• Pain in the abdomen and shoulders – is common for the first few days after surgery and occurs due to the incisions made for the surgery, and residual gas used in laparoscopic surgeries. This pain can be managed with pain relief medication until it settles.
• Nausea and vomiting – post operative nausea and vomiting (PONV) is common following many surgeries, especially laparoscopic gynaecological procedures.
• Change in bladder or bowel habits – as this surgery is completed in the same region as the bowel and bladder, disruption to these organs may occur which can result in a change in their normal behaviours.
• Failure to resolve initial indication for surgery – there is a possibility that no cause is found to explain your symptoms, and there is a small possibility that the symptom(s) you have been experiencing and the reason for this operation, may not resolve (or in rare cases, may worsen). This may result in a need for further investigations or procedures.
• Onset of menopause – can occur in pre-menopausal women if both ovaries are removed. It is not normal operating procedure to remove both ovaries in pre-menopausal women unless specifically indicated. Please ensure you discuss this with your doctor.

A simple way to express and compare the risks of complications is as a percentage (%). This indicates the number of times that complication may be expected to occur out of 100 surgeries completed.

The table below further describes the risk of complications from very common through to very rare.

A complication in one form or another may occur in one in seven procedures. The following list includes potential complications, and their approximate risks of occurring.

• Adhesions - (bands of scar tissue) may form inside the abdomen/pelvis. These are very common with pelvic surgeries and between 55-100%[4] of patients reportedly experience this. Adhesions may range from benign and cause no symptoms, or may become more complex and cause symptoms such as a bowel obstruction in the longer term. These may require further surgery.
• Increased time for surgery – the operating time is generally quite fast (less than 2 hours), however a time greater than 4 hours has been reported in up to 9%[1] of surgeries.
• Readmission to Hospital within 30 days – may be required, for a number of reasons, and may be required in up to 3%(1) of surgeries
• Urinary Tract Infection – may occur in up to 2%[5] of surgeries and is treated with antibiotics.
• Excessive Bleeding or Blood clot – the risk of excessive bleeding requiring a blood transfusion, or a blood clot in the leg (DVT) or lungs (PE) may occur in less than 2%[3] of surgeries
• Injury to the Bladder – there is less than 2%[2] risk of damage to the bladder throughout the surgery. This risk is due to the bladder being in close proximity to the operation in the pelvis. The risk is minimised by ensuring the bladder is empty prior to surgery.
• Requirement for reoperation – there is just over a 1%[1] risk of surgeries requiring an additional operation.

• Infection in the pelvis can occur in approximately 1%[1] of cases. This risk is mitigated by performing the operation in a sterile field.
• Injury to the vagina – this is infrequent, occurring in less than 1%[2] of cases. The surgeons operate carefully to ensure this risk remains as small as possible.
• A hernia (rupture) – may occur at one of the incision sites in less than 1%[2]  of cases
• Conversion to open procedure – planned laparoscopic (keyhole) or vaginal procedure may need to be completed by laparotomy (open procedure) in less than 1%[1] of cases.
• Injury to the ureter(s) – the ureters (tubes from kidneys to the bladder) may be injured during the surgery in less than 1%[2] of cases. There are several techniques the surgeon can implement to ensure that the ureters are positively identified and avoided.
• Injury to the bowel – the same risk of injury to ureters (less than 1%[2]) exists with injury to the bowel. Surgeons utilise careful techniques, operating under direct vision of the laparoscopic camera to ensure the risk of bowel injury is kept low.
• Bowel blockage – after operation may occur in less than 1%[1] of cases. This can be a result of adhesions, direct injury to the bowel, excessive movement of the bowel during surgery, or the use of some pain medications post surgery.
• Wound dehiscence – this is breakdown of the wound and may occur in less than 1%[1] of cases. Risks from the individual can directly impact the frequency in which this occurs, and include things such as the presence of diabetes and smoking, both of which affect wound healing.
• Infection at the operation site – this less than 1%[1] risk is mitigated by operating in a sterile field, and ensuring proper postoperative wound care is implemented and maintained.
• Development of a fistula – this is a new connecting passage between one area and another (for example between the bladder and vagina) and may occur in less than 1%[1] of cases.

• Granulation tissue formation or erosion through the tissue – has a 0.1%[2] risk of occurrence. This may occur due to non-absorbable or slowly dissolving sutures at a time distant to the procedure. It is rarely encountered and may occur in 1:1,000 cases.
• Heart attack or stroke - rarely occurs (in 0.03%[3] of cases) due to the strain on the heart during anaesthesia. Occurrence is very dependent on specific patient conditions, and as such may occur in less than 1:3,500 cases.
• Death – is very rare occurring in only 0.01%[3], or less than 1:10,000 cases.

• Poor wound healing – may occur as a result of the larger wound required for an abdominal hysterectomy. Other factors such as diabetes and smoking also negatively impact wound healing.
• The wound scar may become thickened, red and painful – this may occur with abdominal hysterectomy, particularly if you have a predisposition to keloid or hypertrophic scarring.
• Recurrence of prolapse – the vaginal repair after a vaginal hysterectomy may not be successful in the short or long term, and may need corrective surgery.
• Occurrence of pain during sexual intercourse or altered sexual function – may occur after vaginal repair when undergoing vaginal hysterectomy.

This procedure will require an anaesthetic to put you to sleep while the procedure takes place. For more information about the specific anaesthetic risks involved, please review the anaesthetic information sheet that has been provided to you, and discuss any concerns with the doctor.

Some of the risks outlined above increase with the number of previous surgeries that a patient may have had. Other factors that place patients at higher risk of complication include: higher BMI, higher number of previous pregnancies, larger uterine weights, older age, history of a laparotomy or other abdominal/pelvic surgeries, and an anaesthetic risk assessment of ASA 3 or greater[1].

Please discuss these risks with your doctor so you fully understand what they may be, and ensure they are written on the consent form before you sign it.