Hysterectomy involves the removal of the female reproductive organs when necessary. Minimally invasive or surgical options are available for the removal of these organs. Although it can be performed through different regions of the body, abdominal hysterectomy provides the widest working area. If the entire uterus needs to be removed, a total hysterectomy is performed to carry out this procedure.
What Is Abdominal Total Hysterectomy Surgery?
Hysterectomy is the procedure of removing either the entire uterus or only a part of it, depending on various reasons. Supracervical or subtotal hysterectomy involves removing only the upper part of the uterus while leaving the cervix in place, whereas total hysterectomy removes the entire uterus and cervix. Radical hysterectomy is generally performed only when cancer is present. The surgeon may also remove only the ovaries through a procedure called oophorectomy. The removal of the fallopian tubes is called salpingectomy.
Total abdominal hysterectomy is a procedure performed to completely remove the uterus. In this procedure, the entire uterus and the cervix, known as the neck of the womb, are removed from the body together through an incision made in the abdomen, i.e., the abdominal area. In this procedure, the uterus is removed through a large incision made in the abdomen. However, the ovaries are most often not touched. The process involves only the cervix and the uterus. The incision may be made lengthwise from the navel to the pubic bone, or horizontally just below the navel, extending to both sides. The surgeon uses sutures and staples to close the incision. This procedure is commonly used when cancer is present, when the uterus is enlarged, or when the disease has spread to other pelvic areas. Because the procedure is performed through a large incision and organs are removed, it generally requires a longer hospital stay and recovery period.
Abdominal hysterectomy is an invasive surgical procedure in which the uterus, i.e., the womb, along with the cervix, ovaries, ligaments and fallopian tubes, is removed through a horizontal incision made in the lower abdomen or bikini line. The opening in the abdomen must be wide enough to allow the surgeon easy access to the pelvic organs. However, in some cases, if the uterus is very large or bulky, a vertical incision may be made to give the surgeon easier access to the abdominal cavity. Abdominal hysterectomy is performed under general anesthesia and may last between 60 minutes and 2 hours, depending on the type of hysterectomy. The following side effects may be experienced after total abdominal hysterectomy:
Constipation
Urinary tract infections
Vaginal bleeding
Discharge
How Is Abdominal Total Hysterectomy Surgery Performed?
There are different types of hysterectomy for removing the reproductive organs in women. This procedure does not always require large incisions. However, the size and reason for the organ to be removed influence how the procedure is determined. In uterus removal surgeries performed with a laparoscope, small holes opened in the abdomen are used. A tube with a camera called a laparoscope is inserted through these incisions and allows the internal organs to be viewed. The uterus and cervix to be removed are taken out through the other incisions using the necessary instruments. It is not an open surgical procedure. Another option is vaginal hysterectomy. In vaginal hysterectomy, the surgery is performed through the vagina and the organs removed are the same. This procedure also requires incisions and is not minimally invasive. The other option is abdominal hysterectomy. The organs are removed from the body through a surgical incision made in the abdomen. Which option is appropriate is determined by the surgeon based on the tests performed. It is important to follow the advice given by the doctor for a period before the surgery. When the decision for abdominal total hysterectomy is made, the patient is first given anesthesia through an intravenous (IV) line for the procedure. This anesthesia is administered to help the person be asleep and not feel pain during the surgery. Then, depending on need, the incision is made either as a vertical incision starting just below the navel and extending downward, or as a horizontal incision made in the lower abdomen just below the navel. If a partial hysterectomy is to be performed after the incision is opened, the upper part of the uterus is removed without touching the cervix, but in a total procedure both parts are removed completely. The surgeon uses fine instruments to separate the uterus and cervix from the supporting ligaments and removes them through the incision. After the appropriate type of hysterectomy has been performed, the surgeon closes the incision with sutures and a dressing. After this point, dressings soaked in medication may also be placed in the vaginal area to reduce infection and bleeding.
The recovery process after hysterectomy may vary depending on the type of surgery performed and the person's general health before surgery. The average recovery time for vaginal or laparoscopic hysterectomy is 3-4 weeks. In abdominal hysterectomy, the time needed to be well enough to leave the hospital depends on age and general health level.
After abdominal hysterectomy, it may take approximately 6-8 weeks to fully recover. During this period, rest as much as possible and avoid lifting heavy objects. The abdominal muscles and surrounding tissues need time to heal.Before being discharged from the hospital, various exercises may be taught to the patient and they may be asked to perform them during the recovery process. At the same time, it is important to properly care for the incision during this process. Incision care is carried out in the hospital through regular check-up examinations. Constipation is a condition that may occur after surgery. To prevent this, it is important to drink plenty of fluids and eat fresh fruits and vegetables.
After surgery, a dressing is applied to prevent the incision from becoming infected, and this dressing may need to be changed at healthcare facilities. A catheter may also be inserted to drain urine from the bladder. In abdominal hysterectomy, a drainage tube that will remain for a few days may be used so that fluid does not accumulate in the wound and can be removed from the body.
Why Is Abdominal Total Hysterectomy Performed?
The reason for performing abdominal total hysterectomy may differ for each patient. Before this surgery is performed, the patient's medical history, test results and existing illnesses are carefully evaluated. The most common reason for total abdominal hysterectomy is cancer of the uterus and cervix. If other alternative methods fail to treat the condition, it may also be used to treat uterine fibroids, uterine prolapse, endometriosis, and persistent long-term bleeding. However, a person cannot become pregnant after total abdominal hysterectomy. For this reason, this procedure is not resorted to unless it is absolutely necessary. After all other treatment options have been explored, some women whose quality of life is excessively affected by heavy or very painful periods may benefit from abdominal hysterectomy. If fibroids are present in the uterus, large fibroids can put pressure on the bladder and cause urinary symptoms. Endometriosis occurs when cells are found outside the uterus, frequently in the fallopian tubes, ovaries, and other nearby organs in the body such as the bladder or intestines. For this reason, this surgery may also be considered when there is a high likelihood of endometriosis spreading extensively. In particular, total abdominal hysterectomy may be recommended to reduce life-threatening risk in people with cancer of the cervix, uterus, fallopian tubes or ovaries. Total abdominal hysterectomy may be performed for the following reasons:
Uterus larger than normal
Ovarian and uterine cancer
Endometriosis
Large uterine fibroids
Chronic uterine infection
Severe pain associated with menopause
What Are the Benefits of Abdominal Total Hysterectomy?
Abdominal hysterectomy allows the surgeon to reach the pelvic organs well and to see the organs completely. In this way, the surgeon can quickly identify existing problems. With the abdominal incision opened, it enables the removal of a very large uterus or areas of extensive endometriosis, adenomyosis or scar tissue. Depending on the patient's condition, the surgeon may decide during surgery whether to preserve or remove the cervix. At the same time, it requires less time under anesthesia and during surgery compared with laparoscopic hysterectomy. For people living with masses such as fibroids, adenomyosis or endometriosis, hysterectomy can help reduce or eliminate chronic pain. It can also help prevent unexpected and heavy bleeding. For people who undergo surgery due to cancer, hysterectomy is an important part of the treatment plan. Removal of the uterus and cervix is the most common treatment method for endometrial cancer. Sometimes, the removal of the fallopian tubes, with or without the ovaries and lymph nodes, is also necessary. At the same time, removal of the uterus may be required to prevent the spread of early-stage cancers.
Frequently Asked Questions:
Abdominal total laparoscopy is performed when other treatment options do not respond or when no other treatment option is available. However, the options that can be tried before this surgery are as follows:
Medical treatment
Hormonal therapy
Laparoscopy
Myomectomy
Endometrial ablation
Uterine artery embolization
Vaginal hysterectomy
If no response is obtained from these options, total abdominal hysterectomy may be performed as the first option. Bleeding during this procedure, which is carried out through an open surgical approach, is normal. The surgeon may recommend not using blood-clotting-inhibiting medications before surgery. At the same time, necessary precautions are taken during the surgery. To reduce bleeding that may occur after surgery, dressings and vaginal dressings may be used. During total hysterectomy, the uterus and cervix are removed together. If deemed necessary, removal of the ovaries may also be considered. Abdominal hysterectomy is performed through an incision made from below the navel. The abdominal area is the abdominal cavity and provides the surgeon with the necessary space for removing the uterus. The recovery process after surgery may vary from person to person, but on average it is around 6-8 weeks. A surgery is undergone in which the uterus and cervix are removed, performed openly through the abdominal region. It is the removal of the entire uterus. Removal of the ovaries is not part of the surgery, but if the surgeon deems it necessary, they may also consider removing the ovaries. Total abdominal hysterectomy is a procedure for which the decision must be made carefully. The surgeon must make the decision by taking into account their expertise in the field and the benefits the procedure will provide to the patient. Therefore, the surgeon who will perform the procedure should be chosen carefully, and the healthcare facility where the procedure will be performed should be free of risk with regard to the development of complications. If you have health problems in the uterine area or suspect such problems, you can make an appointment with the Department of Obstetrics and Gynecology to have the necessary examinations.
