Vaginal Hysterectomy

What is Vaginal Hysterectomy

Vaginal hysterectomy is one of the most common types of hysterectomy for uterus removal, known for being minimally invasive, and is often favored due to its better outcomes with fewer complications compared to other methods. It’s typically the preferred choice for hysterectomy when feasible. 

Overview 

Vaginal hysterectomy is a surgical procedure, performed under general, spinal, or epidural anesthesia, to remove the uterus through the vagina. It’s a common solution for various gynecological issues. The procedure also involves the removal of the cervix, eliminating the need for future cervical screenings.

Indications

The decision to perform vaginal hysterectomy is made when other treatments have been unsuccessful. Some of the common conditions where vaginal hysterectomy is indicated are:

• Women experiencing heavy or chronic menstrual pain impact their quality of life.
• Women having heavy bleeding leading to anemia
• Pelvic prolapse, a condition where the uterus or parts of the vaginal wall drops down causing urine leakage, disturbances in bowel movements.
• Uterine fibroids: Uterine fibroids are growths that appear in a woman’s uterus, or womb. They’re typically not harmful and don’t turn into cancer. These fibroids can be so small that they’re only visible under a microscope, but they can also become quite large, filling up the entire uterus and even weighing several pounds. It’s common for more than one fibroid to develop at a time.
• Adenomyosis: This condition happens when a tissue lining the uterus grows abnormally into the uterine wall, leading to an enlarged uterus, causing heavy and painful menstrual bleeding.
• Gynecological cancer. A vaginal hysterectomy is sometimes recommended for women diagnosed with cervical or endometrial cancer to prevent the spread of cancer to another area.
• Multidisciplinary team: The vaginal hysterectomy is performed under the supervision of a team of multidisciplinary experts, including gynecologists, urogynecologists, anesthesiologists, anesthetic technologists, nurses and surgical assistants.

Procedure Details

• Preparatory instructions will be provided before the surgery day which include evaluation of certain blood and urine tests. An enema or bowel preparation will be administered as well
• Once the patient is ready for the surgery, an intravenous infusion will be inserted into the arm to provide fluids and medications. The pubic area will be cleaned with an antiseptic solution and then shaved.
• Though there won’t be an incision in the abdomen, the patient will still need anesthesia because it’s a surgical procedure. The doctor will administer general anesthesia, or epidurals instead.
• While one is under anesthesia, a tube will be inserted down the throat to assist with breathing. Another tube will be used to remove gas from the stomach. These tubes are usually put in and taken when the patient is unconscious.
• An incision is made around the cervix at the top of the vagina to remove the womb and cervix.
• The surgeon will make a small cut in the vagina and use special tools to separate the uterus from the upper part of the vagina, fallopian tubes, ovaries, connective tissue, and blood vessels.
• A small tube, known as a catheter, might be put into the bladder for urine excretion. Special stockings will be fitted to help prevent blood clots in the legs during the surgery.
• Once the uterus has been separated, it will be removed through the vagina. Some surgeons might use a special tool called a laparoscope to help with this process.
• The cut will be closed with stitches that will dissolve on their own over time. The whole surgery usually takes between one and three hours.

Preparing for the Operation

It’s better to quit smoking before surgery, quitting smoking can lower the risk of complications and improve overall health.

The practice of having a healthy diet and maintaining a healthy weight is important as being overweight can increase the risk of complications.

Practicing regular exercise can help prepare the person for operation, promote faster recovery, and improve long-term health outcomes. It is crucial to get advice from a doctor before starting any exercises.

Discuss any vaccinations that may be required to reduce the risk of complications. 

After the Procedure

Following surgery, the patient will spend one to two hours in a recovery room and stay in the hospital overnight. Some women may be able to go home on the same day.

The patient will be prescribed medications to manage pain.

The patient may experience bloody vaginal discharge for several days post-hysterectomy. Hence, they are asked to wear sanitary pads.

Recovery 

Recovery after a vaginal hysterectomy is typically shorter and less painful compared to abdominal hysterectomy. A full recovery usually takes three to four weeks.

Even if you feel recovered, avoid lifting anything heavy (more than 20 pounds or 9.1 kilograms) and refrain from having vaginal intercourse until six weeks after surgery.

Contact your doctor if your pain worsens or if you experience nausea, vomiting, or bleeding that is heavier than a menstrual period.

Emotional Recovery

After a hysterectomy, you might feel relieved because you no longer experience heavy bleeding or pelvic pain.

For most women, there is no change in sexual function after a hysterectomy. In fact, some women report increased sexual satisfaction, possibly because they no longer have pain during intercourse.

It's normal to feel a sense of loss and grief after a hysterectomy. You might also experience depression related to the loss of fertility, especially if you are young and have hoped to have children. If sadness or negative feelings interfere with your daily life, talk to your doctor.

Outcomes of Vaginal Hysterectomy

After a hysterectomy, the women will no longer have periods or be able to become pregnant.

Women may reach early menopause immediately after surgery, which can cause vaginal dryness, hot flashes and night sweats. However, such symptoms can be managed by medications and hormone therapy suggested by concerned doctors.

If the ovaries were not removed during surgery and women will continue to have periods after the procedure, and ovaries will continue to produce hormones and eggs until natural menopause is reached.

Possible Complications

Some complications associated with vaginal hysterectomy can be serious and even life-threatening.

General complications of any operation can include:

• Feeling or being sick
• Bleeding
• Blood clots in your veins
• Infection at the surgical site
• Allergic reaction to the equipment, materials, or medication
• Sudden kidney problems
• Chest infection
• Specific complications of this operation can include:
• Infection or abscess in the pelvic area
• An abnormal connection (fistula) developing between your bowel, bladder, or ureters, and your vagina
• Damage to structures near your womb
• Needing to switch to an abdominal hysterectomy
• A collection of blood (hematoma) forming inside your abdomen
• The top of your vagina (vaginal cuff) coming apart
• Prolapse happening again
• Going through early menopause