An Overview of Hysterectomy

Angie L. Goeser, PharmD; Matthew J. Hasiak, PharmD; Jared L. Hochstettler, PharmD Candidate

Disclosures

US Pharmacist. 2008;33(9):HS11-HS20. 

In This Article

Complications

Although hysterectomy is generally considered safe, several possible complications are associated with the procedure. These complications can result in mild-tosevere morbidity and even (although rare) mortality.[18,20,21] Although their incidence is low, it is important to be aware of the immediate and long-term complications that can result from hysterectomy.

Ureteral injuries are common, owing to the size and location of the ureter, and generally are the result of excessive electrocautery and lasering adjacent to the ureter during surgery.[20] The incidence is reported to be 0.5% for hysterectomy performed for benign disease and up to 1.6% for laparoscopically-assisted hysterectomy.[21] If injury occurs during surgery, repair is more likely to be successful if performed intraoperatively at the time of injury.[20,22]

The risk of bowel injury varies depending on the type and method of the hysterectomy. While uncommon, injury to the rectum or to the ascending or descending colon can occur.[23] The incidence of bowel injuries is 0.4%, with laparoscopically-assisted abdominal hysterectomy carrying the largest risk.[24]

Bladder injuries occur in up to 2% of hysterectomy cases.[25] In vaginal hysterectomy, the bladder can be perforated during entry into the anterior cul-de-sac; in abdominal hysterectomy, injury can occur when the peritoneum is opened or during dissection of the bladder off the lower uterine segment, cervix, and upper vagina.[18] Although most of these complications are corrected during the procedure, postoperative incontinence due to bladder injury during surgery is commonly reported.[26,27]

The most serious postoperative complication of hysterectomy is hemorrhage, which occurs in 1% to 3% of patients.[25] Although all patients are at risk, those having a peripartum hysterectomy, hysterectomy for gynecologic cancer, elective hysterectomy for pelvic inflammatory disease, or pelvic abscesses are at greater risk for developing postoperative bleeding complications.[18,22] If postoperative vaginal bleeding develops and is determined to occur below the vaginal cuff, outpatient suturing of the site will generally stop the bleeding. If the hemorrhage is above the vaginal cuff, further examination in the operating room is warranted. The patient is then stabilized with IV fluids and transfused with two to four units of packed red blood cells. Next, the bleeding will generally tamponade, stop, and form a hematoma that will eventually be reabsorbed into the body.[18,23,28]

Infection is a common postoperative complication associated with hysterectomy. Four percent to 10% of patients undergoing vaginal hysterectomy and 6% to 25% of those having abdominal hysterectomy develop an infection postsurgery.[18,19] In all, regardless of the careful precautions taken, approximately one-third of patients develop postoperative febrile infection.[19] Because of this, the use of preoperative and ostoperative interventions, such as prophylactic treatment with broad-spectrum antibiotics, can contribute greatly to the reduction of infections occurring with hysterectomies.

While the aforementioned complications are more common, the following complications, although rare, also can occur: atelectasis, fallopian tube prolapse, thromboembolic disease, myocardial infarction, stroke, and renal failure.[23,25,28]

Early menopause is the result of hormonal changes secondary to hysterectomy. Early onset of menopause can be associated with hysterectomy even when the ovaries are retained. One study found that menopause occurred four years earlier in premenopausal women who underwent hysterectomy (both ovaries retained) compared with similar women without hysterectomy.[29] Another study examining women who underwent hysterectomy (retaining one or both ovaries) showed that onset of menopause occurred up to 5.5 years earlier than in women who did not have a hysterectomy.[18] One theory for this is that reduced blood flow to the ovaries disrupts their functioning, resulting in improper production of sex hormones.[30,31]

Psychological effects that may manifest following hysterectomy vary from individual to individual. While some studies have found that women experience new feelings of depression, anxiety, decreased libido, or social disruption due to the lengthy postprocedural recovery, other studies have concluded that women undergoing hysterectomy have improved quality of life because their previous unpleasant symptoms have been relieved.[32,33] It is important for patients and their physicians to communicate regularly after the hysterectomy. Patients who experience ongoing depression after surgery should speak with a health care provider to determine the need for counseling or the use of antidepressant medications.

Although multiple complications may result from this procedure, it is important to keep in mind that most women are quite satisfied with the results of surgery and with the significant symptom relief they experience ( Table 1 ).[34]

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