On the Mode of Hysterectomy with Emphasis on Recovery and Well?Being

Abstract: Hysterectomy is the surgical removal of the uterus and it is the most common major gynaecological surgical procedure worldwide. Hysterectomy is most often indicated by benign conditions such as irregular uterine bleeding with or without uterine fibroids. Several modes of hysterectomy are available each using a different surgical approach. Psychological well?being and recovery after hysterectomy have not been carefully investigated in randomised settings. The aims of this thesis were to evaluate different modes of hysterectomy regarding postoperative psychological well?being in long?term follow?up 6 and 12 months after surgery and recovery of general well?being in short?term up to five weeks after surgery. Additional objectives were to study the influence of the women’s stress?coping ability on postoperative psychological well?being and also to analyse other factors associated with postoperative psychological well?being and recovery of general well?being. In a randomised trial (trial 1) of 125 women who had undergone laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH), no significant difference was found between the postoperative psychological well?being of women in the two groups as indicated by four different psychometric measures up to 6 months after surgery. Neither did the day?by?day recovery of general well?being differ between the women in the two hysterectomy groups, even when adjusted for consumption of analgesics. A high stress?coping ability was strongly associated with a higher level of psychological well?being preoperatively and a significantly faster recovery of general well?being regardless of surgical method. In another randomised trial (trial 2) of 179 women who had undergone subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH), with a follow?up time of one year, no significant difference in psychological well?being was found between the two methods. The day?by day recovery of general well?being was the same in both groups. In both trial 1 and trial 2, longterm psychological well?being improved over time during the study period regardless of the mode of hysterectomy. The occurrence of postoperative complications and a low preoperative level of psychological well?being impair postoperative recovery significantly and prolong the duration of sick?leave. In conclusion, the suggested benefits of the less invasive modes of hysterectomy, LH and SH, could not be proven in this study Recovery of general well?being is associated with the woman’s stress?coping and preoperative psychological well?being and the studied modes of hysterectomy seem to be of less importance. This should be taken into account in preoperative counselling. Doing this will give patient and surgeon an open choice of the mode of hysterectomy to be chosen, since short?term recovery and long?term psychological well?being seem to be the same in both groups in the long term.