58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)

Name of the Procedure:

Total Abdominal Hysterectomy (TAH) (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s). Commonly known as Total Abdominal Hysterectomy or simply Hysterectomy.

Summary

Total Abdominal Hysterectomy is a surgical procedure to remove the uterus, including the cervix. In some cases, one or both ovaries and fallopian tubes may also be removed. This operation is typically done through an incision in the abdomen.

Purpose

This procedure is performed to treat various gynecological conditions such as uterine fibroids, endometriosis, chronic pelvic pain, heavy menstrual bleeding, or cancers of the uterus, cervix, or ovaries. The goal is to alleviate symptoms, eliminate disease, and improve overall quality of life.

Indications

• Uterine fibroids causing pain or heavy bleeding
• Endometriosis unresponsive to other treatments
• Chronic pelvic pain
• Uterine, cervical, or ovarian cancer
• Severe, uncontrollable menstrual bleeding
• Pelvic inflammatory disease
• Prolapsed uterus

Preparation

Patients may be instructed to:

• Fast for a certain number of hours before surgery
• Adjust or stop certain medications
• Complete preoperative blood tests, imaging studies, and possibly a pelvic exam
• Arrange for postoperative care and transportation

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. A horizontal or vertical incision is made in the lower abdomen.
3. The uterus, along with the cervix, is detached from the surrounding structures and removed.
4. If applicable, one or both ovaries and fallopian tubes are also removed.
5. The incision is closed with sutures or staples.
6. Post-operative monitoring begins once the procedure is completed.

Duration

The procedure typically takes about 1-3 hours, depending on the complexity and whether additional structures like ovaries and fallopian tubes are also removed.

Setting

Total Abdominal Hysterectomy is usually performed in a hospital operating room.

Personnel

• Surgeon (usually a gynecologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Blood loss or bleeding
• Infection
• Injury to surrounding organs such as the bladder, bowel, or ureters
• Blood clots
• Anesthesia-related complications
• Long-term risks such as hormonal changes if ovaries are removed

Benefits

• Relief from pain and bleeding
• Resolution of gynecologic cancer
• Improved quality of life
• Reduced risk of further gynecologic problems Benefits are usually noticed a few weeks after surgery once recovery has progressed.

Recovery

• Hospital stay of 1-2 days is common.
• Full recovery typically takes 4-6 weeks.
• Instructions may include avoiding heavy lifting, strenuous activities, and sexual intercourse during the recovery period.
• Follow-up appointments to monitor healing and address any concerns are necessary.

Alternatives

• Medical management with medications
• Less invasive surgical options like laparoscopic hysterectomy
• Uterine artery embolization for fibroids
• Endometrial ablation for abnormal bleeding
• Each alternative has its pros and cons, often related to recovery time, effectiveness, and suitability for the patient's specific condition.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. After surgery, some pain and discomfort are expected which can be managed with prescribed medications. Patients may experience fatigue, vaginal bleeding, or discharge for a few weeks. It's important to follow all postoperative instructions to ensure a smooth recovery.