EXPLORATORY LAPAROTOMY TOTAL ABDOMINAL HYSTERECTOMY AND

BILATERAL SALPINGO OOPHORECTOMY (TAHBSO)

Exploratory Laparotomy - is surgery to open up the belly area (abdomen). This surgery is done
to find the cause of problems (such as pain or bleeding) that testing could not diagnose. It's also
used when an abdominal injury needs emergency medical care. This surgery uses one large cut
(incision).
Hysterectomy - is the surgical removal of the uterus. It is most commonly performed for
malignancies and certain non-malignant conditions, like endometriosis or tumors, to control life-
threatening bleeding or hemorrhage, and in the event of intractable pelvic infection or irreparable
rupture of the uterus. Less radical procedures such as myomectomy are sometimes performed for
removing fibroids while sparing the uterus.
Total Abdominal Hysterectomy Bilateral Salpingo-Oophorectomy - is the removal of the entire
uterus, the ovaries, fallopian tubes, and the cervix. TAHBSO is usually performed in the case of
uterine and cervical cancer. This is the most common kind of hysterectomy. Removal of the ovaries
eliminates the main source of the hormone estrogen, so menopause occurs immediately.
What causes Malignancy in Uterine?
1. Hormonal Imbalances:
Estrogen and progesterone are two key hormones that regulate the menstrual cycle and the growth of the
endometrial lining in the uterus.
Imbalances in these hormones, particularly an excess of estrogen relative to progesterone, can lead to
abnormal growth of the endometrial lining, increasing the risk of cancer.
2. Obesity:
Obesity is strongly associated with an increased risk of uterine cancer.
Fat tissues produce estrogen, and excess body fat can result in higher estrogen levels, which can stimulate
the growth of the endometrial lining and contribute to cancer development.
3. Age:
Uterine cancer primarily affects postmenopausal women, with the majority of cases diagnosed in women
over the age of 50.
Aging is associated with changes in hormone levels and cellular processes that can elevate the risk of
cancer development.
4. Endometrial Hyperplasia:
Endometrial hyperplasia is a condition characterized by the abnormal proliferation (growth) of
endometrial cells.
Untreated or inadequately managed endometrial hyperplasia can progress to uterine cancer.
5. Family History and Genetics:
A family history of uterine or other hormone-related cancers (such as breast or ovarian cancer) can
increase the risk of uterine cancer.
Specific genetic mutations, such as those associated with Lynch syndrome, can also predispose
individuals to uterine cancer.
6. Reproductive Factors:
Factors related to reproductive hormones and menstrual patterns can influence uterine cancer risk.
Early onset of menstruation (before age 12), late onset of menopause (after age 55), nulliparity (never
having given birth), or infertility can affect the risk.
7. Lifestyle Factors:
Sedentary lifestyle, poor diet (high in refined carbohydrates and low in fruits and vegetables), and
smoking may contribute to an increased risk of uterine cancer, although the precise mechanisms are not
fully understood.

Priorities for patients undergoing hysterectomy and TAHBSO:

Pain management. Pain is a primary concern after TAHBSO. Adequate pain control is essential
for patient comfort and to facilitate early mobilization and recovery.
Wound care and infection prevention. Surgical site infections can occur after TAHBSO.
Proper wound care, including monitoring for signs of infection such as redness, swelling, or
discharge, is crucial to prevent complications.
Deep vein thrombosis (DVT) prevention. Patients undergoing TAHBSO are at an increased risk
of developing blood clots in their legs (DVT). Measures such as early ambulation, leg exercises,
and prophylactic anticoagulant therapy help minimize this risk.
Bladder and bowel function. Patients may experience difficulties with urination and bowel
movements following TAHBSO. Monitoring and managing bladder and bowel function, ensuring
regular voiding, and preventing constipation are important for patient comfort.
Emotional well-being. Addressing emotional concerns, providing emotional support, and
connecting patients with appropriate resources or counseling services can contribute to their
overall well-being.
Respiratory function. Promoting deep breathing and early mobilization are crucial in preventing
respiratory complications such as pneumonia or atelectasis.
Hormone replacement therapy. Since the ovaries are removed during TAHBSO, hormonal
imbalances may occur.
Post-operative Health Teaching:
Pain Management: Discuss pain management options post-surgery, including medications,
relaxation techniques, and positioning to minimize discomfort.
Wound Care: Provide instructions on how to care for the surgical incision, including dressing
changes, signs of infection to watch for, and when to contact healthcare providers.
Activity Restrictions: Explain any activity restrictions during the recovery period, including
limitations on lifting heavy objects or engaging in strenuous activities.
Diet and Nutrition: Discuss dietary recommendations post-surgery, including adequate hydration,
a balanced diet rich in fiber, and any dietary restrictions based on individual needs.
Hormone Replacement Therapy (HRT): If applicable, provide information on hormone
replacement therapy (HRT), including its benefits, risks, and how to take prescribed medications
as directed.
Emotional Support: Continue to offer emotional support and reassurance to address any concerns
or emotional reactions the patient may experience during the recovery process.
Follow-up Care: Schedule follow-up appointments with healthcare providers to monitor the
patient's recovery progress, address any concerns, and provide ongoing support and guidance.
Symptom Management: Educate the patient about common post-operative symptoms to expect,
such as fatigue, constipation, and changes in urinary habits, and how to manage them effectively.
Resuming Activities: Provide guidance on when it's safe to resume normal activities, including
work, exercise, driving, and sexual activity, based on individual recovery progress.