Abdominal Hysterectomy Consent English

Hospital
CONSENT FOR ABDOMINAL HYSTERECTOMY

(Please read the information below carefully. Do ask questions/ queries/
doubts before you sign the document. Please ensure that your relative signs
as a witness. Federation of Obstetrical & Gynaecological Society of India
wishes you speedy recovery)
Part I: Information about the surgery
1. Name of the procedure: open/ abdominal hysterectomy. Additionally, following

procedures may be done:
Salpingectomy: Right / left / both
Ovarian cystectomy: Right / left / both
Oophorectomy: Right / left / both
(Tick mark what is applicable / strike out what is not applicable)
2. Meaning: Surgical removal of the uterus is called hysterectomy. Uterus along with its
lower part (cervix) is removed in this case. In some cases, the cervix is not removed. Along
with the uterus, ovary (or both ovaries) and/ or fallopian tube (or both fallopian tubes)
may also be removed. Removal of ovary is called oophorectomy and removal of fallopian
tube is called salpingectomy. Sometimes ovaries may have abnormal growths called
“ovarian cysts”. Removal of cysts is called as “ovarian cystectomy.” When the surgery is
performed by making an incision on the abdomen, it is called as open or abdominal
hysterectomy.
3. Purpose/ indications: (The list given below only indicates common reasons and does
not include all indications):
I. Heavy and irregular bleeding from the uterus not responding to medical treatment.
II. Fibroids of the uterus: Mostly fibroids cause excessive bleeding, anaemia, pelvic
pain and symptoms related to pressure on adjacent organs.
III. Uterus which has descended from its place. This is called prolapse.
Consent For Abdominal Hysterectomy 1
52
IV. Endometriosis and adenomyosis/ adenomyoma
V. Cancer involving genital tract or other organs
VI. Certain types of Endometrial hyperplasia.(meaning thickening of the inner lining of
the uterus)
VII. Chronic pain caused due to uterus
VIII. Any other condition:
_____________________________________________________________
__________________________________________ ( for manual entry).
4. Description of the procedure: This surgery may be done under regional anaesthesia
(where in the lower half of the body is made numb or anaesthetised) or under general
anaesthesia (where the patient is put to sleep by giving injection). The doctor makes an
incision on the abdomen. The uterus is separated from the urinary bladder and the rectum.
The uterus is disconnected from all the supports and blood vessels. Thus the uterus is free and is
removed from the body. In case if the ovary, ovarian cyst and/ or fallopian tube is to be removed,
it is also separated from other structures, blood vessels are tied and the part is removed.
5. Benefits & effects of the procedure :
The diseased uterus is responsible directly for the medical condition and the suffering. Thus,
removal of the uterus means removal of the root cause in itself.
After undergoing this surgery, menstruation stops permanently. The woman will not be ableto
become pregnant after this surgery. Woman can resume all other activities including sexual
intercourse after recovering from the surgery.
Effects of removal of the ovaries: As ovary/ ovaries are removed there is no chance that
woman will suffer from the disease of ovary in future life. If both ovaries are removed, the
secretion of female hormones will cease completely. In some women, this may lead to symptoms
of hormone deficiency such as hot flushes, bone pain, bone weakness, weight gain, hair loss,
vaginal dryness. If woman is nearing menopause the hormonal secretion, in any case, may be
very low. Thus removal of ovaries may not cause so much of disturbances.
Medicines may be prescribed by the doctor to deal with these symptoms.

53
Effects of removal of cyst of ovary: If ovary is showing an abnormal growth such as cyst, the
doctor may remove the cyst. Thus, normal tissue of the ovary is retained and only cyst is
removed. Thus, ovary continues to do its job of producing hormones.
Removal of fallopian tube/tubes: The chance of fallopian tube getting diseased in future is
eliminated when the tube is removed. There is some scientific evidence that cancer of ovary
originates in the later part of the tube. Thus removal of fallopian tube may provide protection
from possibility of ovarian cancer in future. However more studies are being done to prove this.
6. Alternatives:
Medical therapy:
If woman is suffering from excessive and / or irregular bleeding, hormonal or nonhormonal
medicines can be given to her. There can be oral medicines or injections.
Hormones can be delivered by a device fitted in the uterus.
Other surgical procedures:

In recent years new techniques have been developed where by the lining of the
uterus is burnt or removed by surgical procedures. There is a possibility that
symptoms may recur or one may not respond to the treatment.
In case of fibroids, only fibroids may be removed. This is called “myomectomy”.
However, there is a possibility that new fibroids may get formed in the uterus during
later life. This will again cause trouble and recurrence of symptoms and may again
need a surgery in later life. Typically, those who want to preserve the menstruation
and child bearing may opt for this alternative.
In case of endometriosis or adenomyoma, only diseased tissue may be removed. Yet
again there is a possibility of recurrence.
54
Other modes of hysterectomy:
Once it is decided to remove the uterus, it is important to understand the ways to d o
the surgery. The hysterectomy can be done by making a surgical cut on the
abdomen or through the birth passage (vagina) or by using laparoscopy.
When uterus is removed via birth passage, there are no incisions on the abdomen. If
the uterus is high up in the pelvis or large in size, this method of operating through
vagina may not be suitable. In laparoscopic surgery there are multiple small
incisions made on the abdomen. But all cases may not be suitable for laparoscopy.
Especially if fibroids are very large or peculiarly placed or if there have been previous
surgeries on the abdomen, laparoscopic surgery may be difficult.
Abdominal surgery is conventional surgery, doesn't need high tech equipment and
is relatively less complex in nature. The surgeon gets relatively easy access to the
tissues. These are the advantages of open surgery over other modes of surgery.
7. Consequences of refusal of the procedure:

If surgery is not done, woman may need to choose other alternative modalities as
discussed above.
If no treatment is done, woman may not get any relief from the suffering.
8. Outline of substantial risks:
With the advances in medical science, surgeries have become safer than in the past.
However any surgery has its own set of risks and complications.
a. Excessive bleeding/ blood accumulation: Sometimes excessive bleeding may
occur during or after the surgery. Transfusion of blood and blood products may be
needed. In case the blood accumulates inside the body cavity, additional procedure
or surgery to remove the accumulated blood and stop the bleeding may be
required.
b. Infection: If the microorganisms from the outside enter the body and are not
resisted by the body's resistance mechanism, the infection can set in. Infection
commonly causes fever, pus formation in the area of the surgery. Additional doses of
antibiotics and sometimes additional procedure may be required to remove the .
55
infection from the body. If the wound does not heal well, it may need repeated
dressings or repair again. Severe infection or sepsis is uncommon
c. Injury to surrounding structures: While the uterus is being separated from the
surrounding structures such as urinary bladder, ureter, bowel, blood vessels may get
injured. The injury may or may not get detected immediately. Whenever detected it
need to be repaired by necessary additional surgery.
d. Anesthesia has become much safer in today's world. It is common to have
drowsiness, vomiting, weakness, throat pain for a day or two after anesthesia.
Headache after spinal and other regional anesthesia is not uncommon. Rarely
temporary weakness, numbness in lower part of the body may be caused after
regional anesthesia.
e. Every Individual has a different way to cope up. Sometimes the scar becomes thick
and sometimes it stays as a thin line. Some- times hernia formation may occur
later. In some cases surgery leads to adhesions of bowel. In later life, if the supports
around the vagina get loosened, the vagina may prolapse partly or fully.
f Very rare conditions: Allergic reaction to any drug including anaesthesia medicines,
blood transfusion, need for assistance for respiration (oxygen/ ventilation), shock,
stroke or heart attack due to strain on the heart, fluid collection in the lungs,
formation of blood clots in veins leading to embolus further leading to damage to
vital organs, loss of function of any limb or organ or paresis are extremely rare but not
unknown complications of any surgery. Rarely if the uterus is densely stuck to other
organs the doctor may find it difficult to complete the procedure.
THIS INFORMATION LEAFLET WAS RECEIVED ON
……………………...........................…………....( date / time)
Signature of the patient: ………….............................……………………..
instruction To Patient: Please Bring This Paper When You Come To The Hospital For
Getting The Surgery/ Procedure Done).


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Hospital

CONSENT FOR ABDOMINAL HYSTERECTOMY

Part I: Information about the surgery

1. Name of the procedure: open/ abdominal hysterectomy. Additionally, following

5. Benefits & effects of the procedure :

Medicines may be prescribed by the doctor to deal with these symptoms.

Consent For Abdominal Hysterectomy 2

Other surgical procedures:

7. Consequences of refusal of the procedure:

THIS INFORMATION LEAFLET WAS RECEIVED ON

……………………...........................…………....( date / time)

Signature of the patient: ………….............................……………………..

Getting The Surgery/ Procedure Done).

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