The word hysterectomy has it’s origin from the Greek ‘ hysteros ‘ , meaning uterus , and ‘ ectomy ‘ meaning removal . Hysterectomy therefore refers to the surgical removal of the uterus (womb) . Such patients, naturally , do not have menstrual periods and cannot bear children. Today , hysterectomy is the commonest major gynaecological operation performed on women. About 600,000 hysterectomies are performed every year in USA . The statistics for India are not known but are likely to be more staggering because of the vast population .

Despite great advances in surgical methods , hysterectomy even today is considered a major undertaking . A recent survey in 2002 showed that this surgery is associated with a mortality of 0.38 per 1000 and serious postoperative complications in about 3% . Therefore , even though hysterectomy is curative for many gynaecological complaints , it is not a benign procedure that can be taken lightly .The important issues are : Is hysterectomy really required for your complaints ? Is there some way by which the uterus can be removed by means other than major abdominal surgery , but with lesser risks ? Can you avoid removal of uterus itself , yet get relief of symptoms ?
With improved understanding of the nature of processes in our body , the reasons for removing the uterus has steadily declined over the years . Patients who have weakness of the walls of the birth canal ( vagina ) or supports of the uterus to give a sensation of ‘ something coming out ‘ have traditionally been offered repair of the supports and removal of the uterus . If the prolapse is of major degree , then this is justified . Increasingly , however , it has been felt that an attempt ‘ to cure the bulge may not treat the reason for the defect ‘. We now tend to treat prolapse in a way similar to hernias of the abdominal wall rather than do a mutilating surgery like hysterectomy . The best news is for those of you who ‘ leak urine ‘ when getting up or coughing . Why should you sacrifice your uterus for this when simple ways of using tension free tapes to support the urinary tube in a relatively minor procedure are available and you can be discharged the same day !
This is the era of minimally invasive endoscopic surgery . Not only are these much safer with fewer complication rates than open abdominal surgery , but they are patient friendly too because no big , rough hands are disturbing your insides . Only fine instruments are inserted , in the case of laparoscopic surgery , through ‘ key holes ‘ in the abdomen . In the case of hysteroscopic surgery , keyholes are not required because there is a natural passage below , the cervix , through which instruments can be introduced inside the uterus . Traditionally surgeries have always taken place in the operating theatre . With the development of newer technologies like these operations can now be done in ‘ day care settings’ . The patient can thus be discharged within 24 hours , has rapid recovery which is important because surgeries are often postponed due to commitments at work or family needs.
The single most common reason for hysterectomy today is fibroids . Fibroids are benign tumors of the muscles of the uterus . Women with small fibroids are best treated by leaving them well alone . Only those fibroids that cause symptoms will need treatment which does not necessarily mean removal of the uterus : fibroids inside the cavity of the uterus can be removed using the hysteroscope from below , others can be treated using laparoscopy , keeping certain limitations for both procedures in mind . If such limitations exist , one can block the blood supply to the fibroids so that they perish , by a procedure called uterine artery embolization . If for some reasons this is not possible or if there are very many fibroids , one can , as a last resort , go for hysterectomy .
Heavy menstrual bleeding affects around 30% of women and causes lethargy, exhaustion and repeated infections due to anaemia . At times , it also results in social embarrassment . Since 1843 when it was first described , hysterectomy has been considered as the ‘ gold standard ‘ for heavy periods . Today , one – fifth of all hysterectomies are done for this reason . In majority of such patients , however , there is no abnormality of the uterus itself but there is hormonal imbalance . Since the uterus is 90% muscle and 10% is the lining of the uterus from where the bleeding actually occurs , it is illogical to remove the whole uterus . Techniques are available whereby only the culprit , the lining of the uterus , is destroyed or ablated , as it is called . Of these ablative methods , computer controlled , heated , fluid filled balloon therapy has the longest safety record in the world . This is a simple 8 minute procedure , with more than 90% success , after which the patient can go home and resume normal life within 2 days without sacrificing her uterus .
With all these exciting possibilities now available , hysterectomy is not a cure or panacea for all gynaecological complaints , considering the impact losing the uterus may have on urinary , bowel , mood and sexual function . Despite these reservations , it is required as treatment of cancer of the uterus and ovaries and sometimes for some non cancer gynaecological problems as well . Whenever possible, it is better to go in for laparoscopic hysterectomy rather than the older open surgery for best benefits .

Dr Nirja Chawla