**Part 4**

**Hysterectomy Post-Operative Care** 

248 Hysterectomy

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Yardeni IZ, Beilin B, Mayburd E, Levinson Y, Bessler H. The effect of perioperative intra-

Yeh YC, Lin TF, Chang HC, Chan WS, Wang YP, Lin CJ, Sun WZ. Combination of low-dose

Zhang XW, Fan Y, Manyande A, Tian YK, Yin P. Effects of music on target-controlled

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**16** 

*United Kingdom* 

**Innovations in the Care of** 

Sepeedeh Saleh and Amitabha Majumdar

*East Lancashire NHS Trust, Lancashire,* 

**Postoperative Hysterectomy Patients** 

Hysterectomy, removal of the uterus, has traditionally been regarded as the definitive surgical treatment for heavy menstrual bleeding. And is one of the most commonly performed operations in the UK. (Marjoribanks, 2006) Whilst menstrual disorders are the most frequent reasons for performing hysterectomy other common indications include chronic pelvic pain, fibroids, malignancy of the uterus, cervix or ovaries and genital prolapse. Hysterectomy is a major surgical procedure with potential for significant physical and emotional complications. It also carries additional social and economic costs.

Hysterectomy rates have been decreasing in recent years, but there remain large variations in population-based rates of hysterectomy across primary care organisations in England, from fewer than 10 per 100,000 to 100 per 100,000 in female populations. (Information for hospital episode statistics) Although hysterectomies were originally all performed via the abdominal route, alternative types of hysterectomy (for example vaginal and laparoscopic hysterectomies) are increasingly popular, particularly when carried out for benign disease. Vaginal hysterectomy is the procedure of choice for uterovaginal prolapse amongst practitioners in the UK. (Jha, 2007) This move away from abdominal surgery is in part due to the less invasive nature of the vaginal and laparoscopic procedures which, as a result, produce arguably better outcomes: an effect most marked when considering post-operative recovery. Current evidence on the safety and efficacy of laparoscopic techniques for hysterectomy (including laparoscopic-assisted vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy) appears adequate to support their use, provided arrangements are in place

Although hysterectomy is generally considered safe several possible complications are associated with the procedure. These complications can result in mild to severe morbidity and even (in rare cases) mortality. Although their incidence is low, it is important to be aware of the immediate and longer-term complications that may arise from hysterectomy. Immediate complications include haemorrhage, bladder and ureteric injury, bowel injury, infection and venous thromboembolism. Long-term complications include the psychological and emotional aspects of such surgery in addition to complications arising from the surgical

**1. Introduction** 

(Lethaby, 1999)

for consent, audit and clinical governance.

menopause and the use of hormone replacement therapies.
