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  HYSTERECTOMY-Is It Necessary?

This is the main surgery which is done and taught in medical colleges in the name of gynaec surgery. If patient is suffering from leucorrhoea/heavy bleeding and medicines are not giving desired relief and family is completed then remove the uterus surgically through abdominal route. If patient is suffering from descent/prolapse of uterus then remove it vaginally. The basic aim was to correct it or cut it.
Na rahega baans Na bajegi baansuri

Usually these were the criteria for hysterectomy in normal looking uterus other than fibroids, adenomyosis, endometriosis or prolapse.

In our private practice for these bookish indications, we performed thousand plus  hysterectomies. Initially in early 1990’s use of laparoscopy was limited to diagnostic purposes and for performing tubal ligation for permanent sterilization. Later on with advent of better visuo-optical lenses and equipments major surgeries like myomectomy, cyst excision, ectopic surgery and even laparoscopic assisted vaginal hysterectomies and total laparoscopic hysterectomies were done using laparoscopic method. It was made popular nationwide by conducting hands on workshops and conferences by few doctors who took the initiative of learning and mastering this surgical skill on foreign shores. In spite of costly equipments and instruments, heavy maintenance cost of equipments, need of skilled assistance and prolonged general anesthesia using costly medicines making laparoscopic surgery costlier than conventional surgery methods, this way of surgery was praised so high that it was made to believe the best form of surgery. The doctor performing lap surgery is supposed to be the best surgeon not only among the fellow doctors but even in general population. So to be in rat race and keep themselves up to date in medical field it became dire necessity to learn laparoscopic surgery and invest heavily in equipments and instruments to upgrade their centers.

Even I went to Germany  to train myself in advance gynaec endoscopic surgery and later on by continuous practice on pelvitrainer I mastered suturing and knotting techniques. With use of Indian make bipolar cautery and instruments I did my first TLH in Uran. By this time a group of doctors were formed who were so much in favor of laproscopic surgery that they try to performe all surgeries laproscopically without being bothered about the size of uterus or patients condition. They took pride in making world record of removing largest fibroid/uterus laproscopically without being bothered about longer general anesthesia time, the side effects of prolonged general anesthesia, need for blood transfusion, its complication and most importantly the high cost of surgery. Even if this surgery makes small hole on patients tummy (as being promoted), it makes larger hole in their pocket.

 Now few senior expert doctors went on to other extreme where they performed non descent vaginal hysterectomies even in large fibroids/big size adenomyotic uterus up to 20 wks size too. And here also record making drive went on and NDVH is being promoted as the best form of surgery as it doesn’t require costly equipments & instruments, skilled assistance, can be performed under regional anesthesia in routine OT setup and most importantly all the advantage of laparoscopic surgery like no scar, no adhesion, faster recovery, lesser stay time are achieved without its setback and it doesn’t burn hole in pocket too. Both these groups have condemned abdominal surgery but in reality whenever laparoscopic surgery or NDVH is not possible, abdominal route of surgery is the last resort for surgical removal of uterus.

The basic reason for avoiding and condemning abdominal surgery is post operative adhesion and ugly scar but if tissue respect is taken care of during surgery then adhesions can be prevented and any way cosmetic scar is in fashion now a days which is promoted for cesarean operations. When cesarean can be done liberally without being worried about adhesion and cosmetic scar are preferred then why we are shying away from performing abdominal hysterectomies in indicated cases? Can anybody throw light on it? Only hitch which comes in the way of abdominal surgery is longer stay time that is why laparoscopic surgery/NDVH is being promoted as day care surgery. But we need to reassess our condition and our Indian scenario where maximum number of women are housewives and after surgery they are advised to take rest for minimum 1 month by elder members of family for better recovery. In our experience we have seen that patient feel more secure and comfortable in hospital under doctor’s supervision till suture removal. This is not foreign country where hospital bills are footed by insurance companies, so they are in hurry to discharge patients as fast as possible to avoid heavy charges of stay period. Here in India still maximum number of patients pays the hospital bill through their own pocket, not by any insurance company or government agencies as still real India means its 75% of population lives in villages and smaller towns. Actually a post-op smiling, mobile patient is a proof of your surgical skills and does free advertising of your abilities as good surgeon among other patients and their visitors.

This is all about different approaches of doing hysterectomies. As far as our approach is concern, we decided the route of surgery depending upon the condition of patients where surgery can be finished in 1hr, need of blood transfusion could be avoided and patient can be discharged within 2-3 days without putting economical burden on them. We could do it because we are skilled in all type of surgery techniques. So according to the need and situation we used the appropriate instrument from our armamentarium to tackle the situation effectively. We firmly believed that route of surgery should be decided according to the patient’s condition, not because of surgeon’s ego in proving their skills ,or to make /break any record to prove superiority or due to greed to extract more money.
   This approach is not restricted to only hysterectomies but it applies to all types of other surgeries like appendicectomy ,cholecystectomy etc.

Nowadays we hardly perform hysterectomies since last 5 years. It might surprise you and it is very normal to think why we have stopped doing hysterectomy in spite of being skilled in all types of surgical techniques.

 Initially we had performed  hysterectomies through all routes-abdominal, vaginal, NDVH, LAVH, TLH. This city caters to  patients of surrounding 10-12 cities not only from UP but also from Bihar and Nepal too .so within very limited time we did thousand plus of hysterectomies for various indications and in their post op follow up we encountered patients complaining of various symptoms like heaviness in pelvic region ,constant dragging pain ,burning sensation while passing urine ,leucorrhoea ,abdominal bloating ,gas ,irregular bowel movements ,mucus in stool ,backache ,joint pains ,headache ,numbness of limbs ,sleeplessness ,tiredness etc. later on diseases related to liver and gall bladder ,psychological disturbances,urinary and nervous system disorders and many other diseases also occurred in few patients. Superficially there seems no relation between hysterectomy and all these complaints but the root cause is same for all the complaints in body-that is accumulation of toxins and hormonal imbalance in the body.

So the main aim should be to treat the root cause of disease not just treating the symptoms .Take an example –if the door is affected by termites and giving trouble then don’t be happy by removing the door. If you remove the door then termite will slowly affect another door/window and in this way eventually whole house will get affected and collapse. One need to take care of termite in first place so the house will be safe and door will work properly with minor repair.

In general people are scared of cancer. Most of the people think when family is completed uterus is not needed any more. It should be removed even if the problem is minor so that there should be no fear of cancer in future. By taking surgical option they make their body cancer proof at least at the uterus level.

 So let’s understand what is cancer? And why it happens?read more in cancer.

Everyone is aware of heart attack, liver cancer and intestinal cancer but does anyone go for preventive surgery? These organs are very important for our body so even withthe risk of cancer we don’t think of removing it. What about prostate? In most of the men suffer from benign  hyperplasia of it in old age and even prostatic cancer and testicular cancer are on rise but still no man opts for or undergoes preventive surgical removal of these organs at the age of 35-40 years and in later case even at the age of 60 years-why ?

Have you ever thought why uterus is made soft target and it is sacrificed in the name of cancer prevention?

 Then why nowadays doctors are so liberal and enthusiastic in removing the uterus?
Is it a hypocrisy ,greed of money or just following the tradition mindlessly? Or surgery being the most adventurous form of treatment which boost the ego……What is it?

Most of the people think that uterus is only made for reproductive function and its only utility is in keeping fetus safely till 9 months and once family is completed it is not needed any more. After completing family its role become like a family member who doesn’t work but live there and creates problems too sometime

  • Kaam ka Na kaaj ka
  • Dushman anaj ka.

But this thinking is totally wrong .it is an unique organ which is located in the  abdominal cavity and small part  of it that is cervix lies in the vagina through which it is connected to exterior. If any changes happen in internal milieu this organ is affected and immediately it shows symptoms in form of discharge or altered bleeding pattern during menses and warns you and makes you aware about the undergoing problems. It rings the bell for upcoming storm and signals you to get prepared to tackle the situation. Like thermometer shows fever-underlying cause for fever could be anything. By showing temperature it warns you and signals you to take medical aid to get cured of underlying disease. Isn’t it? Does anyone break thermometer for showing high temperature? No not a sane person will do it. Then why we are so prompt in removing uterus for minor problems?

In our experience we have seen that in more than 98% of cases there is no need of hysterectomy and patients are not going to get benefited by surgery. Rest  of the cases where hysterectomies are done for large fibroid, adenomyosis, endometriotic cyst, CA stage 1 and prolapse. All these problemsdo not develop overnight .These conditions would not have developed or worsened so far with timely intervention and right management. Again all the uterine problems except prolapse and fibroid are just symptoms. Main reason is hormonal imbalance and accumulation of toxins in the body. So treat the root cause and be completely healthy. Now only condition remains that is prolapse where uterus is displaced (where vaginal hysterectomy is done), it happens due to malnutrition, multiple child births, wrong delivery techniques. So this conditions are totally preventable and surgery is not required.

Now the biggest question which arises in any gynecologist’s mind-if gynecologist will not do it then what is left for gynaec surgery. This is only major surgery after cesarean. How can we axe our major earning source? Let me share our experience of last 5 years regarding this matter. We have not only earned more money  but also trust of our patients and immense job satisfaction which is priceless.

So this was our journey of 17 years from abdominal/vaginal hysterectomies........to laproscopic hysterectomies....to NDVH......to selected few hysterectomies by balanced approach.....and marching towards no hysterectomy.......and the journey continues.
Friends with this we are just sharing our experience and views with everybody.I never followed anything blindly.what ever i am telling you-don't take any-thing i say as gospel truth.I am human, i make mistakes. Test youself whatever i have told you......Try it out,.....experience it and then you will know whether or not i'm telling you the truth.When you examine a gem you must evaluate it from all its facets before you can decide on its value. Is'nt it?