Hysterectomy

Abstract

Hysterectomy is the second most frequently performed surgery after cesarean section among women of reproductive age. The most common indication for hysterectomy was leiomyoma uteri and this was followed by uterine prolapse, endometriosis, cancer, hyperplasia and others (abnormal vaginal bleeding, menstruation irregularity, parametrial and peritoneal infections, disease of cervix, ovary, tube and postpartum incidents, and other neoplasias). Women aged 30 to 54 is the group hysterectomies are most frequently performed on. For benign indications, many countries have favored either the abdominal or the vaginal approach. These traditions have prevailed unaltered for decades. However, since the late 1980s, the new option of laparoscopic hysterectomy has raised questions about the most suitable type of approach. The overall rate of complications was 17.2% for abdominal, 23.3% for vaginal and 19% for the laparoscopic approach, with infection the most common problem. Haemorrhage occurred in 2.1, 3.1 and 2.7% of abdominal, vaginal and laparoscopic hysterectomies respectively. The significant difference between the different routes was that ureteric injury was seven times more common during operations performed by the vaginal than the abdominal route. There are alternative procedures such as endometrial ablation (dysfunctional uterine bleeding) and uterine artery embolization (fibroids). Seventy-five percent of women may avoid hysterectomy by the use of these techniques. The uterine artery embolization is a promising new approach for the treatment of uterine fibroids. However, information is lacking as to the effectiveness in women who wish to maintain fertility. In the treatment of menorrhagia, both hysterectomy and levonorgestrel-releasing intrauterine system (LNG-IUS) decrease lower abdominal pain. LNG-IUS use, but not hysterectomy, has beneficial effects on back pain. Hysterectomy is associated with high levels of satisfaction. Hysterectomy has been compared with endometrial ablation in the treatment of menstrual problems in several studies, which have suggested that 95% of women will be satisfied. Long-term satisfaction is high even in those experiencing pre-operative or early post-operative complications. This means that an alternative treatment has to be extremely good in order to have a higher satisfaction rate than hysterectomy itself. For women who do not wish to retain their uterus, there are gynaecologists who would suggest that there is no necessity to seek an alternative. © 2011 Nova Science Publishers, Inc. All rights reserved.