Name of the Procedure:

Hysterotomy, abdominal
Common name(s): Abdominal Hysterotomy
Technical/medical term: Hysterotomy

Summary

An abdominal hysterotomy is a surgical procedure where a small incision is made in the abdomen and uterus to remove uterine contents, such as in the case of a hydatidiform mole or for an abortion.

Purpose

This procedure addresses medical conditions involving abnormal uterine contents, such as hydatidiform moles (a type of pregnancy tumor) or to terminate a pregnancy. The goal is to safely remove the abnormal tissue or pregnancy contents to prevent complications like infections or excessive bleeding.

Indications

• Presence of a hydatidiform mole
• Miscarriage or failed pregnancy
• Medical necessity for abortion
• Incomplete abortion (retained products of conception)
• Severe medical conditions where continuing a pregnancy is hazardous to the mother's health

Preparation

• Fasting for at least 8 hours before the procedure
• Reviewing and adjusting current medications, particularly blood thinners
• Undergoing pre-operative blood tests, ultrasound, and possibly other diagnostic imaging
• Completing a pre-anesthetic assessment

Procedure Description

1. The patient is placed under general anesthesia.
2. An antiseptic solution is applied to the abdomen to reduce infection risk.
3. A horizontal or vertical incision is made in the abdominal wall.
4. An incision is then made in the uterus.
5. The abnormal or unintended uterine contents are carefully removed.
6. The uterine incision is closed with sutures.
7. The abdominal incision is similarly closed in layers with sutures or staples.
8. A sterile dressing is applied to the incision site.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Performed in a hospital operating room or a surgical center with appropriate facilities.

Personnel

• Surgeon (typically an obstetrician-gynecologist)
• Anesthesiologist
• Surgical nurses
• Surgical assistants

Risks and Complications

Common risks:

• Infection
• Bleeding
• Post-operative pain

Rare risks:

• Damage to surrounding organs (e.g., bladder, intestines)
• Blood clots
• Uterine scarring
• Complications from anesthesia

Benefits

• Removal of abnormal uterine tissue or pregnancy contents
• Prevention of infection and other complications
• Relief from symptoms associated with the abnormal uterine condition

Recovery

• Monitoring in the recovery room immediately post-procedure
• Prescription of pain relief medication as needed
• Instructions to avoid heavy lifting and strenuous activities for several weeks
• Scheduled follow-up appointments to monitor healing
• Abstain from sexual intercourse for a specific period, as recommended by the healthcare provider

Alternatives

• Medication-induced termination (medical abortion, where appropriate)
• Manual vacuum aspiration
• Dilation and curettage (D&C)

Pros and Cons:

• Medical alternatives may be less invasive but are not always appropriate depending on the specific condition.
• Each alternative involves its own set of benefits and risks that should be discussed with a healthcare provider.

Patient Experience

During the procedure:

• The patient will be unaware as they are under general anesthesia.

After the procedure:

• Pain and discomfort managed with prescribed medications
• Encouraged to rest and gradually resume normal activities
• Some bleeding and cramping similar to menstrual periods
• Importance of closely following post-operative care instructions to ensure proper healing and reduce complication risks.