Hysterectomy

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.Uterus prior to hysterectomyLaparoscopical hysterectomyCervical stump (white) after removal of the uterine corpus at laparoscopic supracervical hysterectomyTransvaginal extraction of the uterus in total laparoscopical hysterectomyEnd of an laparoscopical hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. The origin of hysterectomy comes from the ancient Greek view that a women's intense emotions and unstable behavior, referred to as 'hysteria,' was a consequence of her 'wandering uterus.' The term 'hysteria' comes from the Greek word, hysterika, meaning uterus. Therefore, it was believed that the displaced uterus needed to be removed in order to treat the hysteric behavior. Usually performed by a gynecologist, a hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called 'complete') or partial (removal of the uterine body while leaving the cervix intact; also called 'supracervical'). It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. In 2015, according to the American Journal of Obstetrics and Gynecology, more than 400,000 hysterectomies were performed in the United States, of which, nearly 68 percent were performed for benign conditions such as endometriosis, irregular bleeding and uterine fibroids. Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons. However, more recent data suggests that the number of hysterectomies performed has declined in every state in the United States. In fact, from 2010 to 2013, there were 12 percent fewer hysterectomies performed, and the types of hysterectomies were more minimally invasive in nature, reflected by a 17 percent increase in laparoscopic procedures. This suggests that patients are finding viable alternatives to manage their symptoms before opting for hysterectomy. Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall as there are good alternatives in many cases. Oophorectomy (removal of ovaries) is frequently done together with hysterectomy to decrease the risk of ovarian cancer; however, recent studies have shown that prophylactic oophorectomy without an urgent medical indication decreases a woman’s long-term survival rates substantially and has other serious adverse effects. This effect is not limited to pre-menopausal women; even women who have already entered menopause were shown to have experienced a decrease in long-term survivability post-oophorectomy. Hysterectomy is a major surgical procedure that has risks and benefits, and affects the hormonal balance and overall health of women. Because of this, hysterectomy is normally recommended as a last resort after pharmaceutical or other surgical options have been exhausted to remedy certain intractable and severe uterine/reproductive system conditions. There may be other reasons for a hysterectomy to be requested. Such conditions and/or indications include, but are not limited to: In 1995, the short-term mortality (within 40 days of surgery) was reported at 0.38 cases per 1000 when performed for benign causes. Risks for surgical complications were presence of fibroids, younger age (vascular pelvis with higher bleeding risk and larger uterus), dysfunctional uterine bleeding and parity. The mortality rate is several times higher when performed in patients who are pregnant, have cancer or other complications. Long-term effect on all case mortality is relatively small. Women under the age of 45 years have a significantly increased long-term mortality that is believed to be caused by the hormonal side effects of hysterectomy and prophylactic oophorectomy.