Hysterectomy, removal of the uterus, is done most often to relieve pain or other complications of uterine fibroids, endometriosis or uterine prolapse. There are several ways to remove the uterus: abdominally, vaginally, through an incision at the back of the vagina, or laparoscopically. Laparoscopic surgery, a type of abdominal surgery done through very small incisions, is sometimes done in conjunction with vaginal hysterectomy. Laparoscopic hysterectomy can also be done as a separate procedure.
Statistics
Hysterectomy is the second most common surgery performed on women of childbearing age, the Centers for Disease Control and Prevention reported in 2008. More than 600,000 hysterectomies are done each year in the United States. Around 40 percent of women have had a hysterectomy by age 60, Family Practice Notebook reports. Two-thirds of all hysterectomies in the United States are done abdominally via a laparatomy, or open incision, a November 2009 article in "Obstetrics and Gynecology" by ACOG reported, with 22 percent done vaginally and 12 percent done laparoscopically.
Procedures
Abdominal hysterectomy is major surgery, requiring a 5- to 7-inch incision. The incision usually runs horizontally, low on the abdominal wall, but can also be done with a vertical incision. Vaginal hysterectomy is done through the back of the vaginal wall, which avoids any type of abdominal incision. Laparoscopy requires three to four small incisions on the abdominal wall. All three types of hysterectomy are done under general anesthesia.
Pros and Cons
Vaginal and laparoscopic hysterectomies avoid the large incision necessary for abdominal hysterectomy. Vaginal and laparoscopic surgeries also result in fewer postoperative infections than abdominal hysterectomy and a shorter hospital stay. Laparoscopic hysterectomy takes more time than abdominal or vaginal hysterectomy, which can result in more anesthesia complications. Laparoscopic surgery also has a higher risk of injury to the urinary tract than abdominal surgery, the American Congress of Obstetricians and Gynecologists reports.
Abdominal hysterectomy allows better visualization of the abdominal cavity during the surgery. Abdominal surgery may be the best choice for hysterectomies done to remove cancer, because it allows better visualization of nearby structures. Also, not everyone is a candidate for vaginal or laparoscopic hysterectomy. A very large uterus, or the presence of scar tissue from previous surgeries, may rule out the possibility of vaginal surgery.
Recovery
Vaginal hysterectomy allows the fastest recovery and healing times, followed by laparoscopic hysterectomy. Women undergoing abdominal surgery have twice as many incidences of postoperative fever and significantly higher amounts of blood loss than women undergoing other hysterectomy procedures, according to FamilyPracticeNotebook.com.
Considerations
Only a physician can determine the best approach to hysterectomy in an individual woman. Age, general health, patient weight, physician training and the reason for the procedure all influence the decision. In some cases, a vaginal or laparoscopic procedure must be converted to a laparotomy, or open procedure.
References
- "Obstetrics and Gynecology": Choosing the Route of Hysterectomy for Benign Disease; ACOG Committee Opinion No. 444
- American Congress of Obstetricians and Gynecologsts: Hysterectomy
- Centers for Disease Control and Prevention: Hysterectomy in the United States 200-2004
- FamilyPracticeNotebook.com: Hysterectomy
- MedlinePlus: Hysterectomy
