The term hysterectomy refers to the surgical removal of the uterus. Synonymous with hysterectomy, the term uterine extirpation is also used.
What is hysterectomy?
The term hysterectomy refers to the surgical removal of the uterus. Figure centrally shows the uterus from which the fallopian tubes extend to the left and right. The medical term hysterectomy comes from the Greek. Hystéra translates as uterus and the word ektome can be translated as to cut off or excise. If the ovaries are also removed during surgical removal of the uterus, or womb, the procedure is called a hysterectomy with adnexectomy (unilateral or bilateral). Adnexa is the medical term for the ovaries. Subtotal hysterectomy is often distinguished from total surgery. While supracervical hysterectomy does not remove the cervix (neck of the uterus), total surgery removes the entire uterus. Hysterectomy is usually performed for benign conditions. In gynecologic surgery, the procedure is quite common. Possible indications include cysts or fibroids. Around 150,000 hysterectomies are performed in Germany each year. 50 percent of all women are between 40 and 49 years old when their uterus is removed.
Function, effect and goals
The uterus can be removed for a variety of reasons. Benign tumors and functional diseases of the uterus are the main indications for hysterectomy, and 90 percent of surgeries are performed for such conditions. One possible indication is menstrual irregularities. These are also called cycle disorders. Abnormalities of the bleeding rhythm can be distinguished from abnormalities of the bleeding intensity. Additional bleeding or persistent bleeding in the absence of ovulation as well as the complete absence of menstruation (amenorrhea) also belong to cycle disorders. However, an indication for hysterectomy is mainly increased bleeding. While amenorrhea usually remains without problems for women, anemia (anemia) can develop as a result of excessive bleeding. However, the most common cause of hysterectomy is uterus myomatosus. These are fibroids of the uterus. Myomas are benign tumors that develop and grow under the influence of estrogens, progesterones and growth factors. Often, women do not notice the fibroids. However, depending on their location and size, they may develop pain, constipation, discomfort during urination or discomfort during sexual intercourse. Due to impaired mucosal regeneration, bleeding and even anemia may occur. In addition, pedunculated fibroids can twist, causing an acute abdomen. Seventeen percent of all hysterectomies are performed due to endometriosis. Endometriosis is a benign, chronic condition that can cause severe pain. It is caused by endometrium that has settled in the body outside the uterus. It can affect, for example, the ovaries, the vaginal wall, the intestines, or even the lungs and brain. Like the normal endometrium, the dispersed endometrium responds to the menstrual cycle. Endometriosis is a common cause of infertility. If the pain due to endometriosis is too high and there is no desire to have children, the uterus can be removed. Another reason for hysterectomy is uterine prolapse. In uterine prolapse, the uterus pushes through the birth canal to the vagina. This can cause the uterus to partially leak out of the vagina. Only in 10 percent of all cases is the uterus removed due to malignant disease. Possible indications are malignant tumors of the ovaries, cervix or uterus. In addition, a hysterectomy may be required after injury to the uterus or in the case of birth complications with unstoppable bleeding. Roughly, a distinction can be made between a simple hysterectomy, a hysterectomy with adnextomy, a hysterectomy with pelvic floorplasty, and a total operation. The choice of surgical procedure depends on various factors.The indication, the size and shape of the uterus, the mobility of the uterus, the experience of the surgeon and the equipment of the clinic all play a role in the decision-making process. In vaginal hysterectomy, the uterus is removed through the vagina. Laparoscopic hysterectomy, also known as TLH or total laparoscopic hysterectomy, is performed using a laparoscope and with the help of other instruments inside the abdominal cavity. The laparoscopic and vaginal hysterectomy procedures can be combined. In laparoscopically assisted hysterectomy (LAVH), the uterus is operated on laparoscopically and removed through the vagina. In addition, a laparotomy may be performed with preservation of the cervix. This surgery is also called subtotal or supracervical abdominal hysterectomy. Total abdominal hysterectomy is performed through an abdominal incision without preservation of the cervix. When removed through the vagina, the cervix is also removed. In abdominal and laparoscopic surgical procedures, it is possible to preserve the cervix. In both procedures, simultaneous removal of the fallopian tubes and ovaries is also possible. Of course, this additional removal should only be performed if indicated. For some stages of cervical cancer, Wertheim-Meigs radical hysterectomy is the procedure of choice. Here, the uterus, the associated holding apparatus, the upper third of the vagina, and the pelvic lymph nodes are removed.
Risks, side effects, and hazards
It should be noted that hysterectomy results in total infertility in a woman. Thus, in women who wish to have children, the uterus should be removed only if there is no other option. Rarely, removal of the uterus results in wound healing problems or injury to the ureter, bladder, and bowel. Postoperative bleeding may also occur. Other complications of hysterectomy include urinary tract infections, scar fractures, adhesions, pain during intercourse, and subsidence symptoms.
