Total Abdominal Hysterectomy

A total abdominal hysterectomy (TAH) is a surgery to remove the uterus (womb) and cervix through an incision in your abdomen. Depending on your condition, the gynaecological surgeon may also remove the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy). This is a major surgery with a longer recovery time compared to minimally invasive methods (e.g., laparoscopic or vaginal hysterectomy), however with growing evidence based practice and newer technologies, recovery time has now become shorter.

Why is it Performed?

Your gynaecologist may recommend a TAH for:

• Uterine fibroids causing pain or heavy bleeding.
• Endometriosis or adenomyosis unresponsive to other treatments.
• Gynaecological cancers (e.g., uterine, ovarian, or cervical cancer).
• Pelvic organs prolapse (severe cases).
• Chronic pelvic pain with no identifiable cause.

Before Surgery

• Pre-operative assessment:
  • Blood tests, ECG, or imaging (e.g., ultrasound/MRI).
  • Discuss medical history, allergies, and medications (e.g., blood thinners).
• Preparation:
  
  • Fasting: No food/drink for 6–12 hours before surgery.
  • Bowel prep: May be required (e.g., laxatives or enema).
  • Shaving: The abdominal area may be cleaned/shaved.
• Arrange support: Plan for someone to drive you home and assist you for a week or so post-surgery.
• Emotional preparation: Acknowledge feelings of anxiety or loss; speak to your healthcare team.

During the Procedure

• Anaesthesia: General anaesthesia (you’ll be asleep).
• Incision:
  A horizontal (bikini-line) or vertical incision (5–7 inches) is made in the abdomen.
• Surgery:
  The uterus and cervix are detached and removed.
  Ovaries/tubes are removed if necessary (discussed pre-surgery).
• Closure: The incision is closed with stitches or staples.
• Duration: 1–2 hours (longer if complex).

Risks and Complications

• Common (temporary):
  • Pain, bruising, or swelling at the incision site. Fatigue, bloating, or gas pain.
  • Light vaginal bleeding (up to 6 weeks).
• Serious (rare):
  
  • Infection, bleeding, or blood clots (deep vein thrombosis).
  • Damage to nearby organs (bladder, bowel, or ureters).
  • Wound healing issues or hernia formation.
  • Early menopause (if ovaries removed).

Recovery

In the hospital:

• Stay for 1–3 days (varies with recovery speed).
• Pain relief (e.g., IV/prescribed medications).
• Encouraged to walk gently to prevent blood clots.

At home:

• Rest: Avoid lifting >5kg, driving, or strenuous activity for 6–8 weeks.
• Wound care:
  • Keep incision clean/dry; watch for redness, swelling, or discharge.
  • Staples/stitches are removed at a follow-up (7–14 days post-surgery).
• Pain management: Use prescribed medications (e.g., paracetamol, ibuprofen).
• Vaginal care:
  • No tampons, sex, or swimming for 6–8 weeks.
  • Light spotting is normal; report heavy bleeding (>1 pad/hour).

Return to work: Typically, 6–8 weeks (adjust based on job demands).

Long-Term Effects

Menopause: If ovaries are removed, symptoms (hot flashes, mood swings) may start immediately. Hormone replacement therapy (HRT) may be offered.

1. No periods: Permanent end to menstrual bleeding.
2. Body changes: Scarring, possible weight fluctuations, or altered bladder/bowel habits (usually temporary).
3. Sexual health: Most resume normal sexual activity after healing; discuss concerns with your gynaecologist.

Alternatives to TAH

• Medications: Hormonal therapies (e.g., for fibroids or endometriosis).
• Less invasive surgery: Laparoscopic or vaginal hysterectomy (if suitable).
• Uterine artery embolization: For fibroids.