Abdominal Hysterectomy

Transcription

1 Abdominal Hysterectomy Families Division Patient Information Leaflet Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please call: People Centred Positive Our Four Values: Compassion Excellence

2 A hysterectomy is a surgical procedure to remove the womb (uterus). After the operation you will no longer be able to get pregnant. If you haven't already gone through the menopause, you will also no longer have periods, regardless of your age. The menopause is when a woman's monthly periods stop, usually at around the age of 52. Why do I need a hysterectomy? A Hysterectomy is carried out to treat conditions that affect the female reproductive system, including: heavy periods (menorrhagia) long-term pelvic pain non-cancerous tumours (fibroids) ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tubes A hysterectomy is a major operation with a long recovery time and is only considered after alternative, less invasive treatments have been tried. Recovering from a hysterectomy A hysterectomy is a major operation. You can be in hospital for two or three days following surgery and it takes about six to eight weeks to fully recover. Things to consider before having a hysterectomy If you have a hysterectomy, as well as having your womb removed you may have to decide whether to have your cervix or ovaries removed. During the procedure, due to technical difficulty, sometimes the cervix (neck of the womb) may not be removed. These decisions are usually made based on your medical history, your doctor's recommendations and your personal feelings. It is important that you are aware of the different types of hysterectomy and their implications. Page 2

3 Removal of the cervix (total or radical hysterectomy) If you have cancer of the cervix (the neck of the womb), ovaries or womb, you may be advised to have your cervix removed to prevent the cancer spreading. Even if you do not have cancer, removing the cervix means that there is no risk of developing cervical cancer in the future. Many women are concerned that removing the cervix will lead to a loss in sexual function, but there is no evidence to support this. If you have your cervix removed, you will no longer need to have cervical screening tests. If you do not have your cervix removed, you will need to continue having regular screening for cervical cancer (cervical smears). Removal of the ovaries (salpingo-oophorectomy) The National Institute for Health and Clinical Excellence (NICE) recommends that a woman's ovaries should only be removed if there is a significant risk of associated disease, such as ovarian cancer, or technically difficult to leave them behind. If you have a family history of ovarian or breast cancer, removing your ovaries (an oophorectomy) may be recommended to prevent cancer occurring in the future. Your surgeon will be able to discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed. If you have already gone through the menopause, or you are close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy. This is to protect against the possibility of ovarian cancer developing. Some surgeons feel that it is best to leave healthy ovaries in place if the risk of ovarian cancer is small; for example, if there is no family history of the condition. Page 3

4 This is because the ovaries produce several female hormones that can help protect against conditions such as osteoporosis (weak and brittle bones). They also play a part in feelings of sexual desire and pleasure. If you would prefer to keep your ovaries, make sure you have made this clear to your surgeon before your operation. You may still be asked to give consent (permission) for your ovaries to be removed if an abnormality is found during the operation. Think carefully about this and discuss any fears or concerns that you have with your surgeon. Getting ready for surgery If you need to have a hysterectomy, it's important to be as fit and healthy as possible. Good health before your operation will help reduce your risk of developing complications and speed up your recovery. As soon as you know that you are going to have a hysterectomy, take the following steps: Stop smoking (if you smoke) Eat a healthy, balanced diet. Exercise regularly. Lose weight (if you are overweight). You may need to have a pre-assessment appointment a few days before your operation. This may involve having some blood tests and a general health check to ensure that you are fit for surgery. It is also a good opportunity to discuss any concerns that you have and to ask questions. Abdominal Hysterectomy During an abdominal hysterectomy, an incision will be made in your abdomen (tummy). It will either be made horizontally, along your bikini line, or vertically from your belly button to your bikini line. A vertical incision will usually be used if there are large fibroids (noncancerous growths) in your womb or for some types of cancer. Page 4

5 After your womb has been removed, the incision is stitched up. The operation will take about an hour to perform and a general anaesthetic is used. Frequent risks include: wound infection, pain, bruising, delayed wound healing or keloid (an overgrowth of scar tissue that develops around a wound) formation numbness, tingling or burning sensation around the scar. This usually heals by itself but it could take weeks or months to resolve. frequency of micturition (urinating) and urinary tract infection ovarian failure (early menopause). Serious risks include: The overall risk of serious complications from abdominal hysterectomy is approximately four women in every 100 (common): damage to the bladder and/or the ureters (seven women in every 1,000) and/or long-term disturbance to the bladder function (uncommon) damage to the bowel: four women in every 10,000 (rare) haemorrhage requiring blood transfusion, 23 women in every 1,000 (common) return to theatre because of bleeding/wound rupture, and so on: seven women in every 1,000 (uncommon) pelvic abscess/infection: two women in every 1,000 (uncommon) venous thrombosis or pulmonary embolism, four women in every 1,000 (uncommon) risk of death within six weeks, 32 women in every 100,000 (rare). the main causes of death are pulmonary embolism and cardiac disease. Page 5

6 Early menopause If you have had your ovaries removed, it is likely that you will have menopausal symptoms, such as hot flushes, sweating, vaginal dryness and disturbed sleep, soon after your operation. This is because the menopause is triggered once you stop producing eggs from your ovaries (ovulating). This is an important consideration if you're under the age of 40 because early onset of the menopause can increase your risk of developing brittle bones (osteoporosis). This is because the level of the hormone, oestrogen, decreases during the menopause. Depending on your age and circumstances, you may need to take additional medication to prevent osteoporosis. Recovering from a hysterectomy After having a hysterectomy, you may wake up feeling tired and in some pain. This experience is normal after this type of surgery. You will be given painkillers to help reduce any pain and discomfort. If you feel sick after the anaesthetic, your nurse will be able to give you medicine to help relieve this. You may have a drip in your arm and a catheter (a small tube that drains urine from your bladder into a collection bag). You may also have a drainage tube in your abdomen to take away any blood from beneath your wound. These tubes will usually stay in place for one to two days. Dressings will be placed over your wounds. The day after your operation, you will be encouraged to take a short walk. This helps your blood to flow normally, reducing the risk of complications developing, such as blood clots in your legs (deep vein thrombosis). After the catheter has been removed, you should be able to pass urine normally. Any stitches that need to be removed will be taken out five-toseven days after your operation. Page 6

7 Your recovery time The length of time it will take before you are well enough to leave hospital will depend on your age and your general level of health. It will usually be up to three days. It takes about six-to-eight weeks to fully recover after having a hysterectomy. During this time, you should rest as much as possible and not lift anything heavy, such as bags of shopping. Your abdominal muscles and the surrounding tissues need time to heal. Side effects After having a hysterectomy, you may experience some temporary side effects as outlined below. Bowel and bladder disturbances After your operation, there may be some changes in your bowel and bladder functions when going to the toilet. Some women develop urinary tract infections or constipation. Both can easily be treated. It's recommended that you drink one-to-two litres of fluid a day and increase the fruit and fibre in your diet to help with your bowel and bladder movements. Vaginal discharge After a hysterectomy you will experience some vaginal bleeding and discharge. This will be less discharge than during a period but it may last up to six weeks. Visit your GP if you experience heavy vaginal bleeding, start passing blood clots or have an offensive-smelling discharge. Further information can be obtained from for you after abdominal hysterectomy Page 7

8 Useful contact details Hospital Switchboard: Patient Relations Department The Patient Relations Department offer impartial advice and deal with any concerns or complaints the Trust receives. You can contact them via: Tel: You can also write to us at: Patient Relations Department, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR Further information is available on our website: References This leaflet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this leaflet are available on request from: Procedural Document and Leaflet Coordinator Approved by: Clinical Improvement Committee Date of Publication: 07/04/2014 Reference No: lc PL/843 Author: Adele Whitehead Review Date: 01/11/2016