Hysterectomy

Hysterectomy is an operation in
which the uterus is removed. The
cervix, ovaries and/or Fallopian tubes
might also be removed.
It may be done abdominally or
vaginally.
Vaginal hysterectomy usually done
for some cases of uterine prolapse.
 Indications of Hysterectomy
 Obstetrical:
 Rupture of the uterus.
 Uncontrollable post-partum hemorrhage.
 Placenta accreta.
 Gynecological:
 Inflammatory as some cases of genital tuberculosis.
 Tumors: benign (ovarian tumors, fibroids)
 Malignant (cervix, body and ovaries)
 Displacement: some cases of uterine prolapse or chronic
inversion.
 Some cases of dysfunctional uterine bleeding.
 Types of Hysterectomy
1. Subtotal hysterectomy (partial)
involves removing the body of the uterus, but leaving the cervix
in place.
done for post partum hemorrhage and rupture uterus.
2. Total hysterectomy
involves removing the body of the uterus as well as the cervix,
much better than subtotal.
3. Pan hysterectomy
Total hysterectomy and bilateral of both ovaries
4. Radical hysterectomy
is done specifically in the case of invasive gynecological cancer.
Removal of the uterus, both tubes, and ovaries, the upper third of
the vagina, the iliac and obtruator lymph gland.

5. Ultra radical hysterectomy

Anterior excenteration →Removal of the bladder
posterior excenteration →Removal of the bladder and rectum
 Advantages of Subtotal
Hysterectomy

1.-It is easier and quicker than total

hysterectomy
2.There is less danger of injuring the
bladder.
3.Less danger of pelvic infection.
4.The cervix left to act as a support for
vagina.
 Advantages of Total Hysterectomy

1.Provides better drainage of the

operation area.
2.If the cervix is lacerated or
infected, the source of irritant
discharge is removed.
my

Indications of vaginal hysterectomy:

1.Some cases of uterine prolapse.
2.Some cases of dysfunctional uterine
bleeding.
3.Some cases of cancer body
 Advantages of vaginal hysterectomy:
1. Absence of an abdominal scar.
2. Lower incidence of intestinal complication.
3. An associated genital prolapse can be treated at
the same time.

 Disadvantages of vaginal hysterectomy:

1. It is unsafe and difficult in the presence of pelvic
adhesions.
2. The ovaries can not be removed in some cases.
3. It can not be done if the size of the uterus is
larger than a 14 weeks pregnant uterus.
 Postoperative Complications of Abdominal
Hysterectomy
 Shock.
 Hemorrhage.
 Infection,
 Intestinal complications as acute gastric
dilatation.
 Pulmonary complications e.g. bronchitis,
pneumonia, pulmonary collapse.
 Venous thrombosis (DVT, SVT.)
 Post operative anesthetic complications e.g.
Cyanosis, vomiting.
 Remote Complications e.g. vaginal discharge
(infection), vaginal vault prolapse, low back
ach,
 Menopausal symptoms e.g. sadness,
irritability. (in younger female)
 Methods of Treatment
 Deep breathing exercises:
to improve alveolar ventilation. (to minimize changes in lung volume and
gas exchange) from semi-fowler position, the abdominal muscle in slack to
allow greater diaphragmatic excursion
 Rolling
to minimize trunk movement.
 Coughing
Two stage cough preceded by deep breathing (the 1st raises the secretion,
the 2nd facilitate expectoration. Patient applies pressure on the incision by
pillows or hands.
 Huffing:
accomplished by forceful expiration, If the patient unable to do
coughing
 Ankle circles:
To minimize the occurrence of phlebitis and facilitate venous
return.
 Abdominal muscles exercises.
 Aims of Treatment

 Pre-operative
Psychological preparation for the operation.

 Aims of pre-operative treatment:

1. To prepare the patient physically and mentally for
the operation.
2. Teach her the exercises that will be done post
operatively.
3. To improve circulation.
4. To improve respiration.
5. To strength the abdominal muscles
• Post-operative
Aims:
• To improve circulation.
• To improve respiration and prevent chest
complications.
• To avoid muscle wasting.
• To prevent postural problems
Methods
• The same like cesarean section except arm exercises.
• Electrical stimulation to decrease pain (TENS).
• Laser to decrease pain and enhance healing