Abdominal hysterectomy is a definitive procedure for removing a uterus when it is considered safer to perform this operation through an abdominal incision.
The majority of women who require an abdominal hysterectomy have heavy or painful menstrual bleeding, which has failed conservative treatment.
An enlarged uterus causing pressure pain, degeneration of fibroids and uterine carcinoma are other reasons for performing an abdominal hysterectomy.
When considering surgical treatment it is always important to minimise risk.
An abdominal hysterectomy is the best surgical approach when it is anticipated that patients may also have other pelvic problems which would limit surgical access. In such cases an incorrect surgical approach such as vaginal or laparoscopic hysterectomy will increase the risks of surgery and increase complication rates. If any of the risk factors listed below are present then an abdominal hysterectomy is the best choice:
- No uterine prolapse.
- An enlarged uterus due to fibroids or adenomyosis
- Premalignant conditions such as complex endometrial hyperplasia
- Ovaries should be removed because of disease or advanced age
- Pelvic adhesions are anticipated from previous endometriosis or P.I.D.
Routine abdominal hysterectomy is performed through a horizontal incision just above the pubic bone and usually involves a five-day inpatient stay.
When a gynaecological malignancy is suspected patients would always be referred to a gynaecological oncologist. These women will require more extensive surgery with a pelvic clearance involving removal of the uterus, ovaries, omentum, fallopian tubes, and pelvic/abdominal lymph glands.
Hysterectomy for gynaecological malignancy is performed abdominally and usually through a midline vertical incision.