What is Vaginal Hysterectomy & what are its risks? - Dr. Rashmi Chaudhary скачать в хорошем качестве

What is Vaginal Hysterectomy & what are its risks? - Dr. Rashmi Chaudhary

Vaginal hysterectomy is a surgical procedure in which the uterus is removed surgically through the vaginal route with or without the removal of the ovaries. When we remove the ovaries also along with the uterus through the vaginal route we call it a vaginal hysterectomy with Bilateral salpingo-oopherectomy. There are other ways of doing hysterectomy also. Once we remove the uterus through the abdomen we call it abdominal hysterectomy. Sometimes we remove it through the laparoscope, then we call it total laparoscopic hysterectomy. Sometimes we do the laparoscopic assisted vaginal hysterectomy in which we take the help of laparoscopic instruments to remove the uterus as well as the adnexas. Uterus is a muscular pear shaped structure in the lower abdomen. Or pelvis and in front of the uterus is the urinary bladder and the anterior vaginal wall. Behind the uterus is the posterior vaginal wall and the rectum. The lower part of the uterus is a conical structure which projects into the vagina. Vaginal hysterectomy is done for certain conditions. The most common is the pelvic organ prolapse in which the uterus along with the anterior and posterior vaginal wall and the rectum descends from the normal anatomic position. It is mostly due to over stretching of the pelvic floor muscles and the ligaments. The other causes can be abnormal uterine bleeding, cervical dysplasia or some chronic pelvic pain or small fibroids or any pathology. There are certain advantages of doing hysterectomy through the vaginal route. The vaginal route is easy to operate. The post operative stay in the hospital is less. The pain and complications are less. There are certain conditions in which we avoid the vaginal route of hysterectomy like when we the size of the uterus is very big or when we are expecting moderate to severe endometriosis or some adnexal pathology is expected. There are certain complications of vaginal hysterectomy like on the table there can be primary haemorrhage which is more in the case of hypertensive patients or they have any coagulation abnormalities or in case of long standing prolapse where there is too much of fibrosis. Patient in the post operative period can have fever. It is mostly because of the urinary tract infection. Sometimes if there is a prolonged immobilisation there can be clotting of blood in the lower extremities and the vessels. There can be some constipation or urinary retention. Urinary retention mostly happens because of the cystocoele repair. Vaginal hysterectomy is normally very satisfying for the patient because of the post operative pain is less, bleeding is very minimal, the sexual function is not altered. But in some cases some women complain of depression, anxiety, irritability or loss of libido. This is mostly because of interference with the ovarian function leading to decreased oestrogen production in the woman. So in these cases we supplement the woman with some multi vitamins, calcium supplementation and we encourage them for the lifestyle modification, day to day increased physical activity, walking and also the increased intake of soya proteins and the natural isoflavanoids.