Complications of hysterectomy surgery

• A hysterectomy is the removal of the uterus as a consequence of uterine cancer, uterine myomatosis, etc.
• Occasionally, the hysterectomy operation may have some complications associated with other factors, such as obesity.
• Hysterectomy surgery should therefore be performed by an experienced specialist to avoid possible complications.

Hysterectomy is the procedure by which a woman's uterus is removed. Sometimes the removal of the uterus is accompanied by the removal of other organs or adjoining structures that also need to be removed because of the pathology.

Most of the time, the risk factors associated with the hysterectomy operation or the possible complications that may arise after the operation are the issues that most concern women who are going to undergo a hysterectomy.

Like any operation, this one is not free of risks and possible complications that may arise during surgery, although we must not forget that this is one of the most frequently performed operations on women today.

We should point out some risk factors that may lead to complications. Some of these risk factors may be:

• The patient suffers from obesity.
• If the patient smokes.
• If the patient suffers from iron deficiency anaemia.
• The patient has heart or lung disease.
• The patient suffers from diabetes.
• The patient has previously undergone surgery in the pelvic area or has had a serious infection in the area.
• The patient is taking any prescribed or non-prescribed medications. In this regard, it is recommended that the patient informs the specialist before undergoing surgery of all medications she is currently taking.
• Patient 's age.

The surgeon will assess all risk factors and based on his or her experience will make sure that possible complications are kept to a minimum when performing the hysterectomy.

As we have already said, hysterectomy surgery, like any other operation, is not free of risks and/or complications that may occur after the intervention, although we must differentiate the risks and complications according to the type of hysterectomy performed.

Bleeding

Early bleeding may occur during the first 24 hours after the operation. This bleeding may be located in the vaginal area or in the abdomen, depending on the type of hysterectomy performed. However, it is more common for bleeding to occur with a vaginal hysterectomy than with an abdominal hysterectomy.

In these cases, the surgeon will usually tamponade the area when the bleeding is minor. When bleeding is severe, the surgeon must perform an inspection under anaesthesia to fix any problems.

Bleeding may also occur later, between the seventh and twenty-first day after vaginal or abdominal hysterectomy surgery. Some of the reasons for late bleeding may include: reabsorption of suture threads, necrosis of local tissues, sexual intercourse before complete healing, etc.

Infections

They occur especially when a vaginal hysterectomy has been performed, due to the fact that operations in which the vagina has to be opened are associated with contamination by bacteria in the vagina. By taking antibiotics, the infection can be adequately controlled, although this must always be indicated by the specialist.

Infection, like bleeding from haemorrhage, can present symptoms in the first 24-48 hours after surgery. The first symptom is usually a high fever in the patient, although this is not always associated with infection, but may have another origin.

Infections may also occur a few days after the operation and may be located in the surgical wound, in the pelvic area, in the urinary tract, etc. It is important to see a specialist in these cases.

Digestive complications

Generally, the patient's digestive system should be back to normal by the third day after the operation. The small bowel usually recovers within 6 - 12 hours after the operation, the stomach within 12 - 24 hours and the large bowel within 24 - 48 hours. Bowel obstruction occurs rarely, in about 2% of all abdominal hysterectomies and about 0.2% of vaginal hysterectomies. Adhesions (when tissues or organs become stuck to each other or to the abdominal wall) are usually the most common cause of bowel obstruction.

Urinary tract injuries

Mostly occur in abdominal hysterectomies, although this figure is very small, less than 2%. They occur in less than 0.5% of vaginal hysterectomies. In the event that the surgeon locates the lesion during the operation, he will reconstruct it immediately.

To avoid this type of injury, it is essential that the surgeon knows the area to be operated on perfectly well and checks it before completing the surgery.

Fistula formation

Most urinary tract fistulae occur when the hysterectomy is radical (removal of the uterus, cervix, upper vagina and all surrounding lymph nodes and ducts), although they occur in less than 1% of cases. Large fistulas result in urine leakage, which is easily diagnosed by the specialist. Small fistulas may heal on their own.

Gastrointestinal fistulas can also occur, although they are rare and require more complex surgery.

Despite the above-mentioned risks that may occur during or after the hysterectomy operation, the advantages of the operation should be kept in mind.

The main advantage, of course, is the improvement of the patient's symptoms and the elimination of the pain and discomfort she suffered before the operation.

We must bear in mind that, despite the possible complications mentioned, this is one of the most common gynaecological surgeries performed on women, with a very high success rate among patients, provided it is performed by a reputable surgeon specialising in this type of operation.