Endometriosis - Hysterectomy

Total Hysterectomy. In a total hysterectomy the uterus and cervix are removed; this eliminates the risk of uterine and cervical cancer. (Given technical advances and growing surgical experience, a total hysterectomy may eventually be unnecessary except in special circumstances, such as when cancer is present.)

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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.

Bilateral Salpingo-Oophorectomy. Bilateral salpingo-oophorectomy is the removal of the fallopian tubes plus 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 significantly reduces that rates of re-operation and endometrial pain recurrence compared to hysterectomy alone. Oophorectomy also helps to reduce the risk for ovarian cancer by elimination of ovaries and for breast cancer by causing estrogen loss. Premenopausal women should realize, however, that it promotes menopause immediately, which poses a risk for a number of health problems. These include osteoporosis, heart disease, skin wrinkling, and reduction in muscle tone. Estrogen replacement can help offset them.

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. With the abdominal procedure, 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 (called a 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. It is used in less than 20% of cases in African American women and slightly under 40% among Caucasian and other groups.