What are the other Names for the Procedure?
- Abdominal Hysterectomy with Salpingo-Oophorectomy
- Supracervical Hysterectomy with Salpingo-Oophorectomy
- Total Laparoscopic Hysterectomy (TLH) with Salpingo-Oophorectomy
What is Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
- Hysterectomy is a surgical procedure characterized by the surgical removal of the uterus
- Salpingo-oophorectomy is a surgical procedure characterized by the surgical removal of the fallopian tube and ovary
What part of the Body does the Procedure involve?
Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure involves the uterus, cervix, fallopian tubes, ovaries, and vagina.
Why is the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure Performed?
A Hysterectomy is performed for the following reasons:
- Removal of suspected cancerous tumor within the uterus
- Fibroid tumor
- Chronic and excessive bleeding (menorrhagia)
- Uterine prolapse: A condition where uterus gradually slides out of the pelvis, through the vagina
- Adenomyosis: Thickening of the uterus
- Chronic uterine infection
- Severe pain associated with menopause
A Hysterectomy is also performed with the fallopian tubes and ovaries, for the following reasons:
- Removal of suspected cancerous tumor of the ovaries
- Removal of a ovarian cyst
- Ectopic pregnancy (pregnancy within the fallopian tube)
- Removal of an abnormal abscess that forms within the ovaries
- Ovarian abnormality due to severe endometriosis
What are some Alternative Choices for the Procedure?
For certain conditions, a hormonal treatment can be the alternative choice; but, Hysterectomy remains the gold standard procedure.
What are the Recent Advances in the Procedure?
Minimally Invasive Hysterectomy has been a significant advancement in this procedure.
What is the Cost of performing the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
The cost of Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure:
How is the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure Performed?
A Hysterectomy procedure can be performed in two ways:
- Abdominal Hysterectomy: Uterus is removed by making an incision in the abdomen
- Vaginal Hysterectomy: Uterus is removed through the vagina
Abdominal Hysterectomy - this can be done by:
- An open approach (or)
- Minimally-invasive surgical approach
- The surgeon makes an incision starting from above or below the belly button (either up-and-down, or side-to-side fashion)
- Incision is deepened down through all the layers of the abdominal wall (skin, fat, muscle, peritoneum) and abdominal cavity is entered
- Uterine blood vessels are tied, in order to prevent bleeding
- All uterine attachments are divided and the uterus is freed
- Supra-cervical or subtotal hysterectomy: Only the upper part of the uterus is removed; the cervix is left in place
- Total Hysterectomy: Uterus along with cervix is removed
- Radical Hysterectomy: It is generally done in cases of cancer where the uterus, cervix, upper part of the vagina, and the surrounding tissues, and/or organs are removed
- Once uterus is removed, the abdominal wall is closed in layers
Minimally invasive surgical approach:
- It is performed under general anesthesia, so the patient is asleep throughout the procedure
- Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs, on a television screen
- Other cannulas are inserted, which allow the surgeon to divide the blood vessels and to also separate the uterus from all its attachments
- Once the uterus is completely detached, it is removed through a larger incision in the abdomen
Laparoscopic-Assisted Vaginal Hysterectomy (LAVH):
- The technique is very similar to Laparoscopic Hysterectomy, except that the uterus is removed through the vagina
Robot-Assisted Laparoscopic Hysterectomy or da Vinci Hysterectomy:
- The surgeon uses a robot instead of standard laparoscopic instruments, to perform the Hysterectomy
Where is the Procedure Performed?
A Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure is performed at a hospital.
Who Performs the Procedure?
A general surgeon or an obstetrician-gynecologist performs a Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure.
How long will the Procedure take?
The procedure may take anywhere between 1-3 hours depending upon the type of procedure performed.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
Prior to a Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure, the patient may need to undergo certain tests, such as:
- Routine blood and urine analysis
- Abdominal x-ray
- X-ray of the kidneys
- Dilatation and Curettage of the uterus (D & C)
- Ultrasound imaging
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Injection of spinal anesthesia or general anesthesia by injection and inhalation is administered, prior to the procedure.
How much Blood will you lose, during the Procedure?
The blood loss is generally minimal, unless any complications arise.
What are the possible Risks and Complications during the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Infection of the surgical wound
- Accidental injury to the neighboring tissues (bowel, bladder, ureters, or vaginal wall
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
- After the surgical procedure, patients will be sent to an area of the hospital, called postoperative recovery area (PACU), and then admitted to the floor
- The patient’s blood pressure, heart rate, and respiration cycle, will be closely monitored
- Any additional pain associated with the procedure will also be treated
After the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure:
What are the possible Risks and Complications after the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
Post Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure, the following complications may arise:
- Excessive bleeding
- Infection in the surgical wound
- Obstruction of the urinary system or bowel
- Urinary incontinence
- Vesico-vaginal fistula: An abnormal connection between the urinary bladder and the vagina
- Vaginal prolapse
- Chronic pain
What is the Prognosis after the Surgery?
- The outcome is generally successful and most women will notice significant improvement in their symptoms and signs
- For those women, who require bilateral salpingo-oophorectomy, they will need lifelong hormonal replacement therapy, as they will develop menopausal symptoms from not having the ovaries
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Excessive vaginal bleeding
- Loss of bladder/bowel function
- Prolonged vaginal discharge
- Worsening pain and swelling around the surgical wound
- Signs of an infection
- Muscle aches
- Feeling sick
What Post-Operative Care is needed at Home after the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
At home, the following post-operative care is recommended, after a Hysterectomy (Abdominal) with Salpingo-Oophorectomy procedure:
- Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
- Use a heat pad or warm compress to relieve pain due to the incision
- Individuals are advised to have to a clear liquid diet, immediately following surgery. The diet is gradually advanced to solid foods
- Resume showering and keep the wound clean and dry. Gently wash the surgical wound with soap
- It may be required to use sanitary napkins (for bleeding), for about a week or more
- Complete the course of prescribed medication, as advised by your physician
- Take supplemental female hormonal medications, under supervision of the physician
- Resume driving only 2 weeks after the surgical procedure, or when advised by your physician
- Avoid sex till complete healing has taken place (generally 6-8 weeks, or follow the physician’s advice)
How long does it normally take to fully recover, from the Procedure?
It usually takes about 6-8 weeks to fully recover from an Open Abdominal Hysterectomy procedure. The recovery is much faster in patients undergoing Minimally Invasive Hysterectomy.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Hysterectomy (Abdominal) with Salpingo-Oophorectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility or a hospital
- An anesthesiologist (if anesthesia is administered)
- A pathologist (if the tissue is sent for analysis)
- A general surgeon or an obstetrician-gynecologist
The patient is advised to inquire and confirm the type of billing before the Hysterectomy is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA