Hysterectomy - Risks and Complications
Hysterectomy is the surgical removal of the uterus or womb.
Hysterectomy is a major surgery. There are life-threatening and non-life-threatening reasons to undergo hysterectomy (see Health Profile: Hysterectomy). It is a relatively common procedure. However, as with all surgical procedures, there are risks involved. There are currently three ways to surgically remove the uterus. The decision to use one technique over another largely depends on the size and how easily the uterus is moved. Most of the risks involved with hysterectomy are possible regardless of how the uterus is removed.
Abdominal hysterectomy. Involves making an incision on the abdomen in order to remove the uterus.
Laparoscopic hysterectomy. Involves multiple smaller incisions on the abdomen. A laparoscope is used which is a camera placed inside the belly button. The uterus is then grinded into smaller pieces and removed through one of the small abdominal incisions or the uterus is removed as a whole through an incision made in the vagina.
Vaginal hysterectomy. Involves making an incision in the vagina in order to remove the uterus.
Risks and Complications of Hysterectomy
Bleeding. As with any surgery, excessive bleeding is a risk with hysterectomy. It may require transfusion of blood products or even return to the operating room if severe.
Infection. After a hysterectomy, infection can occur in the incision, the vagina, and bladder or inside the abdomen. Infection occurs in about 10% of women who undergo a hysterectomy even after receiving preventative antibiotics before the procedure. Very rarely, infections can progress to an abscess, which is collection of bacteria and pus that must be drained.
Damage to Surrounding Pelvic Organs. The uterus is close to many organs inside the pelvis. These organs can be damaged unintentionally during the time of surgery, especially if the surgery is difficult to due adhesions or large fibroids. Damage to these organs is very rare but can occur. The tubes that carry urine from the kidneys to the bladder are very close to the uterus and can be damaged at the time of surgery. If recognized early, this damage can usually be repaired. The bladder can also be injured at the time of surgery. Depending on the location of bladder injury, it is usually easily repaired and only requires that a Foley catheter remain in place one week after surgery. Other organs that can be injured during a hysterectomy include the bowel. These injuries are usually easily repaired if identified at the time of surgery. Very rarely, there may be serious bowel injuries that may require a temporary colostomy.
Blood Clots. Many pelvic surgeries including hysterectomy increase the risk of getting blood clots either in the legs or in the lungs. Usually after surgery, patients are given a small dose of blood thinner or special stockings to wear on the legs to prevent this complication. Women who do get a blood clot after hysterectomy may need to be on a blood thinner for three to six months after surgery.
Earlier Menopause. Women who have a hysterectomy without the removal of their ovaries usually go through menopause about four years earlier.
Do the complications decrease or increase according to the type of surgical procedure that is used?
Which procedure has the least complications?
Which procedure do you recommend and why?
How many hysterectomies have you performed? How many have had complications?
Do you recommend antibiotics prophylactically?
Will the ovaries be left in place?
Are there any tests before surgery that need to be done to detect any possible problems that may lead to a complication?
Is there anything I can do to decrease the chances of complications?