Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)
CPT4 code
Name of the Procedure:
Total Abdominal Hysterectomy (Corpus and Cervix), With or Without Removal of Tube(s), With or Without Removal of Ovary(s); With Colpo-Urethrocystopexy (e.g., Marshall-Marchetti-Krantz, Burch)
Summary
A total abdominal hysterectomy involves the surgical removal of the uterus and cervix via an incision in the abdomen. This procedure may also include the removal of one or both fallopian tubes and ovaries. Additionally, it entails a colpo-urethrocystopexy to correct urinary stress incontinence by supporting the bladder neck and urethra.
Purpose
The procedure addresses several medical conditions including uterine fibroids, endometriosis, chronic pelvic pain, and cancers of the uterus, cervix, or ovaries. The goals are to alleviate symptoms, prevent further complications, and, in the case of cancer, to remove malignant tissues.
Indications
- Persistent abdominal pain
- Heavy menstrual bleeding
- Uterine fibroids
- Endometriosis
- Pelvic inflammatory disease
- Uterine, cervical, or ovarian cancer
- Stress urinary incontinence
Preparation
- Fasting from midnight before the surgery
- Adjustments to regular medications as advised by the doctor
- Preoperative blood tests, imaging studies, and possibly a pre-surgical clearance physical
Procedure Description
- Anesthesia is administered to ensure the patient is asleep and pain-free.
- An abdominal incision is made.
- The uterus and cervix are detached and removed.
- Depending on the case, one or both fallopian tubes and ovaries may also be removed.
- A colpo-urethrocystopexy is performed by securing the bladder neck and urethra to support structures, preventing urinary stress incontinence.
- The incision is closed with sutures or staples.
Duration
The procedure typically takes 2 to 3 hours.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Gynecologic surgeon
- Anesthesiologist
- Surgical nurses
- Possibly a urologist or another specialist for the colpo-urethrocystopexy part
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs (bladder, intestines)
- Blood clots
- Anesthetic complications
- Post-surgical adhesions
- Urinary problems
Benefits
- Relief from symptoms such as pain, bleeding, and urinary incontinence
- Removal of malignant tissues if cancer is present
- Improved quality of life
- Prevention of future medical complications related to removed organs
Recovery
- Hospital stay of 2 to 3 days post-surgery
- Pain management with prescribed medications
- Gradual return to normal activities within 6 to 8 weeks
- Avoidance of heavy lifting and strenuous exercise during recovery
- Follow-up appointments to monitor healing
Alternatives
- Less invasive surgeries (e.g., laparoscopic hysterectomy)
- Medications to manage symptoms
- Uterine artery embolization for fibroids
- Endometrial ablation for heavy menstrual bleeding
- Non-surgical treatments for urinary incontinence (e.g., pelvic floor exercises)
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, the patient may experience pain, discomfort, and limited mobility, which can be managed with medication and supportive care. Full recovery typically occurs over several weeks, during which the patient should follow their doctor's instructions for activity levels and follow-up care.