Abdominal hysterectomy

Common: more than 1 in 20

Discomfort: expected

It is normal to have some discomfort - which may include pain, irritation, or stiffness - for a few days or weeks after treatment. Pain relief options will be discussed with you.

Significant bleeding

Some bleeding is expected during most procedures, however significant bleeding may require further treatment. Usually it can be dealt with during the procedure, but may lead to a change from the planned procedure, need a blood transfusion, or need further emergency treatment.

Less common: fewer than 1 in 20

Conversion to subtotal hysterectomy

A conversion to a subtotal hysterectomy is where rather than a total hysterectomy (where the uterus and cervix is removed) being performed, the cervix is left behind due to technical difficulties.

If the cervix is not removed it is possible to have some ongoing menstrual bleeding, and as there is still a risk of cervical cancer developing in future the usual guidance remains in terms of cervical screening.

Significant bleeding

Some bleeding is expected during most procedures, however significant bleeding may require further treatment. Usually it can be dealt with during the procedure, but may lead to a change from the planned procedure, need a blood transfusion, or need further emergency treatment.

Rare: fewer than 1 in 100

Perioperative risks

There are a number of complications which having any operation increases the risk of - called perioperative risks ('peri' means 'around the time of'). These include allergic reactions and the risks of having an anaesthetic, which will be discussed with you by an anaesthetist.

Other complications include a chest, urinary, line, or other hospital-acquired infection, blood clots (deep vein thrombosis or pulmonary embolus), problems with the heart (including a heart attack), a stroke, memory problems or worsened kidney function. Any existing medical problem could also deteriorate.

Perioperative complications may increase the length of your hospital stay, require additional treatment including in some cases admission to intensive care, may be life threatening, and can lead to death.

Pre-operative assessment involves considering any investigations that may be appropriate prior to undergoing the operation. Undergoing these investigations, and any changes made based on these results, may reduce perioperative risks. Equally, it is not possible for pre-operative assessment to include testing for all possible conditions that may cause difficulties in the perioperative period.

There are a number of things that you can do in preparing for surgery to reduce the risks. This includes lifestyle changes such as exercising, maintaining a healthy diet, losing weight, and stopping smoking.

Compression injury

A compression injury describes any damage caused by pressure to tissues such as skin or nerves. This type of injury can occur in theatre as you are lying in one position for several hours. Any areas that are at risk, such as bony prominences, are padded during surgery to reduce the risk of compression injury. If this does occur you may experience numbness or a tingling sensation in the affected area, which is usually temporary.

Rarely, a complication called compartment syndrome can occur, where the pressure around the muscles in one of the limbs is too high, which may reduce the blood supply to those muscles. If this occurs, surgery may be required to release the pressure.

Damage to surrounding structures

Nearby structures are at risk of being injured during the procedure. For this operation there is a risk of injury to the bladder or ureters - the tubes which carry urine from the kidneys to the bladder (7 in every 1,000 patients), the bowel (4 in every 10,000 patients) and to major blood vessels.

In the very rare circumstance of significant injury this would usually be repaired immediately, but may need a larger cut in the middle of the tummy, and very rarely a stoma - an opening for faeces or urine on the front of your abdomen (tummy).

A bladder injury would usually be managed with having a catheter in place for 7-14 days after surgery.

In some cases, an oophorectomy or salpingectomy (removal of ovary or fallopian tube) is required, either due to injury or if unexpected disease is seen at time of operation.

There is a risk that damage is not noticed at the time of surgery, leading to symptoms in the days following surgery and potentially further surgery being required.

Common: more than 1 in 20

Wound complications

Wounds can sometimes be uncomfortable, become infected, heal more slowly than normal, may require special dressings to aid healing, or can reopen after they start to heal (dehiscence).

It is common to notice some mild redness, bruising, swelling, numbness, tingling or a burning sensation in and around the wound whilst it heals.

A wound infection is an infection of the skin or underlying tissues, where a cut has been made, often causing redness or swelling. It may require treatment with antibiotics. Occasionally, drainage of a collection of infected fluid (pus) or further surgery is also needed.

Delayed wound healing or wound dehiscence may require further treatment and in some cases surgery may be needed.

The risk of developing a wound complication is higher in some patients, including those who are obese, are smokers, and patients with diabetes.

Vaginal bleeding

Vaginal bleeding is when blood is passed from the vagina. Some bleeding should be expected for the first couple of weeks - similar to a light period, and may last for up to around 6 weeks. Pads should be used rather than tampons to reduce the risk of infection.

Pelvic infection (female)

A pelvic infection is an infection of the pelvis, and may include a urinary tract infection (UTI), or infection of the uterus, fallopian tubes, ovaries or other tissues in the pelvis. Infection in the pelvis can often be treated with antibiotics, but sometimes can lead to more serious infections – such as an abscess in the pelvis – and sepsis, and may require further treatment.

If you are concerned regarding significant pain, have a fever, or abnormal discharge you should seek medical advice.

Sluggish bowels (ileus)

An ileus, or temporary bowel paralysis, is when the bowel slows down following an operation or procedure. This can lead to pain in the abdomen, sickness and constipation.

It usually resolves in a few days but sometimes an X-ray or other investigations may be done to check the symptoms aren't being caused by something else.

Less common: fewer than 1 in 20

Incisional hernia

A hernia occurs when a part of the bowel pushes through the muscles in the tummy, often causing a lump. An incisional hernia is when the hernia is at the site of previous surgery. Bowel can get trapped in a hernia, and so further surgery may be needed to repair the hernia.

Urinary retention

Urinary retention is the medical term for having too much urine in the bladder and not being able to pass it. It is usually managed by temporarily placing a catheter into the bladder to allow the urine to drain out. This can happen due to bruising to some of the nerves in the pelvis and is the reason that the medical team may check that you are managing to empty your bladder appropriately after the operation. Should you have difficulty with emptying your bladder during the first week or so there are a number of different approaches possible. These can include passing a small urinary catheter just when needed, or going home with a catheter in the bladder for a week whilst things settle.

Premature ovarian insufficiency

Premature ovarian insufficiency, also known as premature/primary ovarian failure, is when the ovaries stop working normally, before the age of 40. There is around twice the risk of experiencing premature ovarian insufficiency compared to if the operation is not done. Symptoms - similar to those of natural menopause such as hot flushes, night sweats, irritability etc - may require hormone replacement therapy.

Ongoing symptoms

Despite the procedure, symptoms may continue. Depending on the context this may lead to further tests or treatments being recommended. This may include new or continuing urinary symptoms, pelvic pain and/or prolapse symptoms, depending on the indication for surgery. The likelihood of long-term ongoing symptoms is also heavily dependent on the original indication.

Rare: fewer than 1 in 100

Vaginal vault dehiscence

A vaginal vault dehiscence is where the line of sutures at the top of the vagina come apart. This usually requires emergency surgery to securely re-suture the top of the vagina.

Vesicovaginal fistula

A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, leading to urine leaking from the vagina. Following a hysterectomy a fistula may also occur between the vagina and the ureter (the pipes that carry urine from the kidneys to the bladder).

A fistula most commonly develops around a week post-op and may require treatment to place a stent and/or catheter to allow the fistula to heal, these are left in place for around 4-6 weeks. Most heal over a few weeks, but surgical repair will sometimes be considered where the fistula is persisting long-term.

Rectovaginal fistula

A rectovaginal fistula is an abnormal passage or opening between the rectum and vagina. This may develop within weeks to months of the original surgery and usually requires surgical repair.

Need to go back into theatre

Due to complications following the operation it may be advised to have a further operation during the hospital stay. After this operation this would usually be due to ongoing bleeding, to drain a collection of blood at the top of the vagina, or because of wound complications.

Blood clots (deep vein thrombosis or pulmonary embolus) – 1 in 300 chance

Blood clots can form in the veins of the legs (deep vein thrombosis), causing pain and redness in the leg, and are more likely to occur after a procedure or operation, when people tend to move around less.

These clots can occasionally also travel from the legs to the lung (pulmonary embolus), and can cause problems with breathing. Clots in the leg or lung require treatment such as with blood thinning medications. More rarely a large pulmonary embolism can be life threatening.

Getting moving early after treatment reduces your risk of clots. You may also be advised to wear compression stockings or calf compression pumps and have blood thinning injections following treatment to help reduce the risk of clots. This depends on the treatment you are having and your medical history.

Vaginal vault haematoma (collection of blood) - 1 in 500 chance

A haematoma is a collection of blood within the body, outside of a blood vessel. This can occur at the top of the vaginal canal (vaginal vault). It can sometimes be left to be reabsorbed by the body with time, but will often need a procedure or operation to drain the blood.

Pelvic abscess - 1 in 500 chance

A pelvic abscess refers to a pocket of infected fluid - pus - in the pelvis. Antibiotics are usually needed, but abscesses are difficult to treat with antibiotics alone so a procedure or operation to drain it may be needed.

Death – 1 in 3,000 chance

There is a risk of dying either directly due to the procedure or treatment, or from complications in the subsequent days or weeks. The risk is dependent on many factors including your age and any underlying medical problems you may have. Any likelihood presented will usually reflect the risk of death within 30 days of the proposed treatment. Overall the risk of death within six weeks of the operation is approximately 1 patient in every 3,000.

Common: more than 1 in 20

Symptomatic abdominal adhesions

Abdominal adhesions are bands of scar tissue that can develop between structures in the abdomen and pelvis - for example between loops of bowel - after surgery.

Occasionally, these bands can cause symptoms and complications, for example causing abdominal or pelvic pain, or causing the bowel to become blocked. Where a bowel obstruction occurs this may require surgery or other treatment to resolve the blockage.

Dyspareunia (discomfort during sex)

Dyspareunia is the medical term for experiencing pain during sexual intercourse (sex). Sexual intercourse should be avoided during the first six weeks as the area heals. Some discomfort should be expected during the following weeks.

Less common: fewer than 1 in 20

Abnormal scarring

If the skin is injured, whether by surgery or other means, a scar is formed during the healing process. Normally scars will fade and become paler over time, but do not completely disappear.

Abnormal scarring is when a wound heals leaving a scar that is either larger or a different colour (hypertrophic or keloid scar), or more uncomfortable than is typical. This can occur more often if a wound has taken a long time to heal, and in certain skin types.

Vaginal vault prolapse

A vaginal vault prolapse is where the top of the vagina (vaginal vault) drops down into the vaginal canal.