Hysterectomy—Open Surgery

(Surgical Removal of the Uterus [or Womb]; Abdominal Hysterectomy; Vaginal Hysterectomy)

by Editorial Staff and Contributors

Definition

Reasons for Procedure

Possible Complications

What to Expect

Call Your Doctor

Click here to view an animated version of this procedure.

Definition

Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant.

There are different types of surgeries, such as:

Supracervical hysterectomy—removal of the uterus only
Total hysterectomy—removal of the uterus and cervix (the opening of the uterus leading to the vagina)
Radical hysterectomy—removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
Salpingo-oophorectomy —removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

Reasons for Procedure

A hysterectomy may be done if the uterus is causing health problems that cannot be treated by other means. Some reasons a woman may have a hysterectomy are to:

Treat cancers, such as uterine, endometrial, and ovarian cancers
Remove uterine fibroids
Treat conditions, such as chronic pelvic pain or heavy bleeding

Explore your options before having a hysterectomy. There are other treatments for many of these problems.

Possible Complications

If you are planning to have hysterectomy, your doctor will review a list of possible complications, which may include:

Reactions to anesthesia
Pain
Infection
Bleeding
Fatigue
Injured pelvic organs (bowel and/or bladder)
Urinary incontinence (problems controlling your urine)
Loss of ovarian function and early menopause
Depression
Sexual dysfunction

Some factors that may increase the risk of complications include:

Obesity
Smoking
Heart or lung disease
Diabetes
Previous pelvic surgery or serious infection
Use of prescription and nonprescription drugs during the past month

Be sure to discuss the risks with your doctor before surgery.

What to Expect

Prior to Procedure

Your doctor may do the following:

Blood and urine tests
X-ray of abdomen and kidneys
CT scan
MRI scan
Pelvic ultrasound —a test that uses sound waves to visualize organs in the abdomen
Dilation and curettage (D&C)—surgical removal of tissue from the lining of the uterus (to check for cancer)

You should do the following:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
If instructed, take enemas to clean out your intestines.
Arrange for a ride home and for help at home.
Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia is usually used for this surgery. Anesthesia blocks pain and keeps you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

There are 2 different methods of surgery that are described here.

Open Abdominal Hysterectomy

An incision will be made in the lower abdomen. This is done to expose the tissue and blood vessels that surround the uterus. The tissue will then be cut. The blood vessels will be tied off. The uterus will be removed. Next, the abdominal wall will be sewn back together and the skin will be closed with stitches or staples. If the cervix is also removed, stitches will be put in the top of the vagina.

Abdominal Hysterectomy

The uterus is removed through the abdomen.

Open Vaginal Hysterectomy

This method will not involve any outside incisions. The vagina will be stretched and kept open with special tools. Next, the uterus and cervix will be cut free. The connecting blood vessels will be tied off. The uterus and cervix will be removed through the vagina. Lastly, the top of the vagina will be closed with stitches.

Vaginal Hysterectomy

The uterus is removed through the vagina.

With each procedure, a vaginal packing (sterile gauze) is placed in the vagina. This will be removed after 1-2 days.

Immediately After Procedure

In the recovery room, you will have IV fluids and medications.

How Long Will It Take?

1-3 hours

Will It Hurt?

You will not have pain during the surgery because of the anesthesia. During your recovery time, you will be given pain medication.

Average Hospital Stay

Abdominal hysterectomy: 2-3 days
Vaginal hysterectomy: 1-2 days

Your doctor may choose to keep you longer if you have any complications.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

On the first night, you may be instructed to sit up in bed and to walk a short distance.
During the next morning, the IV will probably be removed if you are eating and drinking well.
You may need to wear special stockings or boots to help prevent blood clots.
To help you urinate, you may have a Foley catheter in your bladder.

At Home

During the first few days, you may have pain, bloating, vaginal bleeding, and vaginal discharge.

When you return home, do the following to help ensure a smooth recovery:

During the first 2 weeks, rest and avoid lifting.
Ask your doctor when you can use tampons. Also ask about Kegel exercises.
Wait 6 weeks before resuming sexual activity.
If you still have a cervix, you will still need regular Pap smears.
Follow your doctor's instructions.

Recovery from open abdominal hysterectomy usually takes 6-8 weeks. Recovery from a vaginal hysterectomy usually takes 3-4 weeks.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occur:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, leakage, or any discharge from the incision site
Incision opens up
Nausea and/or vomiting that you cannot control with the medications you were given or that last longer than 2 days
Lightheadedness or fainting
Cough, shortness of breath, or chest pain
Heavy bleeding
Pain that you cannot control with the medications you have been given
Pain, burning, urgency or frequency of urination, or persistent blood in the urine
Swelling, redness, or pain in your leg

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

Women's Health—US Department of Health and Human Services
http://www.womenshealth.gov

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

Hysterectomy. Women's Health—US Department of Health and Human Services website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html. Updated April 28, 2017. Accessed December 13, 2017.

Hysterectomy. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/Patients/FAQs/Hysterectomy. Published March 2015. Accessed December 13, 2017.

Last reviewed November 2018 by Beverly Siegal, MD, FACOG Last Updated: 12/20/2014

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