Hysterectomy

Aka: Hysterectomy, Transabdominal Hysterectomy, Laparoscopic Assisted Vaginal Hysterectomy, Vaginal Hysterectomy

II. Epidemiology: United States

  1. Annual Incidence: 600,000
    1. Annual Hysterectomy Incidence is nearly twice that of appendectomy in the United States
  2. Surgically absent Uterus in 40% over age 60 years
  3. Most hysterectomies are for benign disease and are elective

III. Indications

  1. Most common indications
    1. Uterine Leiomyoma or Uterine Fibroids (33%)
    2. Abnormal Uterine Bleeding
    3. Endometriosis
    4. Uterine Prolapse
  2. Cancerous and precancerous indications
    1. Endometrial Cancer (10%)
    2. Endometrial Hyperplasia (5%)
  3. Other indications
    1. Persistent Cervical Dysplasia
    2. Adenomyosis
    3. Peripartum bleeding

IV. Procedures

  1. Transabdominal Hysterectomy
    1. Lowest quality of life scores
    2. Highest hospitalization and postoperative costs
    3. Twice the risk of Postoperative Fever
    4. Significantly increased blood loss
    5. Prophylactic antibiotics are recommended
    6. Peipert (2004) Obstet Gynecol 103:86-91 [PubMed]
  2. Laparoscopic Assisted Vaginal Hysterectomy
    1. Same life quality as Vaginal Hysterectomy at 28 days
  3. Vaginal Hysterectomy
    1. Fastest return to normal activities
    2. Highest quality of life scores
    3. Lowest hospitalization and postoperative costs

V. Adverse Effects (serious complication rate: 10%)

  1. Mortality: 6 per 10,000 operations
  2. Urinary Incontinence (increases risk by 40-80%)
  3. Does not adversely effect sexual function
    1. Sexual well-being improves after Hysterectomy
    2. Roovers (2003) BMJ 327:774-8 [PubMed]

VI. Precautions: Prophylactic Oophorectomy at time of Hysterectomy

  1. Benefits
    1. Ovarian Cancer significantly reduced
      1. Note Hysterectomy alone also reduces risk by 35%
    2. Breast Cancer risk is reduced by 50%
  2. Risks (if oophorectomy performed before age 45)
    1. Overall mortality increases
    2. Osteoporosis risk increases
    3. Cardiovascular disease risk increases
    4. Dementia risk increases
  3. References
    1. Parker (2005) Obstet Gynecol 106:219-26 [PubMed]
    2. Rocca (2006) Lancet Oncol 7:821-8 [PubMed]
    3. Rocca (2007) Neurology 69:1074-83 [PubMed]

VII. References

  1. Ryan (1999) Kistner's Gynecology, Mosby, p. 137-9
  2. Brown (2000) Lancet 356:535-9 [PubMed]
  3. van den Eeden (1998) Am J Obstet Gynecol 178:91-100 [PubMed]

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Related Studies

Ontology: Hysterectomy (C0020699)

Definition (CHV) uterus removal
Definition (CHV) uterus removal
Definition (CHV) uterus removal
Definition (CHV) uterus removal
Definition (MEDLINEPLUS)

A hysterectomy is surgery to remove a woman's uterus or womb. The uterus is the place where a baby grows when a woman is pregnant. After a hysterectomy, you no longer have menstrual periods and can't become pregnant. Sometimes the surgery also removes the ovaries and fallopian tubes. If you have both ovaries taken out, you will enter menopause.

Your health care provider might recommend a hysterectomy if you have

Dept. of Health and Human Services Office on Women's Health
Definition (NCI) A surgical procedure to remove the uterine body (partial hysterectomy) or the uterine body and cervix (total hysterectomy).
Definition (NCI_NCI-GLOSS) Surgery to remove the uterus and, sometimes, the cervix. When the uterus and the cervix are removed, it is called a total hysterectomy. When only the uterus is removed, it is called a partial hysterectomy.
Definition (CSP) surgical removal of the uterus.
Definition (MSH) Excision of the uterus.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D007044
SnomedCT 236886002, 22650008, 149878002, 287922008, 149870009
CPT 1013911
LNC LP100604-0
English Hysterectomies, Uterus excision, Excision procedure on uterus, Hysterectomy NOS, hysterectomy, removal of uterus, hysterectomy (treatment), hysterectomy procedure, hysterectomies, hysterectomy procedures, Hysterectomy NOS (procedure), Hysterectomy Procedures, Hysterectomy (procedure), Hysterectomy, NOS, Hysterectomy (procedure) [Ambiguous], Hysterectomy
Dutch hysterectomie NAO, hysterectomie, Hysterectomie, Uterusextirpatie
French Hystérectomie SAI, Hystérectomie
German Hysterektomie NNB, Hysterektomie, Uterusexstirpation
Italian Isterectomia NAS, Isterectomia
Portuguese Histerectomia NE, Histerectomia
Spanish Histerectomía NEOM, resección del útero, procedimiento de resección uterina, histerectomía, SAI, Hysterectomy NOS, histerectomía, SAI (procedimiento), histerectomía (concepto no activo), histerectomía (procedimiento), histerectomía, Histerectomía
Japanese 子宮摘出, 子宮摘出ＮＯＳ, ｼｷｭｳﾃｷｼｭﾂ, ｼｷｭｳﾃｷｼｭﾂNOS
Swedish Hysterektomi
Czech hysterektomie, Hysterektomie, Hysterektomie NOS
Finnish Hysterektomia
Russian EKSTIRPATSIIA MATKI, GISTEREKTOMIIA, ГИСТЕРЭКТОМИЯ, ЭКСТИРПАЦИЯ МАТКИ
Croatian HISTEREKTOMIJA
Polish Wycięcie macicy, Histerektomia
Hungarian Hysterectomia k.m.n., Hysterectomia
Norwegian Fjerning av livmor, Hysterektomi
Derived from the NIH UMLS (Unified Medical Language System)

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