2nd Opinion

My 2nd opinion applauded my OB for doing a vaginal hysterectomy. He said it is the least invasive and requires the least amount of recovery time (yay!). I don't have to repair the cystocele and rectocele, so that's even better because there also won't be a longer recovery time due to that.

The Initial Hysterectomy Information

There are three types of partial hysterectomy procedures:

1. Vaginal Hysterectomy: removes the uterus and cervix through an incision deep inside the vagina. This is usually the method chosen to treat uterine-vaginal prolapse. A vaginal hysterectomy may result in less post-operative discomfort than you would feel after a total abdominal hysterectomy. Other advantages include a shortened hospital stay (1-3 days) and recovery time (4 weeks), and the lack of visible scarring. However, vaginal hysterectomy is not appropriate if very large fibroids are present. The procedure can be performed under general or regional anesthesia.
2. Abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen. Sometimes the procedure also includes removal of one or both ovaries and fallopian tubes. Risks associated with abdominal hysterectomy include:
   Blood clots
   Infection
   Excessive bleeding
   Adverse reaction to anesthesia
   Damage to your urinary tract, bladder or rectum, which may require further surgical repair
   Early onset of menopause
   Rarely, death Hysterectomy ranks as one of the most common surgical procedures among women.


3. Laparoscopic supracervical hysterectomy (LSH) uses a thin, lighted telescope-like instrument called a laparoscope, which acts like a video camera, along with small surgical instruments that are all inserted through three to four tiny incisions (less than 1/4 inch each) in the navel and abdomen. Using the instruments, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, you will not have the same kind of visible scar typical with most traditional, "open" surgeries. LSH causes less stress to the body than the traditional "open" hysterectomy. It was developed to reduce pain, minimize scarring, and shorten recovery time. The procedure can be done on an outpatient basis, which means a woman can be home resting comfortably within 24 hours and back to her normal activities in less than a week. As with all surgery, hysterectomy involves risk, including potential blood loss, infection and damage to other internal organs.
   LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, urinary incontinence and other complications associated with total hysterectomies. Because the cervix is left in place, however, you must be willing to continue annual pap smears to screen for cervical cancer.

Small incisions, less than 1/4" each, are made in the abdomen.
Using a laparoscope and small instruments, the surgeon removes the uterus through one of the opening.

This procedure enables the surgeon to leave the cervix intact.

Things I Need to Make Sure to Discuss With My OB:

1. Make sure he is leaving my cervix
2. Make sure he is leaving my ovaries
3. Discuss what type of procedure he is considering - it sounds like what I want is an LSH
4. What kinds of problems are treated with a hysterectomy?
5. What is the worst that can happen if I decide not to follow this recommendation?
6. If I need a hysterectomy, which type and surgical approach are most appropriate for me? Why?
7. How many times have you performed my procedure? What is your complication rate compared to the national complication rate?
8. Will my ovaries and fallopian tubes be removed during the procedure?
9. Will I have a scar after the surgery? How large and where?
10. How much time will I need to take off work?
11. How soon will I be able to return to my exercise routine after surgery?
12. Will you need to remove my cervix? Why?
13. What changes should I anticipate following surgery?

Side Effects:

• Anxiety
• Depression, mood swings
• Dizziness and nervousness
• Fatigue
• Hair loss
• Headaches
• Heart palpitations
• Insomnia
• Irritability
• Joint pain
• Low sex drive, painful sexual intercourse
• Memory lapses
• Unexplained weight gain
• Urinary incontinence
• Vaginal dryness

Women who have had a hysterectomy are at increased risk for developing heart disease, arthritis and osteoporosis.
There are medical conditions for which hysterectomy may be needed, especially if malignant cancer is involved. However, many hysterectomies are used to remove fibroids and to treat other related conditions. For these kinds of conditions, hysterectomy may be not needed, but women may not know of effective less radical and alternative treatments that should be considered and discussed with their physician. And women are frequently mistakenly afraid of developing cancer if a hysterectomy is not performed and may decide to have the procedure, according to a study as reported by the Reuters News Agency.
When a woman undergoes a hysterectomy, she goes into surgically induced menopause that results in the condition called "hormone imbalance", even if the ovaries are left intact. Even with the ovaries not removed, the blood supply to the ovaries lessens after the surgery and the ovaries usually cease functioning within 1-3 years.