Hysterectomy

Hysterectomy, surgical removal of the uterus. Sometimes only the uterus and cervix are removed; in other cases, called a total hysterectomy and bilateral salpingo-oophorectomy, the uterus, cervix, Fallopian tubes, and ovaries are all removed.

A bilateral salpingo-oophorectomy is the removal of both ovaries and both Fallopian tubes. A hysterectomy may be carried out through an incision in the lower abdomen (abdominal hysterectomy) or, alternatively, it may be performed via the vagina (vaginal hysterectomy), in which case the scar is concealed. Vaginal hysterectomy is associated with a lower death rate and a faster recovery time but it cannot easily be performed if the uterus is very large or if it does not descend into the vagina. Recently, keyhole surgery has enabled a hysterectomy which could normally only be carried out via the abdominal route to be performed via the vagina (laparoscopically assisted vaginal hysterectomy).

Numerous reasons exist for performing a hysterectomy. These range from life-threatening conditions such as cancer, uncontrollable haemorrhage, or overwhelming infection to recurrent attacks of pelvic inflammatory infection, severe endometriosis (the occurrence of uterine lining outside the uterus), large fibroid tumours, or excessive vaginal bleeding.

After a hysterectomy, one of the most common of all surgical procedures, a woman no longer menstruates, and she is unable to bear children. If the hysterectomy includes removal of both ovaries, the woman may experience symptoms of the menopause, or be more likely to develop osteoporosis, because the ovaries are a woman's major source of oestrogen. For this reason, unless the condition necessitates it, surgeons do not usually remove the ovaries in women under 40 years of age.