Procedure for Abdominal Hysterectomy - Simple, BSO

Total abdominal hysterectomy with bilateral salphingo-oophorectomy (BSO) is the removal of the uterus along with the ovaries and fallopian tubes of both right and left sides, sometimes the cervix and the surrounding supporting structures of the uterus as well.

Conditions and Symptoms for Abdominal Hysterectomy

1. Cancers of the Uterus:

   It is the most preferred procedure in this condition to reduce the risk of ovarian cancer as well. The symptoms of uterine cancer being:
   • Abnormal vaginal bleeding – Irregularities in menses
   • Painful urination
   • Vaginal discharge

2. Cancer of the Ovaries:

   Again, since the spread is fast this procedure is preferred, e.g. ovarian epithelial cancer and the symptoms are:
   • Pain, swelling, discomfort in the pelvis
   • Abnormal bleeding through vagina
   • Urinary problems like painful or difficulty in urination, blood in the urine
   • Painful sexual intercourse

3. Cancer of the Cervix:

   Performed in advanced stage where the spread is to the uterus and surrounding structures, as well in stage 2 where the tumor is aggressive.
   • Signs and symptoms are minimal.
   • Detected on routine Pap smear.
   • Bleeding in between periods and after intercourse.
   • Pelvic pain.
   • Abnormal discharge through vagina.

4. Cancer of the Fallopian Tubes.

   The symptoms being:
   • Pain in the lower part of the abdomen.
   • Abnormal vaginal discharge – Clear watery.
   • Bleeding between menstrual cycles.

5. Patients with Risk of Ovarian Cancer

   (who carry the gene responsible for ovarian and breast cancer) undergo bilateral salphingo-oophorectomy treatment as a preventive measure for cancer of ovaries. Here only the ovaries and the fallopian tubes are removed.

Since the types of hysterectomies are many, talking to your doctor in regards to the best procedure for you is important.

Types of Hysterectomies

In this chapter we are discussing about removing the uterus (hysterectomy), ovaries (oophorectomy) and the fallopian tubes (salpingectomy); the techniques are:

1. Total Abdominal Hysterectomy with BSO

   – Here vertical or horizontal incision is taken over the abdomen.

2. Laparoscopic Hysterectomy with BSO

   – This is minimally invasive, small incisions on the abdomen are made and under the guidance of a viewing instrument called the laparoscope, the surgery is performed.

3. Robotic Assisted Laparoscopic Hysterectomy

   – A technique using robotic arms during laparoscopic surgery, this is a newer type of laparoscopic hysterectomy.

Care After Surgery and Hospital Stay

The patient is discharged within 4-5 days in abdominal types. A urinary catheter with the bag collects the urine until the patient is able to pass the urine. The patient has to take ample rest before returning to routine work. Since hysterectomy recovery is slow plenty of fluids and restricted physical activity for 5-6 weeks is recommended. You have to see the doctor if you have the following:

• Fever
• Vaginal bleeding
• Cough or breathlessness
• Swelling, redness or pain in the legs
• Pus from the wound
• Trouble in passing urine or stools, or blood in urine, difficulty in passing the urine, cannot urinate at all, or blood in the urine.
• Skin rash
• Chest pain

The long-term complications are:

1. Vaginal wall weakness (sagging).
2. The patient can never become pregnant.
3. One important complication is menopause; because the ovaries are removed the patient experiences symptoms of hormonal deficiency.