Abdominal Hysterectomy

This operation is indicated when the vaginal route is not deemed suitable. This may be due to previous surgery, suspected additional pathology or sheer size.

The cut is often made on a previous caesarean scar and is generally a bikini cut. In rare circumstances, a vertical incision is made below the belly button. Muscles are split and not cut, thus function is not affected & you will be able to do those sit-ups again 6 weeks after surgery!

Once inside, a little time is taken to restore anatomy, that is to ensure the womb and ovaries are correctly orientated and free of attachments to surrounding organs (called adhesions). The womb is then removed using sutures and/or electrocautery. The vaginal vault is sutured onto the supporting ligaments to guard againts later prolapse or sagging. The ovaries are generally retained and are secured to the pelvic side wall. Ovaries are generally only removed where compromised such as in suspected cancer or extensive benign disease.

The abdomen is closed in 3 layers, firstly the covering membrane or peritoneum, thereafter the muscle sheath and finally hidden sutures below the skin. I use a comfeel dressing which acts like a second skin, preventing movement at the scar and eliminating the risk of unsightly keloid. Please refer to 'do's & don'ts for abdominal surgery for post operative guidelines.

Abdominal Hysterectomy

LLETZ biopsy

Large Loop Excision of the Transformation Zone is the technique used to manage pre-cancerous lesions of the mouth of the womb (cervix) . The procedure can be conducted under local or general anaesthetic.

Stirrups are used and access to the cervix is obtained by means of a speculum. Iodene or acetic acid is used to demarcate the affected area.

Local anaesthetic is injected around the cervix. A semicircular electrode is chosen according to the size of the lesion and it is removed with a clear boundary in one or two sweeps. The biopsy is sent to the laboratory for confirmation of stage and clearance. It may be necessary for an additional biopsy or further surgery. In all cases regular review in the future is required.

Vaginal hysterectomy

The removal of the womb via the vagina. In most cases, this is the route of choice. Vaginal removal obviates the need for a skin incision significantly reducing post operative pain and immobility. I will offer this route in all cases where it is possible.

A spinal or general anaesthetic can be offered for this procedure. We use stirrups to gain vaginal access. The bladder is emptied and catheterised. The mouth of the womb, or cervix, is grasped and infiltrated with local anaesthetic. This helps to define the tissue layers, as well as improve pain control. A circular incision is made in the cervix. The bladder is moved from the upper surface and the rectum from the lower surface.

The membrane surrounding the abdominal cavity, or peritoneum, is punctured, exposing the connecting tissue, ligaments and blood vessels at the sides. These are then clamped and sutures in 3 or 4 steps at each side.The ovaries are inspected and biopsies may be taken. The fallopian tubes may also be removed. A vault repair is then performed using the remnants of the cardinal ligaments to ensure the vaginal vault remains secure and stable.

A corrugated drain and cloth vaginal plug are inserted which remain over night.A scope of the bladder (cystoscopy) may be conducted if you have had previous surgery (such as a C/section) Hospitalisation generally lasts 2 nights.

Pre-op Check list

Dr Douglas Seton, Obestetrician & Gynaecologist Knysna © 2021

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