Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)
CPT4 code
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
- The patient is placed under general anesthesia.
- An antiseptic solution is applied to the abdomen to reduce infection risk.
- A horizontal or vertical incision is made in the abdominal wall.
- An incision is then made in the uterus.
- The abnormal or unintended uterine contents are carefully removed.
- The uterine incision is closed with sutures.
- The abdominal incision is similarly closed in layers with sutures or staples.
- 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.