Hysterectomy

Hysterectomy

Hysteria: Womb-Ectomy: It is derived by combining the Latin words used to mean extraction.

Hysterectomy is a "surgical removal of the uterus" operation for various reasons and is the second most common operation in women after a cesarean section.

Hysteria: Womb-Ectomy: It is derived by combining the Latin words used to mean extraction.

Types of Hysterectomy
Total Abdominal Hysterectomy (TAH)
It is the operation of removing the entire uterus through an abdominal incision. Ovaries (ovaries) are not removed in TAH surgeries.

Generally, in women under the age of 45, the ovaries (ovaries) are left in place as they will continue their activities until menopause. In this way, women do not enter menopause after their menstruation ceases in the postoperative period, and they do not experience problems such as hot flashes, sweating, fever, or palpitations due to the effect of hormones secreted from the ovaries. At the end of a certain period, such menopausal complaints will begin as the ovarian reserve is depleted and the estrogen hormone decreases.

Subtotal Hysterectomy
It is the operation of removing the uterus by leaving the cervix in place with an incision made from the abdomen. These surgeries are generally preferred at young ages (before the age of 40). The purpose of subtotal hysterectomy is to continue menstruation, albeit a little, in the postoperative period, and in this way psychologically relax. The disadvantage is that annual controls of these patients are required in terms of cervix ca (cervical cancer) in advanced ages since the cervix remains after the surgery.

Vaginal Hysterectomy (VAH)
VAH is surgery to remove the uterus through the vaginal route. These surgeries are more frequently performed in women due to uterine prolapse called “uterine prolapse”.

The vaginal removal of the uterus heals much faster than the incisions made in the abdomen, in this way, the patients can stand up much more easily, return to their work more quickly, and the risks such as post-operative pain and infection are seen to be less.

When necessary, bladder prolapse (cystocele) and prolapse of the last part of the bowel (rectocele) surgeries can be performed simultaneously with vaginal hysterectomy surgery. VAH surgeries are preferred in only one-quarter of women compared to abdominal hysterectomies.

Total Abdominal Hysterectomy + Bilateral Salpingoopherectomy (TAH + BSO) It is the operation of removing both ovaries together with the uterus.

Especially in patients over 45 years of age, the ovaries are removed along with the uterus. The purpose of TAH+ BSO surgeries is to protect the patient against possible ovarian cancers in the future, considering that the ovaries of the person will be depleted with menopause. In addition, TAH + BSO surgeries are also preferred for people under the age of 50 who have cysts in their ovaries or have endometriosis problems.

Patients who have their uterus and ovaries removed enter menopause suddenly, this situation is called "surgical menopause". For this reason, complaints such as hot flushes, night sweats, fever, distress, and palpitations begin 15-20 days after the surgery, rather severely and suddenly compared to women who normally go through menopause. For this reason, such problems can be reduced in appropriate patients with estrogen hormone treatments (ERT) to be performed shortly after the surgery.

Total Abdominal Hysterectomy + Unilateral Salpingoopherectomy (TAH+USO)
It is the operation of removing only one of both ovaries along with the uterus. This type of surgery is one of the rare operations preferred in young patients who have a problem in only one of the ovaries together with the uterus. The aim is to prolong the time of the person's entry into menopause with the hormones secreted by releasing the single ovary.

Laparoscopy Assisted Hysterectomies
This type of surgery is performed through a one-cm incision made into the navel with the help of a device called “Laparoscope”, allowing viewing from the monitor by entering the abdomen with a camera, and cutting the suspensory ligaments of the uterus with surgical instruments inserted through the incisions of approximately half a cm from the inguinal regions. includes removal.

In this way, the wound healing rate is better since there is no abdominal incision in the patients. Laparoscopic hysterectomies are a class of special operations that should be performed by experienced gynecologist surgeons.

In which cases hysterectomy operations are performed?
Hysterectomy operations are most frequently performed for the following reasons.

Removal of fibroids
Hysterectomies are most frequently performed due to myoma, which originates from the uterus and is included in the group of benign tumors. In the medical literature, myoma is referred to as uterine fibroid, myoma, uterine myoma, fibroid, leiomyoma, or myoma uteri.

Among the people, it is known by names such as uterine tumor and benign uterine tumor. Myomas cause menstrual irregularities and related anemia, groin pain, menstrual pain (dysmenorrhea), constipation, frequent urination,kidney and urinary tract problems in women.

Myomas are less likely to become cancerous in women. However, surgical removal is the only treatment method for fibroids that grow rapidly and cause severe problems in a short time in routine ultrasonographic follow-ups. In some cases, especially young patients may have child expectations, and it may be preferable to leave the uterus in place and only remove the fibroids (myomectomy surgery).

Complete removal of the uterus at advanced ages aims to protect the patient from a second surgery by growing the millimetric fibroids in the uterus over time.

Cancer
Uterine cancer (Uterine Ca), cervical cancer (Cervix Ca), and ovarian cancer (Over Ca) operations can be performed frequently in cases of removal of the uterus.

Endometrial Hyperplasia
Pathological thickening of the membrane called "endometrium", which covers the inside of the uterus, may predispose to cancer. Although certain medical treatments can be applied, hysterectomy operations can be preferred in patients with recurring problems and the advanced age group.

Menstrual Irregularities Not Responding to Treatments
Hysterectomy operations can be performed if menstrual irregularities (frequent and intense menstruation) continue despite the medical treatments applied, and if the person has completed their fertility (ie, if there is no future child wish).

Especially in cases called "Adenomyosis" and where the uterus grows as a whole, complaints such as constant groin pain, menstrual irregularity, and painful menstruation can occur. In these cases, hysterectomy operations are frequently considered.

Endometriosis
Endometriosis is a disease characterized by the placement of cells in the uterus in the abdomen and the development of adhesions (adhesions) by multiplying there. In patients with endometriosis, complaints such as painful menstruation (dysmenorrhea), inability to conceive (infertility), and severe pain during intercourse (dyspareunia) are observed. Sometimes, ovarian cysts called “endometrioma (chocolate cysts)” may also occur. Removal of the uterus in endometriosis is an option that should be considered last.

Uterine Buc
The uterus may protrude from the vaginal canal (uterine prolapse), especially in cases of multiple normal deliveries and a lack of connective tissue elasticity. In this case, the uterus is completely removed by operations performed vaginally (from below). This type of surgery is called “Vaginal Hysterectomy (VAH)”.

However, in some special cases, especially in the young patient group, the lower part of the uterus can be cut and hung up.

Birth and Pregnancy Complications
The inability of the tired uterus to contract strongly (uterine atony) after cesarean or normal births can cause excessive bleeding. Such situations are the reason for "emergency hysterectomy" and if it is delayed, the patient may be lost. Likewise, in cases where the uterus is ruptured at birth (uterine rupture) or punctured during abortion (uterine perforation), primary repair may be insufficient, and immediate removal of the uterus may be life-saving.

Other Causes
Hysterectomy operations can also be performed in rare cases such as tubo-ovarian abscesses (abscesses covering the tube and ovaries), ovarian and abdominal cysts, and endometrial polyps.