Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vagina.
Vaginal hysterectomy in Iran involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, if your uterus is enlarged, vaginal hysterectomy may not be possible.
Hysterectomy often includes removal of the cervix as well as the uterus.
Depending on the patient's condition, the particular city in Iran, the facilities available in the hospital, and the method of hysterectomy, the vaginal hysterectomy cost in iran start from $1300.
Total vaginal hysterectomy is an excellent operation when removal of the uterus is indicated in cases of either benign disease or carcinoma in situ of the cervix. The technique described here is simple and easy and can be accomplished with a minimum of operative time. There are four basic steps involved in performing a vaginal hysterectomy:
(1) entrance into the anterior and posterior cul-de-sac to expose the broad ligament,
(2) progressive clamping of the broad ligament from the uterosacral cardinal ligament to the tubo-ovarian round ligament,
(3) suspension of the vaginal cuff by suturing it to the uetrosacral cardinal ligament, and
(4) plication of the uterosacral ligaments in the midline to obliterate the cul-de-sac and reduce the chances of enterocele. The vaginal cuff can be progressively suspended as the hysterectomy takes place rather than suspended separately at the end of the hysterectomy.
There are four separate sutures that help suspend the vaginal cuff:
(1) the initial suture into the uterosacral cardinal ligaments,
(2) the pursestring reperitonealization suture that reinforces the uterosacral cardinal vaginal cuff suture,
(3) the vaginal cuff reefing suture, and
(4) the uterosacral ligament sutures tied across the midline at the end of the procedure.
The purpose of the operation is to remove the uterus via the vagina.
Physiologic Changes. Removal of the uterus results in the cessation of menstrual flow and causes sterility. In addition, it eliminates any existing cervical or uterine disease.
Points of Caution. Care must be taken to ensure that entry into the anterior cul-de-sac is made before the uterus is totally removed to avoid accidental entry into the bladder.
If the anterior and posterior cul-de-sacs can be entered, there is a significant reduction in bleeding from the pedicles of the clamped broad ligament.
The pedicles of the broad ligament should be retroperitonealized before reefing the vaginal mucosa.
The vaginal mucosa should not be closed. the edges of the vaginal mucosa should be reefed with a running locking 0 synthetic absorbable suture and left open for drainage.
Vaginal hysterectomy treats many different gynecologic problems, including:
Fibroids. Many hysterectomies are done to permanently treat fibroids — benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. If you have large fibroids, you may need an abdominal hysterectomy — surgery that removes your uterus through an incision in your lower abdomen.
Endometriosis. Endometriosis occurs when the tissue lining your uterus (endometrium) grows outside of the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
Gynecologic cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, your doctor may recommend a hysterectomy to treat it. Most of the time, an abdominal hysterectomy is done during treatment for ovarian cancer, but sometimes vaginal hysterectomy may be appropriate for women with cervical cancer or endometrial cancer.
Uterine prolapse. When pelvic supporting tissues and ligaments get stretched out or weak, the uterus can lower or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. Removing the uterus with hysterectomy and repairing pelvic relaxation may relieve those symptoms.
Abnormal vaginal bleeding. When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy can solve the problem.
Chronic pelvic pain. If you have chronic pelvic pain clearly caused by a uterine condition, hysterectomy may help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy for pelvic pain.
For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You may not even need to consider hysterectomy unless medications and less invasive gynecologic procedures have failed.
You cannot become pregnant after you've had a hysterectomy. If you're less than completely sure that you're ready to give up your fertility, explore other treatments.
Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:
Surgical risks are higher in women who are obese or who have diabetes or high blood pressure.
There is a risk of injury to other pelvic and abdominal organs during vaginal hysterectomy, including the bladder, ureters or bowel.
It's normal to feel anxious about having a hysterectomy. Here's what you can do to prepare:
Gather information. Before the vaginal hysterectomy surgery in iran, get all the information you need to feel confident about it. Ask your doctor and surgeon questions. Learn about the procedure, including all the steps involved if it makes you feel more comfortable.
Follow your doctor's instructions about medication. Find out whether you should change your usual medication routine in the days leading up to your hysterectomy. Be sure to tell your doctor about any over-the-counter medications, dietary supplements or herbal preparations that you're taking.
Discuss what type of anesthesia you'll have. You may prefer general anesthesia, which makes you unconscious during surgery, but regional anesthesia — also called spinal or epidural block — may be an option. If you're having a vaginal hysterectomy, regional anesthesia will block the sensation in the lower half of your body.
Arrange for help. Although you're likely to recover sooner after a vaginal hysterectomy than after an abdominal one, it still takes time. Ask someone to help you out at home for the first week or so.
After-effects of general anaesthesia
Most modern anaesthetics are short lasting. You should not suffer from any after-effects for more than a day after your surgery. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired.
You may have a catheter in your bladder to allow drainage of your urine. This is usually for up to 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have difficulties passing urine, you may need to have a catheter for a few more days.
A Vaginal Hysterectomy is performed through your vagina so the scar will be out of sight. However, if you have keyhole surgery as part of your operation, you will have between two and four small scars on different parts of your abdomen. The scar will be anywhere between 0.5 cm and 1 cm long.
Stitches and dressings
Removal of the stitches in your vagina is not required as they are dissolvable. You may notice a stitch, or part of a stitch, coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about. If you have keyhole surgery, your cuts may be closed by stitches or glue. Glue and some stitches dissolve by themselves. Other stitches may need to be removed, you will be given information about this. Your cuts will initially be covered with a dressing.
You may have a pack in your vagina after the surgery to reduce the risk of bleeding. A nurse will remove this after your operation while you are still in the hospital.
You can anticipate to have some vaginal bleeding for one to two weeks after your procedure. This is like a light period and is red or brown in colour. Some women have slight or no bleeding initially, and then have a sudden flow of old blood or fluid about 10 days later. This usually stops quickly. You should use sanitary towels rather than tampons as using tampons could rise the risk of infection.
Pain and discomfort
You can expect pain and uneasiness in your lower abdomen for the first few days after your surgery. When leaving hospital, you will be provided with painkillers for the pain you are undergoing.
Post-surgery your bowel may slow down for the time being, causing air or 'wind' to be trapped. This can cause some discomfort until it is passed. Getting out of bed and walking around will help. Once your bowels start to move, the trapped wind will ease.
Starting to eat and drink
After the surgery, you may have a drip in your arm to provide fluids. When you are able to drink again, the drip will be removed. You will be offered water or cup of tea and something light to eat.
There is a small possibility of formation of blood clots in the veins in your legs and pelvis (deep vein thrombosis) after any surgery. These clots can travel to the lungs (pulmonary embolism), which could be fatal. You can reduce the risk of clots by:
Start walking/moving about as soon as you can after your operation.
Perform exercises while you are resting, for example: pump each foot up and down briskly for 30 seconds by moving your ankle or move each foot in a circular motion for 30 seconds and bend and straighten your legs - one leg at a time, three times for each leg.
You may also advised other methods to reduce the risk of a clot formation, particularly if you are overweight or have other health issues.
You will be given guidance and information about exercises to help you recover fast and ways to gain mobility without difficulty.
Tiredness and feeling emotional
You may feel tired post-surgery as your body is using a lot of energy to heal itself. You may need to take a nap during the day for the first few days. A hysterectomy can also be emotionally traumatic and many women during this stage feel tearful and emotional.
Recovery from a hysterectomy if can be longer if:
You had health complications before your operation; for example, women with diabetes may heal at a slower pace and may be more prone to infection.
You are overweight - Patients can take a longer duration to recuperate from the effects of the anaesthetic and there is also a higher risk of complications such as infection and thrombosis.
There were any other complications during your surgery.