58291 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

Name of the Procedure:

Vaginal hysterectomy for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
(Medical term: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy)

Summary

A vaginal hysterectomy is a surgical procedure where the uterus is removed through the vagina. In cases where the uterus is larger than 250 grams, it may also involve the removal of one or both fallopian tubes and/or ovaries.

Purpose

This procedure is performed to treat various uterine conditions, such as large uterine fibroids, severe endometriosis, uterine prolapse, or persistent abnormal bleeding. The goal is to alleviate symptoms, improve quality of life, and, in some cases, prevent potential malignancies.

Indications

• Large uterine fibroids causing pain or bleeding
• Severe endometriosis or adenomyosis
• Symptomatic uterine prolapse
• Chronic pelvic pain unresponsive to other treatments
• Abnormal uterine bleeding not controlled by medication
• Uterine, ovarian, or tubal cancer

Preparation

• Patients are usually required to fast for 8-12 hours before the surgery.
• Medication adjustments may be necessary, especially anticoagulants.
• Preoperative diagnostic tests such as blood work, pelvic ultrasound, or MRI may be required.
• Anesthesia consultation to discuss sedation options.

Procedure Description

1. The patient is placed under general anesthesia.
2. A speculum is inserted into the vagina to provide access.
3. The surgeon detaches the uterus from the surrounding structures, including the fallopian tubes and ovaries if they are being removed.
4. The uterus (and any additional structures) is removed through the vaginal canal.
5. Any necessary repairs, such as suturing or cauterizing blood vessels, are performed.
6. The vaginal incision is closed with dissolvable stitches.

Duration

The procedure typically takes 1.5 to 3 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Surgeon (gynecologist)
• Surgical nurse
• Anesthesiologist or nurse anesthetist
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (bladder, bowel, ureters)
• Blood clots
• Adverse reaction to anesthesia
• Long-term complications like pelvic organ prolapse or urinary incontinence

Benefits

• Relief from pain and other symptoms
• Resolution of heavy or irregular uterine bleeding
• Improved quality of life
• Reducing the risk of uterine or ovarian cancer where applicable

Recovery

• Most patients stay in the hospital for 1-2 days post-surgery.
• Light activity is recommended for the first few weeks; avoid heavy lifting and strenuous activity for about 6-8 weeks.
• Follow-up appointments to monitor healing and address any concerns.
• Pain management with prescribed medications and measures like ice packs.

Alternatives

• Medical management with hormonal treatments or medication
• Less invasive surgeries like laparoscopic or robotic hysterectomy
• Uterine artery embolization (for fibroids)
• Endometrial ablation (for abnormal bleeding)

Each alternative has its own pros and cons, such as varying recovery times and different success rates in symptom relief.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel pain. Post-procedure, patients may experience discomfort and pain, which can usually be managed with prescribed medications. Recovery involves gradually resuming normal activities, adhering to a follow-up care plan, and attending follow-up visits with the healthcare provider.