Hysterectomy or removal of uterus involves surgically removing the uterus. In France, 85 000 1 women are affected by this every year, usually between 45 and 50 years, following a benign pathology.
Well mastered by surgeons, hysterectomy is a common procedure that improves the quality of life of patients. It may nevertheless worry. What are the indications, risks, consequences? All explanations to understand and live better the response.
Why a hysterectomy?
Hysterectomy is usually offered when no other alternative or medication or conservative treatments are cons-indicated or ineffective. Its main indications are bleeding and / or pain caused by benign conditions (fibroids, adenomyosis ...). It can also help treat some prolapse or gynecological cancers.
Total hysterectomy is the most common. It involves removing the uterus and sometimes entirely certain neighboring tissues such as tubes and ovaries. The partial hysterectomy or subtotal, leaves in place the cervix.
What is the procedure?
Hysterectomy is performed under general or regional anesthesia. The uterus is separated from the surrounding tissue and extract one or more fragments.
Three surgical approaches can be used:
Vaginal, or "low path" is through the bottom of the vagina. This is the way to go for total hysterectomy because it allows the lightest operative and leaves no visible scar. It is also the fastest (50 minutes against 80-90 minutes for the following).
The abdominal, or "high path" involves opening the abdomen on 10-15 cm as for a cesarean section.
The laparoscopic approach uses a mini camera. The latter and the instruments are inserted into the abdomen through four small incisions. Laparoscopy can also facilitate vaginal surgery.
Professor Hervé Fernandez 2, head of gynecology and obstetrics department at the hospital of Kremlin Bicetre, remarks: "In France, the vaginal concerns 55% of interventions, abdominal 25-30% and 15-20% laparoscopy 3. the type of intervention depends on the characteristics of the uterus, the indication for hysterectomy, the expertise of the surgeon, history and wishes of the patient. "
What are the risks associated with hysterectomy?
Like any surgery, hysterectomy has certain risks. "Mortality, outstanding concerns less patient in 10,000, said Prof Fernandez. Complications occur in 3-5% of procedures. They are mainly represented by wounds to adjacent organs, bleeding, infections .. . the novelty in recent years is the melt, coagulation technique that avoids using son and reduces bleeding, facilitating postoperative. pain is also better supported. "
In practice, it should ask the advice of his doctor in case of pain, heavy bleeding, fever, vomiting, or other irregularities occurring postoperatively.
Are there any precautions after surgery?
The return home occurs two to five days after hysterectomy. The week following the intervention, moderate bleeding is common. After four to six weeks, colorful losses corresponding to the son that stand, can also occur.
The work stoppage is usually three to four weeks. The baths are to avoid the first ten days and, as with any surgery, you should not engage in physical activity for four to six weeks.
It is sometimes advisable to wait up visit, a month after the intervention, before having sex, Dr. Fernandez believes that it is not justified: "Sexual activity, with or without penetration, may resume as soon as the woman feels ready. "
What are the consequences of hysterectomy?
If the woman was premenopausal before surgery, hysterectomy involves no particular change if not a disappearance of symptoms requiring the intervention.
If the patient was not menopausal and that the ovaries are left in place, hysterectomy causes the disappearance of rules and the lack of possibility of pregnancy but the hormonal cycle continues. If the ovaries were removed, hysterectomy leads to menopause that will eventually be corrected with hormone replacement therapy.
"There is no reason for hysterectomy causes weight gain, mood disorders or sexuality, insists Prof. Fernandez. The uterus and cervix are not involved in sexuality and remove does not change the length of the vagina. most often, there is no urgency for intervention and patients can take the time to discuss it with their doctor. "
1. from 70 to 75 for 000 women with benign disease and 10 to 12 000 for a cancer is about 85 000 women all indications from the CNGOF.
2. Interview with Prof. Hervé Fernandez, head of the Gynecology and Obstetrics Service in Kremlin Bicetre hospital, he is a member of the French College of Gynecologists and Obstetricians (CNGOF), March 2011.
3. Program medicalization of information systems (PMSI) 2016.