Hysterectomy

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Hysterectomy
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• Hysterectomy is an operation in which the uterus
  is removed. The cervix, ovaries and/or Fallopian
  tubes might also be removed.
• It may be done abdominally or vaginally.
• Vaginal hysterectomy usually done for some cases
  of uterine prolapse.

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Indications of hysterectomy

• Obstetrical
• Rupture of the uterus.
• Uncontrollable post-partum hemorrhage.
• Placenta accreta.
• Gynecological
• Inflammatory as some cases of genital
  tuberculosis.
• Tumors benign (ovarian tumors, fibroids)
• Malignant (cervix, body and
  ovaries)
• Displacement some cases of uterine prolapse or
  chronic inversion.
• Some cases of dysfunctional uterine bleeding.

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Types of hysterectomies

• Subtotal hysterectomy (partial)
• involves removing the body of the uterus,
  but leaving the cervix in place.
• done for post partum hemorrhage and rupture
  uterus.
• 2. Total hysterectomy
• involves removing the body of the uterus as
  well as the cervix, much better than subtotal.
• 3. Pan hysterectomy
• Total hysterectomy and bilateral of both
  ovaries
• 4. Radical hysterectomy
• is done specifically in the case of invasive
  gynecological cancer.
• Removal of the uterus, both tubes, and
  ovaries, the upper third of the vagina, the iliac
  and obtruator lymph gland.
• 5. Ultra radical hysterectomy
• Anterior excenteration ?Removal of the
  bladder
• posterior excenteration ?Removal of the
  bladder and rectum

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Advantages of subtotal hysterectomy

1. -It is easier and quicker than total hysterectomy
2. There is less danger of injuring the bladder.
3. Less danger of pelvic infection.
4. The cervix left to act as a support for vagina.
5. The cervix discharge lubricates the vagina

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Advantages of total hysterectomy

1. Provides better drainage of the operation area.
2. If the cervix is lacerated or infected, the
   source of irritant discharge is removed.

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vaginal hysterectomy

• Indications of vaginal hysterectomy
• Some cases of uterine prolapse.
• Some cases of dysfunctional uterine bleeding.
• Some cases of cancer body

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• Advantages of vaginal hysterectomy
• Absence of an abdominal scar.
• Lower incidence of intestinal complication.
• An associated genital prolapse can be treated at
  the same time.
• Disadvantages of vaginal hysterectomy
• It is unsafe and difficult in the presence of
  pelvic adhesions.
• The ovaries can not be removed in some cases.
• It can not be done if the size of the uterus is
  larger than a 14 weeks pregnant uterus.

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Postoperative Complications of abdominal
hysterectomy

• Shock.
• Hemorrhage.
• Infection,
• Intestinal complications as acute gastric
  dilatation.
• Pulmonary complications e.g. bronchitis,
  pneumonia, pulmonary collapse.
• Venous thrombosis (DVT, SVT.)
• Post operative anesthetic complications e.g.
  Cyanosis, vomiting.
• Remote Complications e.g. vaginal discharge
  (infection), vaginal vault prolapse, low back
  ach,
• Menopausal symptoms e.g. sadness, irritability.
  (in younger female)

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Methods of treatment

• Deep breathing exercises
• to improve alveolar ventilation. (to minimize
  changes in lung volume and gas exchange) from
  semi-fowler position, the abdominal muscle in
  slack to allow greater diaphragmatic excursion
• Rolling
• to minimize trunk movement.
• Coughing
• Two stage cough preceded by deep breathing
  (the 1st raises the secretion, the 2nd facilitate
  expectoration. Patient applies pressure on the
  incision by pillows or hands.
• Huffing
• accomplished by forceful expiration, If the
  patient unable to do coughing
• Ankle circles
• To minimize the occurrence of phlebitis and
  facilitate venous return.
• Abdominal muscles exercises.

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Aims of treatment

• Pre-operative
• Psychological preparation for the operation.
• Aims of pre-operative treatment
• To prepare the patient physically and mentally
  for the operation.
• Teach her the exercises that will be done post
  operatively.
• To improve circulation.
• To improve respiration.
• To strength the abdominal muscles

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• Post-operative
• Aims
• To improve circulation.
• To improve respiration and prevent chest
  complications.
• To avoid muscle wasting.
• To prevent postural problems
• Methods
• The same like cesarean section except arm
  exercises.
• Electrical stimulation to decrease pain (TENS).
• Laser to decrease pain and enhance healing

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