During abdominal hysterectomy, your surgeon detaches your uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The lower part of your uterus (cervix) is usually removed (total hysterectomy) but may sometimes be left in place (partial hysterectomy). If necessary, your surgeon may remove additional pelvic organs and tissue, such as your ovaries or fallopian tubes.
Before the procedure
Before surgery, you may have tests done to check for cancer, which could change your surgeon's approach to surgery. Tests may include:
- Cervical cytology (Pap test), which detects the presence of abnormal cervical cells or cervical cancer
- Endometrial biopsy, which detects abnormal cells in the uterine lining or endometrial cancer
- Pelvic ultrasound, which may show the size of uterine fibroids, endometrial polyps or ovarian cysts
The day before and morning of your surgery, you will be instructed to shower using soap provided by your surgeon to reduce your risk of infection. A preoperative cleansing of your vagina (vaginal douche) or preoperative cleansing of your rectum (enema) also may be done. Immediately before surgery, you'll receive an intravenous antibiotic medication to minimize your risk of infection after the procedure.
During the procedure
A hysterectomy typically is performed under general anesthesia, so you won't be awake during the surgery. The procedure itself generally lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.
To begin the procedure, a member of your surgical team passes a urinary catheter through your urethra to empty your bladder. The catheter remains in place during surgery and for a short time afterward. Your abdomen and vagina are cleaned with a sterile solution before surgery.
To perform the hysterectomy, your surgeon makes a cut (incision) in your lower abdomen, using one of two approaches:
- A vertical incision, which starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone
- A horizontal bikini-line incision, which lies about an inch above your pubic bone
The type of incision depends on many factors, including the reason for your hysterectomy, the need to explore the upper abdomen, the size of your uterus and the presence of any scars from prior abdominal surgeries. For instance, hysterectomies performed for endometriosis, large fibroids and gynecologic cancers are done mainly through a vertical incision.
After the procedure
After surgery, you'll remain in the recovery room for a few hours. Your health care team will:
- Monitor you for signs of pain
- Give you medicine for pain and to prevent infection
- Encourage you to get up and walk around soon after surgery
An abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. You'll need to use sanitary pads for vaginal bleeding and discharge. It's normal to have bloody vaginal drainage for several days to weeks after a hysterectomy. However, let your surgeon know if you have bleeding that's as heavy as a menstrual period or bleeding that's persistent.
The abdominal incision will gradually heal, but a visible scar on your abdomen will remain.