Women's health - Hysterectomy

We understand that having an operation can be a very stressful experience. This information aims to alleviate some of your concerns. It explains briefly what to  expect before you come to hospital, the events that may occur during your stay and what to expect when you are discharged from hospital. However, this is a guide only, as each person may require differing treatments. 

What is a hysterectomy?

A hysterectomy is an operation to remove the uterus and, usually, the cervix. The  ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part
of therapy for cancer. You should have a clear understanding of your reason for this
surgery. If not, please ask your doctor.

What are the alternatives to this treatment?

A number of other conservative options may be appropriate for your particular
condition and will normally have been considered prior to your decision to undergo a
hysterectomy.

How is this done?

The procedure is normally performed under a general anaesthetic and takes approximately one hour. However, you can expect to be in theatre and recovery for up to three hours.

To commence your anaesthetic a drip is inserted into your arm. Once you are
asleep you will have a urinary catheter inserted. The importance of the catheter
is to reduce the size of your bladder, keeping it away from the operation site and
reducing the risk of complications. Once the catheter is inserted the operation
can commence.

There are three ways to remove the uterus:

• Vaginal hysterectomy—the removal of uterus and closing of the wound is performed through the vagina. There is no cut in the abdomen. 
• Laparoscopic hysterectomy—about four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries and tubes in  the pelvis. The uterus is usually then removed through the vagina.
• Abdominal hysterectomy—the uterus is removed through a cut in the  lower abdomen. The cut is about 15–20 cm in length and runs across  your abdomen, usually below the bikini line. Less commonly, it may be  necessary to have a cut that runs from the belly button down to the pubic  area.

What are the risks of undergoing this procedure?

Although the risks associated with hysterectomy are low, you should be aware
that every surgical procedure has some risk. This may also depend upon the
type of surgery you have.

Specific risks to be aware of in relation to vaginal hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy include:

• Severe bleeding from large blood vessels around the uterus or top of vagina. This is not common. Emergency surgery may be required to repair the damaged blood vessels, or a blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
• Infection in the operation site, pelvis or urinary tract. Treatment may include antibiotics.
• Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured—expected to happen to approximately one in every  140 women. Further surgery will be needed to repair the injuries. For bladder injuries, a catheter may be put into the bladder to drain the urine away until the bladder is healed. For ureter injury, a plastic tube (stent) is placed in the ureter for some weeks.If the bowel is injured, part of the bowel may be removed with a possibility of a temporary or permanent colostomy (bag on the abdomen to collect faeces).
• The bowel may not work after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
• Rarely, a connection (fistula) may develop between the bladder and the vagina. This causes uncontrollable leakage of urine into the vagina and requires further
  corrective surgery.
• A change in the sensory nerves of the bladder and bowel. Constipation and
  bladder problems may occur.
• Psychological changes may occur after surgery. Feelings of depression and
  anxiety can be prolonged after surgery. Counselling may be of some benefit.

Specific risks to be aware of in relation to laparoscopic hysterectomy and abdominal hysterectomy wounds:

• Bleeding into the wound internally from surrounding blood vessels. A drain may be required to drain fluid from the wound and antibiotics may also be required.
• The layers of the wound may not heal well and the wound may open up. A hernia (weakness/hole in the deeper tissues) may form in the long term which may require repair by surgery. An infection may involve ongoing wound care with dressings and antibiotics.
• The scar can be thickened, red and may be painful. This can be disfiguring and may be permanent.
• Numbness under or around the wound is relatively common and, while it normally resolves, it may be permanent.

General risks during all operations:

• Small areas of the lungs may collapse, increasing the risk of chest infection. This may require antibiotics and physiotherapy.
• Clots in the legs with pain and swelling. Rarely, part of this clot may break off and go to the lungs which can be fatal.
• A heart attack because of strain on the heart or a stroke. Extremely rarely, death is a possibility in anyone undergoing an operation.
• Chronic abdominal pain related to internal scarring (adhesions).

Some women have an increased risk of complications:

•  Women who are very overweight may have an increased wound infection, chest infection, heart and lung complications and blood clots.
• Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

Procedure planning day

When you had your appointments with your specialist, the case manager and the preadmission clinic, planning for your surgery began, including:

• an explanation of your surgery
• signing the consent form
• booking the date of your surgery
• estimation of the day you will be going home
• booking your post-operative six week follow-up appointment, or phone call
• the provision of information regarding your pre-operative physiotherapy
  appointment
• discussion of your patient information booklet and its contents. 

Below is a summary of your procedure plan and follow-up appointments:

Preoperative planning

• Date of surgery
• Date of admission (if different to surgery date)
• Expected length of hospital stay (laparoscopic or vaginal hysterectomy is two days . Abdominal hysterectomy is three days)
• Estimated date of discharge
• Surgeon
• Anaesthetist
• Case manager
• Pre-operative physiotherapy appointment

Postoperative consultations

• Specialist follow-up appointment (your specialist follow-up appointment is made in advance to guarantee you a booking time. As rescheduling is difficult we wish to suggest requests for rescheduling is limited to medical requests and unforeseen circumstances)
• Abdominal hysterectomy postoperative appointment
• Vaginal hysterectomy postoperative appointment
• Laparoscopic hysterectomy post-operative appointment
• Allied health follow-up appointments.

The assessments taken during your time with the case manager and the preadmission service provide important information on your health and social  status allowing your particular needs to be identified and managed. Appropriate  referrals will be made either prior to, or following, your surgery.

Things to do before you come to hospital

• It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to hospital. Please bring X-rays, any ECG reports and all your blood test results with you to hospital, along with your medications. Your medications need to be in their labelled containers or Webster pack.
• If you are taking any blood thinning or arthritis medications please follow the instructions provided by your preadmission nurse or pharmacist, as sometimes it is important that these medications be stopped in preparation for your surgery. You should continue your regular medications, unless advised otherwise. If you are a smoker it is also important for you to stop smoking.
• It is important for you to be familiar with, and start practising, your breathing and leg exercises, which you will need to commence once you have woken up from your operation, and getting in and out of bed.
• You may be required to have a bowel preparation, which will empty your bowel prior to the surgery. If this is required, you should only have fluids (clear soups, jellies, cordials, juices or similar drinks) in the 24 hours prior to the surgery. The bowel preparation medication should be taken as prescribed.
• In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery.
• If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or unforseen personal circumstances please notify Bookings at Mater Health Services on telephone 07 3163 8244 as soon as possible and provide them with your name, the reason for the cancellation and if you require the surgery to be rescheduled.  
• You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified
  • At midnight if your procedure is in the morning
  • At 6 am if your procedure is in the afternoon.
• You will need to shower and dress into clean clothes prior to coming into hospital. While showering it is important to include cleaning your naval area well. No skin products such as deodorant, perfume, body lotion or powder are to be used following your shower. It is important that you do not shave your operation site as this increases the risk of wound infection.
• Please remove all body jewellery.
• As Mater is unable to accept liability for losses it is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only. While Mater does not take responsibility for your personal belongings our Security Office will hold any lost property that is handed in.

What to bring to hospital

• Toiletries
• Comfortable sleep-wear
• Underwear
• Sanitary pads
• All usual medications
• All X-rays
• Medicare card
• Your patient information booklet.

The day of your surgery

Before your surgery

• You will be admitted to hospital and prepared for surgery in the Day Procedure Unit, Level 5, Mater Adult Hospital, unless otherwise arranged.
• The assessment form completed at the preadmission service will be reviewed and your health team will plan for your individualised care while in hospital, discuss any concern you may have and support you may require after discharge. If any changes to your circumstances have occurred since the preadmission interview, please notify your nurse. Your nurse will also check that your consent form has been signed, or organise for it to be signed, before your operation.
• It is an infection control requirement at Mater that you will be required to have swabs taken if you have transferred from, or worked at, another health care facility or you have had previous resistant infections. This is usually identified, and attended to, at the preadmission clinic. Your admission nurse will check if these three swabs have been taken and will complete the test if there are further swabs required.
• The medications you brought to hospital will be collected. Please remember to ask for these to be returned to you when you leave the hospital. Please inform the nurse admitting you if you have been taking any blood thinning, arthritis medication or aspirin prior to your admission, as these may have needed to be stopped before your operation day. It is usual for you to continue taking your other prescribed medications.
• You may walk as much as you like up until two hours prior to your surgery. Please notify staff if you leave the ward.
• You will have an identification armband applied. This will stay on for the duration of your stay for identification and safety reasons. If you have any known allergies, you will have an allergy armband applied.
• Your nurse will take a set of baseline observations, weigh you and may ask you to provide a urine sample for routine testing.
• It may be necessary to clip any hair in the surgical area.
• You will be asked to dress into theatre clothing.
• You will be measured for special stockings and will need to have these put on prior to going to theatre. Also a compression device will be applied to your legs approximately two hours prior to your operation. These assist with blood flow through your legs and decrease the risk of blood clot formation while you have decreased mobility.
• You may be prescribed a pre-anaesthetic medication before you go to surgery.
• Before you leave for theatre a pre-operative checklist will be completed with you by your nurse. This checklist will be repeated in the operating reception area. Apart from your wedding band, which will be covered with tape, no jewellery or metal is to be worn to theatre.
• It is important to continue practising your breathing and leg exercises which you will need to commence once you have woken up from your operation.

For more information on this surgery, visit the page below

Hysterectomy surgery

Mater acknowledges consumer consultation in the development of this patient information.

Mater Doc Num: PI-CLN-460013

Last modified 25/9/2019.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 20/1/2014