subtotal hysterectomy


hysterectomy

 [his″tĕ-rek´to-me] surgical removal of the uterus. Within the past decade this has become a common major surgery in the United States. Controversy continues over whether many hysterectomies are really necessary. In making the decision for hysterectomy, patients often seek a second medical opinion and are encouraged to discuss options with health care givers and family members. Clinical indications for hysterectomy include pelvic relaxation; pain associated with congestion, endometriosis, or chronic pelvic inflammatory disease; fibroid tumors; recurrent ovarian cysts; excessive and debilitating bleeding; and cervical, ovarian, and uterine malignancies, premalignancy, and other high-risk conditions.Potential Complications. Whether the surgery is vaginal or abdominal will affect the location of the surgical site and incidence of complications. In general, abdominal incisions are made horizontally and low in the abdomen just above the symphysis. The vaginal route usually is chosen when a patient is obese, when abdominal scarring from previous surgery is present, and for removal of a prolapsed uterus or one in which stage 0 cancer is localized in the cervix.
Incisions made above and around the cervix in vaginal hysterectomy heal more rapidly than do abdominal incisions, and intestinal complications such as ileus are less likely. However, vaginal hysterectomy patients have a higher incidence of postoperative bleeding and infections, especially of the urinary tract.Patient Care. Two major areas of concern in the care of patients having a hysterectomy are psychosocial implications and physical care during the perioperative period.Psychosocial Implications. The psychosocial impact of removal of the uterus is a major concern of professional caregivers. Patients may be misinformed about basic anatomical and physiological features of the female reproductive tract and the functions of the uterus, fallopian tubes, and ovaries, or they may not know the effects of the contemplated surgery and are anxious about how it might influence their roles as women.
There should be sufficient time to determine what the patient knows, to answer her questions, and to dispel any misinformation she might have. Preoperative teaching does not necessarily mean that it is done the night before surgery. In fact, at that time the patient may be preoccupied with anxieties about major surgery and fears about pain and perhaps death. In that state of mind she would probably be unable to assimilate most factual information presented to her. At this point relieving the patient's anxiety is a top priority.
A patient's ability to adjust to the loss of a reproductive organ will be influenced by her sense of self as a woman, her age and previous socialization in regard to the roles of women, and the attitudes and expectations of her spouse, family and friends. Negative or positive attitudes can arise from her beliefs about how the surgery will affect her sexual expression and function and her vocational and avocational involvement and enjoyment of life. If the woman has experienced long-term pain and discomfort or has no desire to have more children, she may be favorably disposed toward the surgery. However, she may feel a profound sense of loss and purpose in her life. Negative attitudes toward the hysterectomy can have serious and adverse psychologic effects months or even years after the surgery.Physical Care After Surgery. Measures such as coughing, turning, deep breathing, and early ambulation to avoid circulatory and respiratory stasis are appropriate whether the hysterectomy is abdominal or vaginal.
Bleeding is a potential danger because of the abundant vascularity of the female pelvis. Dressings and perineal pads are checked regularly every two to four hours, or more often as indicated. The patient who has had vaginal surgery usually has a vaginal packing with a drain attached to the distal end. Some vaginal bleeding and oozing of serosanguineous fluid can be expected, but if there is frank bleeding of more than a light menstrual flow, or if the patient is passing clots around the pack, there is cause for concern. Heavy bleeding, a rapidly distended abdomen, referred shoulder pain, and change in vital signs are signs of an emergency that requires a return to the operating room to find and stop the source of blood loss.
Patients with an abdominal incision are monitored and dressings checked for excessive bleeding. If there is evidence of increasingly larger deposits of blood on the dressing, reinforcement of the dressing and notification of the surgeon are indicated.
The urinary output and characteristics of the urine are observed for signs of urinary tract infection. If the patient has an indwelling catheter, special catheter care is necessary. A poorly draining catheter or one that is totally blocked can lead to bladder distention and abdominal pressure. To avoid additional pressure on the abdomen and sutures, the patient is positioned on her side or back with her knees slightly flexed. High Fowler's position is contraindicated and there should be no pillows or break in the bed to produce pressure behind the knees.
Prior to discharge from the hospital the patient is given instructions in self-care; these should be written so that the patient can refer to them at home if necessary. They should include information about surgical menopause and estrogen therapy if the ovaries were removed; restrictions on douching and sexual intercourse; prevention of constipation; care of the incision; and reportable symptoms such as redness, swelling, pain, or drainage at the operative site and elevation of body temperature. Abdominal cramps and changes in bowel habits also should be reported to the professional caregiver.
The patient should also have opportunities to discuss personal contacts regarding sexual activity and her new body image. Although this may have been discussed during the preoperative period, she may be more receptive after the surgery is over and she is on the way to recovery. Some hospitals and clinics have support groups for women contemplating or recovering from hysterectomy. These can be a great support to patients and provide them with additional information and a forum for expressing and dealing with their emotional reactions to hysterectomy.abdominal hysterectomy that performed through the abdominal wall. Called also abdominohysterectomy and laparohysterectomy.cesarean hysterectomy cesarean section followed by removal of the uterus.radical hysterectomy hysterectomy with excision of the pelvic lymph nodes and wide lateral excision of parametrial and paravaginal supporting structures.subtotal hysterectomy that in which the cervix is left in place.total hysterectomy that in which the uterus and cervix are completely excised.vaginal hysterectomy that performed through the vagina.

su·pra·cer·vi·cal hys·ter·ec·to·my

removal of the fundus of the uterus, leaving the cervix in situ. Synonym(s): subtotal hysterectomy

subtotal hysterectomy

(sŭb-tōt′l)n. See supracervical hysterectomy.

Patient discussion about subtotal hysterectomy

Q. I have had a partial Hysterectomy 3 yrs. ago and I am now having menstrual bleeding what is wrong with me? since my hysterectomy I have had a few episodes of light vaginal bleeding, but for the past week I have had what I would consider a period and it wont stop, after a bowel movement it seems to be bright red and quite a lot of bloodA. i would go with brwnis65- go see your doctor stat. don't wait up for real damage! and if you have blood in your feces - that is not a good sign too, it needed to be checked up.

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