as key-hole procedures. If uterus is enlarged below the level of umbilicus, laparoscopic hysterectomy may be possible. Open hysterectomy operations are almost always performed through a bikini-line incision unless the fibroids are too large or there are other factors.
Is removal of ovaries or cervix always necessary?
Removal of ovaries or cervix is always optional! Typically, removal of ovaries is recommended in women over the age of 50yrs as the ovarian function is declining and there is a 1 in 70 risk of developing ovarian cancer in the future. Removal of cervix will mean no more smears which is attractive to many women.
What are the risks of hysterectomy operation?
Infection, bleeding, injury to surrounding organs and thromboembolism (blood clot in legs or chest) are associated with this procedure. An injection of intravenous antibiotics is given at the beginning of the procedure and aseptic precautions are followed to minimise risk of infection. Bleeding is usually minimal and with careful technique this risk is reduced. Risk of injury to surrounding organs is minimal especially if you haven’t had any operations before.
Thromboembolism (blood clot) is a risk due to reduced mobility and pelvic lump (fibroids) slowing down pelvic circulation. Special stockings are used along with calf-pumps to keep circulation active. Special blood thinning injections are given to reduce this risk further. Adhesions (scar-tissue) formation is also a risk and meticulous control of bleeding and minimal tissue handling is essential.
What about recovery?
Recovery after laparoscopic hysterectomy is very quick. Hospital stay is 24 hours and most women are back to normal activity levels after 2 to 4 weeks. Open hysterectomy is associated with longer hospital stay (3-5 days) and return to normal activity levels takes 4 to 6 weeks.
Further information about recovery can be obtained by downloading the following leaflets published by the Royal College of Obstetricians and Gynaecologists, London.