Uterine Fibroids and Hysterectomy - Hysterectomy

Supracervical Hysterectomy. In a supracervical hysterectomy the uterine body is removed and the cervix is retained. Retaining the cervix helps support the pelvic floor and may help maintain full sexual sensation, but the risk for cervical cancer remains.

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Bilateral Salpingo-Oophorectomy. Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries. It may be performed with either total or supracervical hysterectomy. In deciding to remove the ovaries, a woman must be aware of various consequences, both positive and negative.

Oophorectomy helps to reduce the risk for ovarian cancer by elimination of ovaries and breast cancer by causing estrogen loss. Ovarian cancer is very rare, in any case, except in women with a family history of the disease. Even in these women, removal is not 100% preventive. It can still develop from cancer cells that may be present in the lining of the pelvis (the peritoneum).
Losing ovarian function means estrogen and testosterone loss, which can increase the risk for menopause-related conditions. These include osteoporosis, heart disease, skin wrinkling, and reduction in muscle tone. Estrogen replacement, however, can help offset these problems.

Abdominal vs. Vaginal Hysterectomy

There is still a further choice, which is whether the hysterectomy should be performed through an incision in the abdomen or performed through the vagina. A variant of vaginal hysterectomy, called laparoscopic-assisted vaginal hysterectomy (LAVH), is yet another option.

Abdominal Hysterectomy. Abdominal hysterectomy is the most common procedure and is used in over 80% of hysterectomies in African-American women and about 60% in Caucasian and other ethnic groups. It is best suited for women with large fibroids, when the ovaries need to be removed, or when cancer or pelvic disease is present. With the abdominal procedure, a wide incision is required to open the abdominal area from which the surgeon removes the uterus. If possible, the incision should cut horizontally across the top of the pubic hairline (the bikini incision). This incision heals faster and is less noticeable than a vertical incision, which is used in more complicated cases. The patient may need to remain in the hospital for three to four days, and recuperation at home takes about four to six weeks.

Vaginal Hysterectomy. Vaginal hysterectomy requires only a vaginal incision through which the uterus is removed. This approach is most often performed for small fibroids (although advances in imaging and other techniques may allow it to be used on larger fibroids). At this time it is used in less than 20% of cases in African-American women and slightly under 40% between Caucasian and other groups.