Recovering from

total abdominal hysterectomy

- bilateral salpingo-oophorectomy
and omentectomy

We dedicate this book to all of the women

who have entrusted their care to us.
By allowing us to take part in their surgery and after care,
they have shared an important time in their
lives with us and taught us a great deal.

Contributors:
Physicians: Dr. L. Elit, Dr. F. Moens, Dr. J. Mazurka
Nurses: Betty Anne Lane, Tracey Mullen, Heidi Thomas
Medical Secretary: Joanne Ricciardone
Patient Education Services, Hamilton Health Sciences

Hamilton Health Sciences, 2006 and 2010.

Table of Contents
Page

Part 1: Learning about this condition ..................................... 3 - 16

Part 2: Learning about your hospital stay and

your health care team ................................................ 17 - 28

Part 3: When you go home ................................................... 29 - 35

This book contains the answers to the most common questions

women have about total abdominal hysterectomy bilateral
salpingo-oophorectomy and omentectomy. It also provides information
to help you recover in the hospital and at home.
This book will not replace talking with your caregivers, but may make
it easier. Please share your concerns with us, write down questions
you wish to ask the Health Care Team.

Questions:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
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Recovering from TAH - BSO and omentectomy

Recovering from TAH - BSO and omentectomy

Part 1:
Learning about this condition

Recovering from TAH - BSO and omentectomy

Recovering from TAH - BSO and omentectomy

What is a total abdominal

hysterectomy bilateral salpingooophorectomy and omentectomy?
There are 3 parts to this surgery:
1. A total abdominal hysterectomy, or TAH, is the removal
of your uterus or womb. The cervix is also removed.
2. Bilateral salpingo-oophorectomy, or BSO is the removal
of your tubes and ovaries.
3. Omentectomy which is the removal of the omentum.
The omentum is an apron of fat which covers the other
organs in the abdomen.

Why do I need surgery?

This surgery is needed whenever there is a pelvic mass or growth.
Often the cause of the pelvic mass is not known until after
the surgery. After the surgery a doctor called a pathologist examines
the tissues of the mass under the microscope. Only then can we be
sure if it is cancer or not.

Recovering from TAH - BSO and omentectomy

Your doctors and other health care providers will discuss

all treatment plans with you. They may use these words to
describe what you have:
Tumour which is an abnormal growth or mass to describe what
you have. This does not mean that you definitely have cancer but
is a word used to help describe what is going on.
Benign means that it is not cancer.
Malignant means that it is cancer.
If the tumour is not cancer, the surgery will be the only treatment
you will need. If the tumour is found to be cancer, you may need
to have further treatment such as chemotherapy or radiation.
Each persons treatment plan is different so that you can get the
best results possible.

What is the reason for my surgery?

There are two main reasons for surgery.
The first is to find out what the abnormal growth or mass is and
in what organ it started.

Recovering from TAH - BSO and omentectomy

The second reason is to allow for the removal of as much of the

mass as possible. Tumour cells are very tiny (microscopic).
If cancerous, some may have spread to the nearby organs.
To reduce the risk of spread, the surgeon will remove those organs
as well. That is why, even though the tumour may have started on
the ovary, that the uterus, tubes and omentum are also removed.
When the operation is complete, the surgeon will check the liver,
spleen, diaphragm and all the surfaces in your abdomen. This is to
see if these organs are healthy. For this reason, your incision may
be an up and down line from the pubic hairline to several inches
above the belly button.
Blood tests can be done to find out more about your mass. In most
cases, blood tests cannot identify a cancer but will show how well
the body is functioning.

Recovering from TAH - BSO and omentectomy

What fills the empty space when

everything is removed?
Normally, the uterus, ovaries and tubes fill a space in your lower
abdomen about the size of your hand. The small bowel or intestines
are just above. After a TAH-BSO, the intestines will dip down to fill
the space.

Will I have to take hormones after

my ovaries are removed?
There is no single answer to this question.
During the years when you can have children, you produce
hormones each month. They prepare your body for pregnancy
and also maintain the health of your bones, vagina and breasts.
If the ovaries stop working early either through surgery or
in menopause, you will no longer produce the same amount
of hormones. This may lead to side effects such as hot flashes,
thinning of the bones or dryness in the vagina. Changes made to
diet and lifestyle can help lessen some of these side effects or
you may choose to take hormones.

Recovering from TAH - BSO and omentectomy

There are times when a doctor would not recommend hormones.

There is some evidence that certain cancers or medical conditions
get worse when taking hormones.
There are non-hormone medications that can be prescribed to ease
the symptoms of menopause if you need them.
Therefore it is very important to discuss all these issues openly with
your nurse and doctor to make the best decision for yourself.
If you cannot or choose not to take hormones:
For vaginal dryness, use a water-soluble lubricant such
as K-Y Jelly and spend more time becoming aroused
before intercourse.
To keep your bones strong, walk or exercise briskly for
20 minutes 3 times a week. Be sure to maintain a healthy
well balanced diet and limit salt, alcohol and caffeine to help
keep your bones healthy and strong. Also, talk to your family
doctor about scheduling routine bone density exams.

Recovering from TAH - BSO and omentectomy

When will I know if I have cancer

or not?
You and your family may want to know the answer to this question
as soon as possible. If fluid is removed from the abdomen and
cancer cells are found in it, the condition is known to be a cancer.
During the operation, it may be possible to tell from what the mass
looks like whether or not it is a cancer.
However, to be completely sure the mass is cancer, it needs to be
looked at very carefully under the microscope by a specialist called
a pathologist. This examination usually takes up to 2 weeks.

What does it mean if there is cancer

left inside after the surgery?
Surgery is done to remove most if not all of the tumour.
Sometimes, this is not possible. Both cancer of the ovary,
tube and cancer of the peritoneum (lining of the abdomen)
are like this. Sometimes, because the tumour and organs are
stuck together, it is too difficult to separate them for removal.
Other times, tumour seedlings are scattered over such a large
area that it is next to impossible to remove them.

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Recovering from TAH - BSO and omentectomy

In these cases, your doctor will recommend chemotherapy or

radiation to shrink or kill any remaining cancer cells. Further surgery,
if needed, is done at a later date.

How long will I be in hospital?

A usual hospital stay is about 3 to 5 days. This is just an estimate.
Your hospital stay may be longer or shorter than this. When the
doctors feel you are ready, you can go home.

How long does recovery take?

Total recovery has 3 parts: physical, emotional and sexual.
These 3 parts of the recovery period may happen at different times.

Physical
Physical recovery includes healing of the skin incision and return
of energy. This can take 6 to 8 weeks. At the end of this time,
most women will be back to their usual work and social activities.

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Recovering from TAH - BSO and omentectomy

Emotional
Emotional recovery means adjusting to the shock of having a
cancer, being away from home and believing you can become well
again. It also means feeling comfortable with yourself and the
changes in the appearance of your body after your surgery.
Emotional recovery may happen at the same time as physical
recovery, or it may take longer.

Sexual
Sexual recovery involves a return to your previous patterns
of lovemaking, or making changes that fit with your partners and
your needs. The outer sexual organs, the vagina and the brain
(your most important sexual organ) remain the same. So does
your normal, human need to feel loved and cared for.

If you would like, we can talk with you about positions and activities
that can help you and your partner enjoy a comfortable relationship.
The length of time for this recovery varies, but it is possible with
patience and care. It can take 1 to 3 months, but it is not unusual
for it to take longer.

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What changes will there be

sexually?
Most women report few sexual changes as a result of this operation.
Healing of all incisions usually takes 6 to 8 weeks. After that, it is
possible to start having intercourse again. Of course, affection and
touching are possible before that time if the couple wishes.
This surgery will not change the womans ability to have
satisfying sexual relations or change her level of interest in sex.
Women may notice the following changes:
The vagina may be shorter in its relaxed state, if the top
section has been removed with the uterus. As the vagina is
very stretchy, most people cannot tell the difference during
lovemaking. In the aroused state, the vagina naturally
lengthens.
The operation should not affect your ability to have an orgasm
or sexual climax. However, a climax causes muscle
contractions in the uterus as well as other parts of the body.
Since the uterus is no longer there, some women have said
there is a slight difference in their orgasms.

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Recovering from TAH - BSO and omentectomy

If menopause had not previously started, it will now.

Many women find the vagina does not get as wet as it did
before menopause. It is therefore a good idea to spend more
time becoming aroused while making love so the vagina can
be ready. It also helps to use a water-soluble lubricant such
as K-Y Jelly. Oil based lotions and Vaseline will not flow
freely out of the body and should not be used.
A cancer diagnosis and surgery can be stressful. If you have
been tired, anxious or worried, you may find that your interest
in sex is less. Talking to your partner or health care providers
along with time and patience will often help your sexual
feelings return. By 6 months, most women report a return
to their usual lovemaking.

Will I have a lot of pain?

This is a common concern. However, the more comfortable you are,
the quicker you will recover. Comfort also allows you to take an
active part in getting well again. During your pre-op visit,
the anesthesiologist will talk to you about pain control. There are
2 main types of pain control used after surgery.

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The first is called Patient Controlled Analgesia, or PCA. It consists of

a mechanical pump that delivers morphine by intravenous (IV) when
you push the button. There is a dose and time limit set on the pump
so you do not have to worry about giving yourself too much
morphine. As well, when morphine is used to control pain after
surgery there is no need to worry about becoming addicted to it.
You will find that you may use it a lot the first day or so and then less
each following day. Patients usually have a PCA for 2 to 3 days.

The second type of pain control is an epidural. The anesthesiologist

places a tiny tube into your back area during surgery. The tube is
then taped to your back and over your shoulder. A special pump will
then deliver medication continuously so that you will feel less pain in
the surgical area. Some patients have slight numbness or heaviness
of one or the other thigh/leg. This is normal and will be closely
watched by the nurses. This gets better when the epidural is
taken out. You will still be getting up and walking with the epidural
in place after surgery. Patients usually have an epidural in
for 2 to 3 days.

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Part 2:
Learning about your hospital
stay and your health care team

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This part of the book describes your care in the hospital. The goal
of care is to help you recover and to prepare you for going home.
A number of people will be involved in your care. They are all part
of your health care team.
The most important person on the team is you! You will take part
in your care too. A team needs to work together.

Who is my main doctor?

I have met so many
Your main doctor is a specialist called a Gynecologic Oncologist.
One of his/her roles in your care is to coordinate other medical
specialists so that you get the best possible care. These doctors
may look after women who need their surgery skills, but do not
have cancer.
At the Cancer Centre, the Gynecologic Oncologist reviews your
medical history to get a full picture of your situation. Before your
surgery and depending on your needs, he/she may ask other
doctors to see you. These doctors are from: Anesthesia,
Respirology or Internal Medicine.
When you leave the hospital, a Gynecologic Oncologist will see
you regularly for a length of time to make sure that your
treatment has been complete.

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Who does my surgery?

A team of Gynecologic Oncologists does the surgery. Everyday
while you are in the hospital, one of the members of the team will
see how you are doing and plan your treatment. Your treatment plan
is reviewed with other doctors and nurses.
The team also works with social workers, nutritionists and
physiotherapists to make sure you get all the care you need.

How will the nurses help my

recovery?
Nurses will be available to guide you every step of the way.
They will prepare you both physically and mentally for your
operation, recovery and going home.

What should I expect before

surgery?
Planning ahead
It is also important to plan for your healthy recovery before surgery.
Be sure to get groceries and banking done a few days before hand.

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Recovering from TAH - BSO and omentectomy

Also, arrange for help with meals, child care, pets, gardening and
housework because rest is most important for the first few weeks
after surgery.
Be sure you have someone to drive you where you need to go
during this time as the doctor may not advise driving for a while.
Pre-op Clinic
Up to 2 weeks before your surgery you need to have a Pre-op
Clinic visit. There, the nurse will review your surgery and ask you
specific questions about your health. You will have blood taken as
well as a chest x-ray. An EKG (electrocardiogram) may also be
done to check your heart. The team needs this information to plan
your care. The information is also helpful to see your progress
as you heal.
The nurse will also review with you:
The consent form you signed at the doctors office
How to clean your bowels out
When to stop eating and drinking
What medications you take the morning of your surgery
What tubes and drains you may have right after surgery such
as a urinary catheter a soft tube in the bladder to drain urine
into a bag

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Recovering from TAH - BSO and omentectomy

The pre-op nurse will also teach you the deep breathing and
coughing exercises that you will need to do after surgery.
Doing these will help you keep your lungs healthy and reduce the
risk of pneumonia-see page 26. You may want to practice these
before your surgery.
Just before surgery
have a shower or bath
remove nail polish from fingers and toes
remove all jewelry including body piercing

On the day of your surgery

On the day of surgery, you will go to Same Day Surgery. This is
Ward 592 at the Juravinski Hospital. There they will take your
belongings and put your name on them and take them to the area
you will be staying after surgery. It is important not to bring anything
of value (money or personal). All rings and jewelry must be taken off
before surgery, so it is best to leave them at home or with a family
member for safekeeping.
You will change into a hospital gown, empty your bladder and
remove your dentures and contact lenses if you wear them.
An intravenous, or IV will be started to give you fluids and some
medications that are needed before, during and after surgery.
You may receive some medication to make you sleepy.

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Recovering from TAH - BSO and omentectomy

Once these preparations are completed, you will go to the holding

area about one half hour before your surgery. Usually, one person
may stay with you at that time.
We cannot be sure of the exact time of your surgery. The time
may be slightly earlier or later than planned.
Once you go in to the operating room, your family members can wait
in the waiting room to talk to the surgeon after the operation. If your
family wishes to speak to the surgeon after surgery, please let your
surgeon know this.
After the surgery, you will go to the recovery room where the nurses
will look after you. When you are fully awake, you will go to the ward
to complete your recovery. As routine, some women go to the
Intensive Care Unit (ICU) after the surgery. Your doctor will tell you
if this is necessary.

What should I expect after surgery?

As you recover from your operation, the nurses will provide the
following care:
Review your pain control options with you to help maintain
your level of comfort. Remember, pain is an individual
experience and cannot be compared to others.

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Watch for drainage from the incision after surgery. It is

not unusual to have the dressing removed the next day
and left uncovered. Usually there is only a small amount
of reddish pink drainage from your incision.
Check for vaginal bleeding. A pad is worn to check this
and for comfort.
Change your dressing as often as needed to promote healing.
You may use ice chips soon after surgery to keep your mouth
moist and to help prevent nausea. The next day you will
receive clear fluids and gradually increase your diet as your
bowel function returns.
Maintain your IV. IV fluids are needed until you are drinking
enough to meet your bodys needs. As well, an IV provides
a way for the nurse to give you medications to help prevent
nausea, heartburn, itching or antibiotics if needed.
Encourage you to do the leg and breathing exercises every
2 hours while awake. On the day after surgery, your nurse will
help you get out of bed and into a chair. You will start walking
short distances and your nurse and other members of the
health care team will urge you to increase your activity a
little each day. They will show you how to support your
abdomen when getting out of bed so you do not put any
stress on your incision.

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Clean and care for the bladder catheter tube until your
bladder can work normally again. The catheter is in place
for about 24 to 48 hours.
Give you a warm blanket for your abdomen. Bowel activity
is slow at first and many women feel bloated and have
gas pains. Pain medication helps but walking is most
effective to help get the gas moving and ease the discomfort.
Give stool softeners so your bowel movements will be soft
and easy to pass so as not to put added strain on the incision
area.
Give a medication called Heparin by needle in your
upper thighs to help prevent blood clots from forming.
This medication will be stopped as soon as you are
walking regularly.

The nurses plan your care according to your individual needs.

We encourage you to help plan your care. We are happy to
answer any questions regarding your care and hospital stay.

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Recovering from TAH - BSO and omentectomy

For several days after your surgery, your activity will be less
than normal. During this time, your lungs breathe more shallowly
at rest. Fluid build up may occur in the lungs. This could lead to
complications, therefore it is very important to do the following:
Breathing exercises
1. Take a slow deep breath and fill your lungs. Hold the breath
for a count of 3. Slowly blow out.
2. Repeat 8 to 10 times each hour.
3. Cough 3 times after your finish deep breathing.
Remember to hold your incision with a pillow or
folded blanket.

Change your position every 2 hours.

Lie on alternate sides, change the height of the bed or sit up
in a chair.

Walk
You must walk several times a day to regain your general strength.
A nurse or family member can help you push the IV pole. Increase
the number of times you walk as well as the distance each day.

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Recovering from TAH - BSO and omentectomy

How important is nutrition?

Nutrition plays a major role in your recovery.
Healthy eating can help give you energy and strength. A balanced
diet of protein, fruit, vegetables and whole grains will help your
body heal. Your diet can also prevent problems with constipation.
Eat foods with fibre such as bran, whole grains, fruits and
vegetables to keep your bowels healthy and regular.
If you have any questions about your diet, please write them
down and ask your nurse or doctor.

What does the Social Worker do?

The social worker supports your emotional and financial concerns.
A new diagnosis of cancer and treatment can be frightening.
Patients and families often have very strong and upsetting feelings
at this time. The social worker can help you recognize and express
those feelings.
Sometimes the illness and recovery can affect your role in the home,
either as breadwinner, spouse or caretaker of older parents,
or dependent children. The social worker is aware of the turmoil
this creates in the family and can support you in finding other
sources of help.

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During your hospital stay and recovery, you may be entitled to

sick benefits either from your employer plans or other sources.
The social worker can help you sort out your benefits.
A social worker is available on request from yourself, your family
or your health care team.

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Part 3:
When you go home

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What is CCAC?
CCAC stands for Community Care Access Centre.
CCAC is a program, which arranges nursing, physiotherapy,
nutrition and social services when you go home, if needed.
Other needs which the program provides include:
drugs, dressings and medical supplies
hospital and sick room equipment

The CCAC case manager will go over your needs with you so
appropriate services can be provided once you are home. If you are
not eligible for the program, the case manager can help find other
sources of care. You may need to make arrangements with friends
and family to help you during your recovery.

How does CCAC help?

CCAC helps the healing process to continue in your own home.
If you need professional care when you get home, the doctor will
ask the Home Care Co-ordinator to see you. If you think you will
need more help and it has not yet been mentioned, tell your nurse
or doctor of your needs.

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When you go home

Most patients are ready and eager to go home 3 to 5 days
after surgery. If you go home with staples in your incision,
arrangements will be made for you to go to your family
doctors office to have them removed.
Your doctor will give you a prescription for pain pills.
When you have less pain, you may prefer to take plain
Tylenol. If you find that an activity gives you pain, stop
and rest. Wait a few days before trying that activity again.
Some people heal more slowly than others. If you still need
nursing care for your incisions or your bladder is still slow to
function home care will be provided.
Your incision should be a clean, dry, and closed line. Look at
your incision before you leave the hospital so that you will
be able to see if there are any changes to it when you are
at home.
Once home, you can continue to increase your activity
level gently. Remember that your need for relaxation and rest
will still be greater than normal. At first you may find activities
such as climbing stairs, lifting your children or vacuuming too
hard for you. If you feel tired, stop and rest. Exercise can help
your recovery as well. Walking is an excellent exercise that
you may enjoy. You can gradually walk farther or faster for
more exercise.

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You may have a shower to help keep your incision clean and
to help it to heal. You may have a bath but for the first few
weeks patients usually prefer showers. Be sure to always
completely and carefully pat dry your incision after washing.
After your surgery, you may feel a little discomfort when
passing urine. Be sure to drink 6 to 8 glasses of water or
other clear liquids such as cranberry juice each day to help
prevent problems.
You use a lot of emotional energy during a cancer diagnosis
and surgery. Rest and relaxation will help your recovery.
Activities you enjoy will also renew your energy and sense of
well being. Relaxation techniques learned in hospital can help
recovery at home too.
Many patients also strongly believe in the power of prayer.
You may or may not be religious, but your spiritual beliefs can
bring peace of mind as you recover.

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Follow-up visits
You will be given an appointment for a follow up doctors visit
before you leave the hospital.
Regular follow up appointments are made in the Cancer Centre.
You will be seen a few weeks after your surgery and your
Gynecologic Oncologist will determine how often you need
to be seen. These visits will vary from every month to yearly.

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When to call the doctor

Call the doctor if you have:
chest pain, coughing, difficulty breathing or coughing blood
foul smelling vaginal discharge from the vagina, an increased
amount of discharge or any bright red bleeding or clots from
your vagina
fever higher than 38.5oC or 100.4oF
pain swelling or tenderness in your calf or thigh
dizziness for more than a few seconds or fainting
burning or bleeding when you pass urine, or passing
urine often
change in bowel habits
concerns about your incisions such as:
swelling, hardness or leaking
redness, bleeding or drainage
pain, which does not get better with pain pills

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Phone numbers
Call this number first Office

905-389-5688

Juravinski Hospital

905-389-4411

Juravinski Cancer Centre

905-387-9495

Doctor: ________________________________
Nurse: _________________________________
Follow-up appointment: ___________________

Questions to ask at my
follow-up visit:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

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 Hamilton Health Sciences, 2006

PD 5328 - 05/2010
dt/May 12, 2010
WPC\PtEd\LrgBk\TotalAbdomHysterBilateralSalpingo-th.doc