Hysterectomy became relatively common 110 years ago,because the procedure became more safe. Antibiotics, anesthesia, antisepsis (hand- washing) and pathology made surgery less a barber’s specialty and more a legitimate practice of medicine. The risk of dying during the procedure dropped from about 70% to less than 10%. Many embraced this new procedure for the treatment of many complaints that fell under the general heading of “prolapsus”, a condition felt to be caused by “tight lacings, sexual abuse, singing, dancing, riding on horseback and skating”. Women’s reproductive organs were felt to be the “troublesome seat of disease” and were removed to “re-establish the general health”. At one point, legitimate gynecologists publicly chastised the medical community for performing unnecessary hysterectomies to treat unrelated problems. Unnecessary surgery is far less common today. Unprincipled people exist in all areas, from plumbers to electricians, mechanics, housekeepers, politicians, religious leaders, lawyers, doctors, etc. But to assume that everyone in a profession is unscrupulous, or is involved in a conspiracy of silence or misinformation is to paint with far too broad a brush. Hysterectomy is a procedure that has attracted its share of attention as potentially unnecessary; many books have been published questioning its validity and usefulness in situations where, for instance, cancer does not exist. However, symptoms that require treatment are not fictitious, or “hysterical”. Many women truly suffer from heavy, painful, debilitating menses, from pelvic pain, from pelvic masses that interfere with normal bowel and bladder function, with scarring that causes pain with or without intercourse, and with serious medical conditions adversely affected by bleeding or pregnancy. Options with regard to treatment are available; not everyone needs a hysterectomy for the management of symptoms, and even women who require a hysterectomy do not necessarily need a traditional, abdominal hysterectomy. Treatment today depends on symptoms. The vast majority of hysterectomies are performed for fibroids - smooth muscle tumors that are almost always benign. Unless fibroids are symptomatic, very large, growing rapidly, or are otherwise suspicious for malignancy, or are interfering with normal bowel and bladder function, they need not be treated at all. Fibroids can be treated conservatively and not removed as long as they behave. Sometimes hysterectomy is still the best option, especially in situations where the risk of recurrence is too great, conservative management has failed, or a woman desires definitive surgery. Today, about 600,000 hysterectomies are performed each year. One-fourth to one-third of all women in the US have a hysterectomy by age 60. Of those, 70% are of the “traditional” type, meaning an abdominal incision with removal of the uterus and the cervix. At Everywoman’s Health, the majority of hysterectomies are performed laparoscopically. The success of alternative approaches to hysterectomy depends to a large extent on the surgical experience and expertise of the operator. Definitions: Total hysterectomy = removal of the uterus and cervix, no matter what route Subtotal or supracervical hysterectomy = removal of the uterus, leaving the cervix behind Myomectomy = removal of the fibroids alone, leaving the uterus and cervix behind Vaginal hysterectomy requires removal of the cervix Clarification: Incision types: Abdominal incision may be vertical (up and down) or horizontal (side-to-side) Laparoscopic incisions may be placed wherever necessary and are usually about ½ inch. Laparoscopic surgery generally involves making 3-4 incisions. Some options are absolutely not recommended for cancer or precancerous conditions of the uterus, ovaries, or cervix. A frank discussion with a physician and/or oncologist is necessary to determine what options are available under those circumstances. Vaginal hysterectomy requires an incision in the vagina, where it is invisible. Other procedures may be included with the hysterectomy, depending on bladder symptoms (incontinence) or bowel issues (needing help to evacuate stool). Be sure to discuss these issues with your doctor. |
| Alternatives to Traditional Hysterectomy |
| By Brenda L. Kehoe, M.D. |
| Abdominal incisions |
|
hysterectomy:
|
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |