Abdominal Total Hysterectomy with Removal of Adnexes (Ovaries and Fallopian Tubes)
Introduction
Abdominal total hysterectomy with bilateral adnexectomy is a surgical procedure involving the removal of the uterus along with both ovaries and fallopian tubes. It is a common gynecological surgery recommended for various benign and malignant conditions. This surgery is considered definitive and often life-altering, especially for women with cancer, endometriosis, or severe pelvic pain.
What is the Treatment/Procedure?
A total abdominal hysterectomy with bilateral salpingo-oophorectomy involves:
- Total Hysterectomy: Removal of the uterus and cervix.
- Bilateral Adnexectomy: Removal of both ovaries and fallopian tubes.
This procedure is performed through an incision in the lower abdomen and may be combined with other treatments depending on the underlying condition (e.g., chemotherapy for cancer).
Indications
This surgery is advised for patients with:
- Uterine, ovarian, or cervical cancer
- Large fibroids causing pressure symptoms
- Severe endometriosis
- Chronic pelvic pain
- Abnormal or heavy uterine bleeding not controlled by other treatments
- Ovarian cysts or tumors (benign or malignant)
- Prophylactic removal in high-risk patients (e.g., BRCA mutations)
Procedure Details
a) Preoperative Preparation
- Blood tests, imaging (ultrasound, MRI/CT)
- General anesthesia
- Bowel prep and fasting
b) Surgical Steps
- A horizontal (bikini line) or vertical abdominal incision is made.
- The uterus, cervix, both ovaries, and fallopian tubes are carefully separated and removed.
- The vaginal vault is closed, and the incision is sutured.
- Drains may be placed temporarily to avoid fluid buildup.
c) Duration
- Takes about 1.5 to 3 hours.
- Hospital stay: 3 to 5 days.
Effectiveness
- Highly effective in eliminating disease in cases of cancer or severe benign conditions.
- Reduces recurrence of diseases like endometriosis or fibroids.
- Often leads to a significant improvement in quality of life for those with chronic pelvic pain or bleeding.
Risks and Side Effects
Surgical Risks
- Bleeding
- Infection
- Injury to nearby organs (bladder, bowel)
- Blood clots
Postoperative Effects
- Surgical menopause if ovaries are removed
- Hot flashes, mood changes, vaginal dryness
- Hormonal imbalance (may require hormone replacement therapy)
- Emotional impact related to fertility loss
Recovery and Aftercare
Immediate Post-Op
- Pain control and antibiotics
- Early mobilization to prevent clots
- Wound care
At Home
- Recovery time: 4 to 8 weeks
- Avoid heavy lifting, driving, and intercourse until cleared
- Light exercise and pelvic floor therapy may be encouraged
Follow-up
- Wound and healing check after 2 weeks
- Histopathology results discussion
- Hormonal support or further treatment, if needed
Cost and Availability
The cost of abdominal hysterectomy with adnexectomy varies by country, hospital, and whether it’s done for cancer or benign conditions. The procedure is widely available in most tertiary care and specialty hospitals worldwide.
Patient Experiences
Many patients report:
- Relief from debilitating symptoms
- Improved quality of life
- Initial emotional and hormonal adjustment
- Gratitude for early detection (in cancer cases)
Patients undergoing surgery for malignancy may also receive chemotherapy or radiotherapy and have a longer recovery journey.
Cost in Different Countries (USD)
| Country | Approximate Cost (USD) |
|---|---|
| China | $3,000 – $6,000 |
| India | $2,000 – $4,500 |
| Israel | $9,000 – $15,000 |
| Malaysia | $3,500 – $7,000 |
| South Korea | $5,000 – $9,000 |
| Thailand | $4,000 – $7,500 |
| Turkey | $3,000 – $6,500 |
| USA | $12,000 – $25,000 |
Note: Costs may vary based on hospital type, duration of hospital stay, use of robotic/laparoscopic assistance, and whether it is cancer-related.
Frequently Asked Questions (FAQ)
Q1. Is this surgery done laparoscopically?
Yes, but the abdominal route is chosen for larger tumors or complex cases.
Q2. Will I go into menopause after this surgery?
Yes, if both ovaries are removed, menopause is immediate.
Q3. Can I have sex after a hysterectomy?
Yes, typically after 6-8 weeks and once healing is complete.
Q4. Will I need hormone replacement therapy (HRT)?
Possibly, especially if you’re under 50 and ovaries are removed.
Q5. Is the surgery painful?
Pain is well managed with medications; discomfort subsides in a few days.
Q6. Can cancer come back after this surgery?
There’s a low chance, but it depends on the cancer stage and type. Regular follow-ups are essential.
Conclusion
Abdominal total hysterectomy with removal of adnexes is a life-saving and symptom-relieving surgery for many women. Though the decision can be emotionally challenging, it provides significant health benefits in the context of cancer, chronic pain, and hormonal disorders. With proper care, support, and follow-up, patients can lead healthy and fulfilling lives post-surgery.