Unilateral salpingo oophorectomy (Salpingo oophorectomy is the resection of the adnexa with the ovaries)
It can be done incase of emergency, planned, obstetric or gynecological indications
It can also be laparoscopic hysterectomy, open or robotic hysterectomy. Laparoscopic and Robotic hysterectomy are the new advancements
Laparoscopic hysterectomy- surgery is done in 45min-2 hours and patient get discharged in the next post operative day. Maximum 1 or 2 days hospital stay is required
Robotic hysterectomy- is not better than the laparoscopic hysterectomy. There is no advantage of doing robotic hysterectomy over a laparoscopic hysterectomy. It is far more expensive. It is technical ease in doing for the surgeon but for the patient, there is no difference between laparoscopic or robotic hysterectomy
Indications of Hysterectomy
Fibroid uterus is the most common indication. Almost 40-45% of surgeries done.
Pap smear ( to rule out coexistent dysplasia on the cervix)
Take precaution for venous thrombus embolism ( patient should be given leg physiotherapy and exercises after immediate post operative)
Antibiotics (only give induction antibiotics) within 1 hour
Complications of Hysterectomy
Intraoperative injuries to bowel, bladder, vessels
Injury to the ureter. In hysterectomy, injury is common while ligating the uterine artery and the most common site is at the site of crossing the uterine artery. The overall most common site is at the pelvic brim.
Postoperative Complication of Hysterectomy
Hemorrhage- it can be immediate, can be visualized immediately or may not be visualized if it is retro peritoneal than there are signs like increase pulse rate and patient going into shock
Reactionary hemorrhage- occurs in the first 24 hours because of slip of a ligature
Secondary hemmorhage - after 24 hours until 2-3 weeks. The most common cause is infection.
Wound infection- 4-6% cases
Urinary retention - is due to bladder hypotonia, can be because of drugs
Ureteric injuries- post op flank pain
Bladder injury or vesico vaginal urethera or uretero vaginal fistula
Prolapse of the fallopian tube through the vault
Laparoscopic-assisted vaginal hysterectomy -
Diagnostic laparoscopy + vaginal hysterectomy or adhesolysis + vaginal hysterectomy
Resection of the adnexa
Uterine resection after bladder mobilization
Total Laprascopic hysterectomy- removing whole uterus abdominally and suturing wall abdominally
Importance of the ovaries
Conserve ovaries as long as possible atleast till 50 years of age. If there is surgical oophorectomy before 50 years, they will be most likely having coronary artery disease by 65 years
Is done incases of gene mutation BRCA1 and BRCAII
Ist degree females relatives have Ca breast or Ca ovary
Frequently Asked Questions
What happens after a hysterectomy?
Might experience hot flashes, vaginal dryness. If the ovaries are removed before menopause, the woman will no longer get periods and wont be able to get pregnant.
How long does a hysterectomy procedure last?
Surgery is done in 45min-2 hours and the patient gets discharged the next post-operative day. Maximum 1 or 2 days hospital stay is required
What are the most common side effects of a hysterectomy?
Prolapse of the fallopian tube
How common is it to get a hysterectomy?
Dysfunctional uterine bleeding
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