Hysterectomy - Risks and Complications

Definition

Hysterectomy is the surgical removal of the uterus or womb.

Description

Hysterectomy is a major surgery. There are life-threatening and non-life-threatening reasons to undergo hysterectomy (see Health Profile: Hysterectomy). It is a relatively common procedure. However, as with all surgical procedures, there are risks involved.

Risks

The risks include:

• Infection

• Postoperative hemorrhage (bleeding)

• Possible nerve damage

• Chronic irritation at the scar at the top of the vagina

• Bowel obstruction

• Urinary tract injury

• Blood clots

• Persistent pain

• Complications of general anesthesia

• Risks from blood transfusions (if necessary)

Complications

Infection is a very common complication of hysterectomy, because of both the normal microbial population of the area, and the use of bladder catheters after surgery.

Women frequently report a change in sexual responsiveness and ability to enjoy intercourse after hysterectomy. Concerning this potential complication, one needs to distinguish carefully between hysterectomy that includes removal of the ovaries, which clearly can cause hormonal changes, and hysterectomy that leaves the ovaries in place, a procedure that preserves the normal female hormonal balance, but may alter pelvic and vaginal sensations.

Other complications following vaginal and abdominal hysterectomy can include enterocele (a herniation of the vagina into the pelvic cavity) and complete and incomplete prolapse of the vaginal vault.

Pulmonary embolism is a potentially fatal complication of any surgery in the lower body. The rate of embolism in vaginal hysterectomies is about one-fifth that of abdominal hysterectomies (0.3 percent versus 1.7 percent).

Urinary retention can follow almost any surgery, but is especially common after operations on the abdomen and pelvis.

Hysterectomy And Removal Of Ovaries

If a candidate for a hysterectomy is over the age of 45, the suggestion may be made that the ovaries be removed at the same time. For a woman who is still menstruating, this will produce instant menopause. From that moment on, she will make no more estrogen (except for the small amount produced by the fat tissue) and generally receive hormone replacement therapy.

The argument for routinely removing the ovaries is that the patient is either fast approaching menopause or has already passed it. Consequently, there is no need to retain the ovaries since the childbearing years are over.

It is also argued that removing the ovaries will eliminate the possibility of ovarian cancer, a deadly disease with no early warning signs.

You and your physician must decide together if the benefits of hysterectomy outweigh the risks involved.

Questions to Ask Your Doctor

Do the complications decrease or increase according to the type of surgical procedure that is used?

Which procedure has the least complications?

Which procedure do you recommend and why?

How many hysterectomies have you performed? How many have had complications?

Do you recommend antibiotics prophylactically?

Will the ovaries be left in place?

Are there any tests before surgery that need to be done to detect any possible problems that may lead to a complication?

Is there anything I can do to decrease the chances of complications?