SUB TOTAL HYSTERECTOMY
1. INTRODUCTION
The decision to undertake surgery is an important one. It must be realized and accepted that complications may occur. Although major complications are not common, they may be disabling and even life threatening, and may require further surgery to correct. This can lead to prolonged recovery time and even permanent disability.
The benefits of the operation must be weighted against the risks. A full consideration of alternative treatments should be made including the consequences of no treatment.
It is your responsibility to make sure that you understand the proposed surgery and to ask any questions if you are unsure.
2. PROCEDURE
Sub Total Hysterectomy is performed by removing the fundus or upper part of the uterus. The ovaries and the cervix together with the ligamentous supports of the upper vagina are left intact.
The cervix is not removed and the top of the vagina is not disturbed. The internal support ligaments remain intact to provide strength in the long term support of the pelvis.
3. ADMISSION TO HOSPITAL
This normally occurs the morning of the operation. You should have nothing to eat, drink or smoke from midnight the night before. If the operation is to be in the afternoon, you can have a light breakfast before 6.00am eg toast, tea or coffee. If you develop a cough, cold or fever before the operation it may need to be postponed.
The appropriate anaesthesia will be decided by the anaesthetist and should be discussed with him or her. The anaesthetist will arrange the appropriate premedication if required. If you are over 50 we will arrange for you to have an ECG and a Chest X-Ray prior to surgery.
If you are currently taking Aspirin, Indocid, Naprosyn or other anti-inflammatory drugs, these should be discontinued ten days before the operation. Please bring a packet of sanitary pads with you to the hospital with your own night attire and toiletries.
4. RECOVERY
Your will wake up in the post operative recovery room within the theatre complex. You may have an oxygen mask fitted comfortably over your mouth and nose. There may be an intravenous "drip" (IV) needle in your arm. Analgesic medication will be prescribed to help prevent any post operative pain.
There may be some nausea and vomiting, although medication to counteract this is routinely given during this operation. If you continue to feel nauseated, notify the nursing staff so that further medication may be administered. The nursing staff will measure the volume of urine passed each time to make sure that there is no retention of urine. In this case a small 'in-out' catheter
will be passed to empty the bladder. A catheter may be left in the bladder for the first 24 hours after surgery so that you do not have to get up from bed on the first night.
Once fluids are tolerated, the intravenous 'drip' will be removed. You will normally be allowed to go home within 4 days of the operation. A longer hospital stay can be arranged according to personal circumstances.
5. DISCHARGE HOME
This operation was designed to minimise discomfort for for patients in comparison to the usual abdominal procedure. It is important not to return to work and normal activities for at least 6 weeks.
Please remember to be sensible. Most problems that occur do so because sutures tear out of the wound due to excessive straining and lifting. Vaginal intercourse should be resumed as soon as you feel your wound is comfortable. Most sutures take 6 weeks to dissolve, and if necessary can be removed earlier. Try to prevent constipation with orange juice, bran and other fibre products.
It is important to exercise extreme care when getting in and out of a car or getting up from a chair. In particular, the knees should be kept together as
much as possible during such activity, especially lifting and squatting.
6. FOLLOW-UP
An initial appointment should be made eight weeks after the operation, or earlier if there is a problem. There may be some vaginal bleeding for the first few days after the operation. You should be able to pass urine normally. Contact Dr Farnsworth if you have any problems in the postoperative recovery phase.
7. RESULTS OF THE OPERATION
You will have no periods after your hysterectomy. A small amount of bleeding is possible if there is any endometrial tissue left in the residual uterus.
If your ovaries are also removed for one reason or another you will need to consider hormone replacement therapy.
8. COMPLICATIONS
Complications are rare, but it must be understood and accepted that these can occur. The complications that can occur include but are not limited to the
following:
a) Infection - there may be a simple infection of the urine or wound requiring antibiotics alone. However, a pelvic abscess could develop requiring drainage.
b) Haemorrhage - this occurs in approximately 5% of patients who undergo a hysterectomy. A blood transfusion is rarely required.
c) Injury to Bladder or Ureter- this occurs in less than 1% of patients. Please notify Dr Farnsworth of any change in your bladder symptoms.
d) Fistula Formation - damage to the bladder, ureter or bowel can lead to leakage of urine or faeces into the vagina. This is a rare but serious complication of the surgery.
e) Retention of Urine - this is rare but may occur after any surgery. Catheterisation may be needed temporarily.
f) Deep Venous Thrombosis - a possible complication of any surgery, but much less likely with this type of hysterectomy where you are mobilized much earlier than usual.
g) Bowel ileus - temporary shutdown of the bowel can be very uncomfortable. You may need a drip until your bowel starts to function normally again.
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