Whether a woman has either a vaginal hysterectomy or abdominal hysterectomy depends on the reason for the hysterectomy as well as her doctor's preference. A woman can have a vaginal hysterectomy if her uterus is no more than slightly larger than normal and also if she has little to no Endometriosis or Adenomyosis. A woman will usually require an abdominal hysterectomy if she has cancer in any of the pelvic organs, or if she has severe Endometriosis or Adenomyosis. Also if she has large fibroids or many abdominal adhesions or a very large uterus. An abdominal hysterectomy can be done with either a midline incision or a bikini incision. A midline incision is normally from the belly button straight down to just above the pubic hairline. A bikini incision is a horizontal incision made just above the pubic hairline.

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Pros and Cons of the different types of surgery Vaginal Hysterectomy The advantages of having a vaginal hysterectomy are: The length of time in surgery may be shorter for vaginal vs. abdominal The length of time in the hospital may be shorter You will have no scar on the abdomen as with abdominal surgery Vaginal hysterectomy costs less than abdominal hysterectomy Disadvantages may be: All organs are removed through the vagina, if a woman's uterus is very large this can make the surgery more difficult. And could also lead to the surgeon having to change the type of surgery and doing it abdominally. Laproscopic Assisted Vaginal Hysterectomy The advantages of having a LAVH are: There are only a few small scars on a women's abdomen The length of time in the hospital is shorter Disadvantages may be: This type of hysterectomy takes the longest amount of time It also costs the most A very large uterus cannot be removed this way. Also the surgeon can't remove areas of endometriosis or adhesions with this type of surgery Abdominal Hysterectomy The advantages of having an abdominal hysterectomy are: The surgeon can easily see the pelvic organs and remove them The surgeon can easily see areas of endometriosis and/or adhesions and remove them Disadvantages may be: This type of surgery usually requires more time than a vaginal hysterectomy, which requires more time under anesthesia. The woman usually will have pain around the incision following surgery The length of time in the hospital is usually longer The incision leaves a scar on the women's abdomen

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