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Salpingo-oophorectomy

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Salpingo-oophorectomy



How a hysterectomy is performed 

There are different types of hysterectomy. The operation you have will depend on the reason for the surgery and how much of your womb and reproductive system can safely be left in place.

The main types of hysterectomy are described below.

Total hysterectomy

During a total hysterectomy, your womb and cervix (neck of the womb) is removed.

A total hysterectomy is usually the preferred option over a subtotal hysterectomy because removing the cervix means that there is no risk of you developing cervical cancer at a later date.

Subtotal hysterectomy

A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.

This procedure is not performed very often. If the cervix is left in place, there is still a risk of cervical cancer developing and regular cervical screening will still be required.

Some women want to keep as much of their reproductive system as possible, including their cervix. If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.

Total hysterectomy with bilateral salpingo-oophorectomy

A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there is a significant risk of further problems – for example, if there is a family history of ovarian cancer.

Your surgeon will be able to discuss the pros and cons of removing your ovaries with you.

Radical hysterectomy

A radical hysterectomy is usually carried out to remove and treat cancer when other treatments such as chemotherapy and radiotherapy aren't suitable or haven't worked.

During the procedure, the body of your womb and cervix will be removed, along with your fallopian tubes, part of your vagina, ovaries, lymph glands and fatty tissue.

Performing a hysterectomy

There are three ways that a hysterectomy can be performed. These are:



vaginal hysterectomy



abdominal hysterectomy



laparascopic hysterectomy



Vaginal hysterectomy

During a vaginal hysterectomy, the womb and cervix are removed through an incision that is made in the top of the vagina.

Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.

After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.

A vaginal hysterectomy can either be carried out under a general anaesthetic (where you will be unconscious during the procedure), a local anaesthetic, or spinal anaesthetic (where you will be numb from the waist down).

A vaginal hysterectomy is usually preferred over an abdominal hysterectomy because it is less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.

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 (non-cancerous growths) in your womb or for some types of cancer.

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.

An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it is not possible to remove it through your vagina.

It may also be recommended if your ovaries need to be removed.

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small incision in your abdomen.

This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.

Laparoscopic hysterectomies are usually carried out under general anaesthetic.




Vaginal hysterectomy illustration key

1. removing uterus through vagina
2. pelvic bone
3. bladder
4. fallopian tubes and ovaries



Getting ready

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.

 

Why a hysterectomy is necessary 

A hysterectomy is a major operation for a woman that will only be recommended if other treatment options have been unsuccessful.

The most common reasons for having a hysterectomy include:



heavy periods (menorrhagia), which can be caused by fibroids, for example



pelvic pain, which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids



prolapse of the uterus 



cancer of the womb, ovaries or cervix 



Heavy periods

Many women lose a large amount of blood during their monthly periods. They may also experience other symptoms, such as pain and stomach cramps.

For some women, the symptoms can have a significant impact on their quality of life. Sometimes heavy periods can be caused by fibroids, but in many cases there is no obvious cause.

In some cases, removing the womb may be the only way of stopping persistent heavy menstrual bleeding when:



other treatments have proved ineffective



the bleeding has a significant impact on quality of life and it is preferable for periods to stop



the woman no longer wishes to have children



Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive system.

If detected early, the infection can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, resulting in long-term pain.

A hysterectomy to remove the womb and fallopian tubes may be recommended if a woman has severe pain from PID and no longer wants children.

Endometriosis

Endometriosis is a condition where cells that line the womb are also found in other areas of the body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.

If the cells that make up the lining of the womb become trapped in other areas of the body, it can cause the surrounding tissue to become inflamed and damaged. This can lead to pain, heavy and irregular periods, and infertility (inability to conceive).

A hysterectomy may remove the areas of endometrial tissue causing the pain. However, it will usually only be considered if other less invasive treatments have not worked and the woman decides not to have any more children.

Fibroids

Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size.

The symptoms of fibroids can include:



heavy or painful periods



pelvic pain



frequent urination or constipation



pain or discomfort during sex



A hysterectomy may be recommended if you have large fibroids or severe bleeding and you do not wish to have any more children.

Adenomyosis

Adenomyosis is a common condition where the tissue that normally lines the womb starts to grow within the muscular wall of the womb. This extra tissue can make your periods particularly painful and cause pelvic pain.

A hysterectomy can cure adenomyosis but will only be considered if all other treatments have failed and you do not wish to have any more children.

Prolapse of the uterus

A prolapsed uterus happens when the tissues and ligaments that support the womb become weak, causing it to drop down from its normal position.

Symptoms can include back pain, a feeling that something is coming down out of your vagina, leaking urine (urinary incontinence) and difficulty having sex. A prolapsed uterus can often occur as a result of childbirth.

A hysterectomy resolves the symptoms of a prolapse because it removes the entire womb. It may be recommended if the tissues and ligaments that support the womb are severely weakened and the woman does not want any more children.

Cancer

A hysterectomy may be recommended for the following cancers:



cervical cancer



ovarian cancer



cancer of the fallopian tubes



uterine cancer (cancer of the womb)



If the cancer has spread and reached an advanced stage, a hysterectomy may be the only viable treatment option.


Deciding to have a hysterectomy

If you have cancer, a hysterectomy may be the only treatment option. For other conditions, it's a good idea to ask yourself the questions listed below before deciding to have the procedure.



Are my symptoms seriously affecting my quality of life?



Have I explored all other alternative treatment options?



Am I prepared for the possibility of an early menopause?



Do I still want to have children?



Don't be afraid to ask your doctor as many questions as you want.

 

How a hysterectomy is performed 

There are different types of hysterectomy. The operation you have will depend on the reason for the surgery and how much of your womb and reproductive system can safely be left in place.

The main types of hysterectomy are described below.

Total hysterectomy

During a total hysterectomy, your womb and cervix (neck of the womb) is removed.

A total hysterectomy is usually the preferred option over a subtotal hysterectomy because removing the cervix means that there is no risk of you developing cervical cancer at a later date.

Subtotal hysterectomy

A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.

This procedure is not performed very often. If the cervix is left in place, there is still a risk of cervical cancer developing and regular cervical screening will still be required.

Some women want to keep as much of their reproductive system as possible, including their cervix. If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.

Total hysterectomy with bilateral salpingo-oophorectomy

A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there is a significant risk of further problems – for example, if there is a family history of ovarian cancer.

Your surgeon will be able to discuss the pros and cons of removing your ovaries with you.

Radical hysterectomy

A radical hysterectomy is usually carried out to remove and treat cancer when other treatments such as chemotherapy and radiotherapy aren't suitable or haven't worked.

During the procedure, the body of your womb and cervix will be removed, along with your fallopian tubes, part of your vagina, ovaries, lymph glands and fatty tissue.

Performing a hysterectomy

There are three ways that a hysterectomy can be performed. These are:



vaginal hysterectomy



abdominal hysterectomy



laparascopic hysterectomy



Vaginal hysterectomy

During a vaginal hysterectomy, the womb and cervix are removed through an incision that is made in the top of the vagina.

Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.

After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.

A vaginal hysterectomy can either be carried out under a general anaesthetic (where you will be unconscious during the procedure), a local anaesthetic, or spinal anaesthetic (where you will be numb from the waist down).

A vaginal hysterectomy is usually preferred over an abdominal hysterectomy because it is less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.

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 (non-cancerous growths) in your womb or for some types of cancer.

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.

An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it is not possible to remove it through your vagina.

It may also be recommended if your ovaries need to be removed.

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small incision in your abdomen.

This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.

Laparoscopic hysterectomies are usually carried out under general anaesthetic.




Vaginal hysterectomy illustration key

1. removing uterus through vagina
2. pelvic bone
3. bladder
4. fallopian tubes and ovaries



Getting ready

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.

 

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).

If you had an abdominal hysterectomy, 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. If you have had a vaginal hysterectomy, you may have a gauze pack inserted into your vagina.

This is to minimise the risk of any bleeding after the operation and will usually stay in place for 24 hours. You may find it slightly uncomfortable and feel like you need to empty your bowels (do a poo).

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).

A physiotherapist may show you how to do some exercises to help your mobility. They may also show you some pelvic floor muscle exercises to help with your recovery.

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 to seven days after your operation.

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.

If you have had a vaginal or laparoscopic hysterectomy, you may be able to leave between one and four days later. If you have had an abdominal hysterectomy, it will usually be up to five days before you are discharged.

You may be asked to see your GP in four to six weeks, but follow-up appointments with the hospital are not usually needed unless there are complications.

It takes about six to eight weeks to fully recover after having an abdominal hysterectomy. Recovery times are often shorter after a vaginal or laparoscopy 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.

If you live by yourself, you may be able to get help from your local authority while you are recovering from your operation. Hospital staff should be able to advise you further about this.

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 plenty of fluids and increase the fruit and fibre in your diet to help with your bowel and bladder movements.

For the first few bowel movements after a hysterectomy, you may need laxatives to help avoid straining. Some people find it more comfortable to hold their abdomen to provide support while passing a stool.

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.

Menopausal symptoms

If your ovaries are removed, it is likely you will experience severe menopausal symptoms after your operation. These may include:



hot flushes



anxiety



weepiness



sweating



You may have hormone replacement therapy (HRT) after your operation. This can be given in the form of an implant, injections or tablets. It usually takes around a week before having an effect.

Emotional effects

You may feel a sense of loss and sadness after having a hysterectomy. These feelings are particularly common in women with advanced cancer, who have no other treatment option.

Some women who have not yet experienced the menopause may feel a sense of loss because they are no longer able to have children. Others may feel less "womanly" than before.

In some cases, having a hysterectomy can be a trigger for depression. See your GP if you have feelings of depression that won't go away. They will be able to advise you about various available treatment options.

Talking to other women who have had a hysterectomy may help by providing emotional support and reassurance. Your GP or the hospital staff may be able to recommend a local support group for you.

The Hysterectomy Association also provides hysterectomy support services, including a one-to-one telephone support line, counselling, and "preparing for hysterectomy" workshops.

Getting back to normal

Returning to work

How long it will take for you to return to work will depend on how you feel and what sort of work you do.

If your job does not involve manual work or heavy lifting, it may be possible to return after four to eight weeks.

Driving

Don't drive until you're comfortable wearing a seatbelt and can safely perform an emergency stop.

This can be anything from between three and eight weeks after your operation. You may want to check with your GP that you are fit to drive before you start.

Some car insurance companies require a certificate from a GP stating that you are fit to drive. Check this with your car insurance company.

Exercise and lifting

After having a hysterectomy, the hospital where you were treated should give you information and advice about suitable forms of exercise while you recover.

Walking is always recommended, and you can swim after your wounds have healed. Don't try to do too much, because you will probably feel more tired than usual.

Don't lift any heavy objects during your recovery period. If you have to lift light objects, make sure that your knees are bent and your back is straight.

Sex

After a hysterectomy, it's generally recommended that you don't have sex until any vaginal discharge has stopped and you feel comfortable and relaxed, or after a minimum of six weeks.

You may experience some vaginal dryness, particularly if you have had your ovaries removed and you are not taking HRT.

Many women also experience an initial loss of sexual desire (libido) after the operation, but this usually returns once they have fully recovered.

At this point, studies show that pain during sex is reduced and that strength of orgasm, libido and sexual activity all improve after a hysterectomy.

Contraception

You no longer need to use contraception to prevent pregnancy after having a hysterectomy. However, you will still need to use condoms to protect yourself against sexually transmitted infections (STIs).

 

Complications of a hysterectomy 

As with all types of surgery, a hysterectomy can sometimes lead to complications.

Some of the possible complications are described below.

General anaesthetic

It is very rare for serious complications to occur after having a general anaesthetic (1 in 10,000 anaesthetics given).

Serious complications can include nerve damage, an allergic reaction, and death. However, death is very rare – there is a 1 in 100,000 chance of dying after having a general anaesthetic.

Being fit and healthy before you have an operation reduces your risk of developing complications.

Bleeding

As with all major operations, there is a small risk of heavy bleeding (haemorrhage) after having a hysterectomy.

If you have a haemorrhage, you may need a blood transfusion (where you receive blood from a donor).

Ureter damage

The ureter (the tube urine is passed through) may be damaged during surgery, which happens in around 1% of cases. This is usually repaired during the hysterectomy.

Bladder or bowel damage

In rare cases, damage to abdominal organs such as the bladder or bowel can occur. This can cause problems such as infection, incontinence or a frequent need to urinate.

It may be possible to repair any damage during the hysterectomy. You may need a temporary catheter to drain your urine or a colostomy to collect your bowel movements.

Infection

There is always a risk that an infection will develop after an operation. This could be a wound infection or a urinary tract infection. These aren't usually serious and can be treated with antibiotics.

Thrombosis

A thrombosis is a blood clot that forms in a vein and interferes with blood circulation and the flow of oxygen around the body. The risk of developing blood clots increases after having operations and periods of immobility.

You will be encouraged to start moving around as soon as possible after your operation. You may also be given an injection of a blood-thinning medication (anticoagulant) to reduce the risk of clots.

Vaginal problems

If you have a vaginal hysterectomy, there is a risk that you will have problems at the top of your vagina where the cervix was removed. This could range from slow wound healing after the operation to prolapse in later years.

Ovary failure

Even if one or both of your ovaries are left intact, they could fail within five years of having your hysterectomy. This is because your ovaries receive some of their blood supply through the womb, which is removed during the operation.

Early menopause

If you have had your ovaries removed, it's likely that you'll have menopausal symptoms soon after the operation, such as hot flushes, sweating, vaginal dryness and disturbed sleep. 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.
 


Salpingo-oophorectomy