Surgical spike: Rise in hysterotomies raise concern

Hysterectomy is the surgical removal of the uterus, which may also include removal of the cervix, ovaries, fallopian tubes and surrounding structures. A study published by District Health Society (DHS) and National Family Health Survey (NFHS) 2019-21 showed a rising number of hysterectomies as compared to that reported by NFHS in 2015-16.

From the study conducted in women aged 15-49 years who had not menstruated for six months, 3.2% of the sample population had undergone the procedure. For many, it was the result of an emergency, but for others, it is done as a deliberate decision to end the reproductive cycle. 

Patriot talks with Dr Sarika Gupta, Gynecologic Oncologist at Apollo Indraprastha Hospital, to understand the trend and patterns of hysterectomy.

“The most common reason for anybody to undergo hysterectomy is abnormal uterine bleeding. Sometimes the fibroids can cause abnormal uterine bleeding, endometriosis (a disorder in the tissue that lines the uterus), carcinoma and cancer”, said Dr Gupta.

As per the evidence, she added, “The first-line treatment is always done by medicines. When that approach fails, that’s when the surgical procedure is initiated.”

Types of procedures

There are three types of hysterectomy procedures: vaginal, laparoscopic and robotic. 

“Vaginal hysterectomy is a minimal access surgery where the uterus is removed via vagina. It is commonly practised as it involves low risk and leaves no external scars. In case of increased complications, laparoscopic and robotic surgeries are preferred. Robotic hysterectomy comes with advantages of lesser pain and recovery time as compared to that in other surgeries. It is more prevalent in urban areas as most rural hospitals don’t have access to such technologies”, claims Dr Gupta.

According to the statistics analysed, more than two-thirds of women who have undergone a hysterectomy procedure had the operation in a private healthcare facility. She further said, “In most cases, the patients would want immediate and guaranteed relief. As a medical practitioner, I always prefer medical treatment at first, and if it needs further intervention, the patient can proceed with a surgery.”

Rural demography 

According to the available data on rural women, 29.7% of the surgeries were performed in public health facilities, 69.9% were performed in private health facilities, and the source of remaining 0.4% is unknown.

The national capital has witnessed a rise in the number of hysterectomies in the updated data. On comparing data from rural and urban demographics, a spike is observed in the number of hysterectomies in rural areas, while cases in the latter category seem to have reduced.

Dr Gupta explains that she has had patients from rural areas who had the uterus removed at the age of 34-35. Most of them feel that once the family is complete, one can get rid of the uterus so that they won’t be impregnated again. It is a common practice followed by most women as a solution for menstruation and pregnancy-related problems. Another reason for the increased rate of hysterectomies in rural areas is the irregular usage of medicines. 

“If a patient is diagnosed with a disease, she has to follow the routine of dosage. When this routine breaks, further complications like abnormal bleeding occur, leading the women to go for hysterectomy”, says Dr Gupta.

If the doctor prescribes a biopsy in cases of fibroids, the male partner also suggests the patient undergoes hysterectomy because they feel that it is better to completely remove the organ rather than coming to a hospital daily.

In rural areas, there are cases where unqualified doctors perform hysterectomy leading to further complications.

Post-op risks

Any kind of surgical procedure has risk factors associated with it. There is the anaesthetic risk, along with serious pain which are inherent to any surgery, bleeding, haemorrhage, inadvertent injury to the nearby organs or hernia. Other complications can occur later in life. 

Some patients experience a vaginal prolapse after the procedure. Once the uterus is removed, there is no support for the top of the vagina and it gradually droops outside.

“If ovaries are removed along with the uterus before a certain age, life expectancy is reduced. Generally, ovaries are not removed as they produce oestrogen. Lack of proper information can lead to unwanted removal of the ovaries”, she added.

Dr Gupta also pointed out, “Some patients may undergo the procedure to get rid of their backache and later find out that the procedure is a failure as they still have the back pain.”

Societal standards

Creating awareness among the public is the only way to reduce unwanted hysterectomies. Women should know that the uterus has functions other than childbearing.

However, hysterectomy is not a method of permanent contraception. In India women still feel that it is their responsibility to take care of family planning, as they are the ones who give birth. Female sterilisations are more prevalent than male, though male sterilisation procedure is an external and less risky process compared to that of women.

“What most of them don’t know is that the uterus not only has the purpose of fertilisation and pregnancy. Uterus also provides structural integrity, which supports bladder, pelvic bones and other organs. Also, studies show that sexual satisfaction is reduced after the procedure”, added Dr Gupta.

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