What Is TAH-BSO?

Total Abdominal Hysterectomy and Bilateral Salphingo-

Oopherectomy.

This is the removal of the uterus including the cervix as well as the tubes and
ovaries using an incision in the abdomen. A hysterectomy is the surgical
removal of the uterus. Hysterectomy may be total, as removing the body and
cervix of the uterus or partial, also called supra-cervical. Salpingo refers
specifically to the fallopian tubes which connect the ovaries to the uterus.
Oophorectomy is the surgical removal of an ovary or ovaries.

INDICATION

Endometriosis- is an abnormal condition in which

endometrial tissue is found in internal sites other than the
uterus. Overall incidence in women of reproductive age is
5% to 10%. Women in their mid-30s are most commonly
affected, though it can appear anytime form first menses to
menopause. There is a familial disposition.

Benign Uterine Tumors (Leiomyomas)- fibroids, fibromas,

fibromyomas, fibroleiomyomas, and myomas.

Leiomyomas are benign uterine tumors that arise from the

uterine muscle tissue. They are the most common tumors of
the female genital tract and occur in 20% to 30% in women.
They are seen more often in African-American women, and
are more common in women approaching menopause.

Endometrial or Uterine Cancer- is the most common

malignancy of the female genital reproductive system.

In 2007 the American Cancer Society estimated that 39,080

new cases of uterine cancer would be diagnosed in the United
States with an estimated 7400 women dying of uterine cancer.
The 5-year survival rate is 96% if the cancer is discovered at an
early stage.It is most strongly related to an imbalance between
estrogen and progesterone levels, resulting in excessive
circulating estrogen.
 Ovarian Cancer- the second most common gynecologic
cancer, accounts for 3% of cancer occurrence and 6% of
cancer deaths in women and is the leading cause of death
from reproductive malignancies in women. An estimated 22,
430 new cases of ovarian cancer are expected to be
detected in the United States in 2007, with 15, 280 deaths.
White women show higher rates of ovarian cancer than do
African-American women. Early diagnosis of ovarian cancer
is uncommon.

RISK AND SIDE EFFECT

Hysterectomy has been found to be associated

with increased bladder function problems, such
as incontinence. When the ovaries are also
removed, estrogen levels will fall. This removes
the protective effects of estrogen on the
cardiovascular and skeletal system. A
menopausal woman has a three times greater
risk of developing cardiovascular disease such as
atherosclerosis, peripheral artery disease or of
having a heart attack when compared to
premenopausal women. Studies have also found
that the risk of developing osteoperosis may
increase
INTERNAL ORGANS
a. Uterus. The uterus is a hollow organ about the size and
shape of a pear. It serves two important functions: it is the
organ of menstruation and during pregnancy it receives the
fertilized ovum, retains and nourishes it until it expels the
fetus during labor.
-The uterus is located between the urinary bladder and the
rectum. The uterus consists of the body or corpus, fundus,
cervix, and the isthmus. The major portion of the uterus is
called the body or corpus. The fundus is the superior,
rounded region above the entrance of the fallopian tubes.
The cervix is the narrow, inferior outlet that protrudes into
the vagina. The isthmus is the slightly constricted portion
that joins the corpus to the cervix.
-The walls are thick and are composed of three layers: the
endometrium, the myometrium, and the perimetrium.

b. Vagina - is the thin in walled muscular tube about 6 inches

long leading from the uterus to the external genitalia. It is
located between the bladder and the rectum. It provides the
passageway for childbirth and menstrual flow; it receives the
penis and semen during sexual intercourse.

c. Fallopian Tubes (Two) -Each tube is about 4 inches long

and extends medially from each ovary to empty into the
superior region of the uterus. They transport ovum from the
ovaries to the uterus. There is no contact of fallopian tubes
with the ovaries. The distal end of each fallopian tube is
expanded and has finger-like projections called fimbriae,
which partially surround each ovary. When an oocyte is
expelled from the ovary, fimbriae create fluid currents that
act to carry the oocyte into the fallopian tube. Oocyte is
carried toward the uterus by combination of tube peristalsis
and cilia, which propel the oocyte forward. The most
desirable place for fertilization is the fallopian tube.

d. Ovaries (two)- The ovaries are for oogenesis-the

production of eggs (female sex cells) and for hormone
production (estrogen and progesterone). They are about the
size and shape of almonds. They lie against the lateral walls
of the pelvis, one on each side. They are enclosed and held
in place by the broad ligament.

e. cervix (or neck of the uterus)

-is the lower, narrow portion of the uterus where it joins
with the top end of the vagina. It is cylindrical or conical in
shape and protrudes through the upper anterior vaginal wall.

f. urethra
-is a tube that connects the urinary bladder to the genitals
for removal out of the body. In males, the urethra travels
through the penis, and carries semen as well as urine. In
females, the urethra is shorter and emerges above the
vaginal opening.

DIAGNOSTIC PROCEDURES

Before any type of hysterectomy, women should have

the following tests in order to select the optimal
procedure:
Complete pelvic exam including manually examining
the ovaries and uterus.
Up-to-date Pap smear .
Pelvic ultrasound may be appropriate, depending on
what the physician
 A decision regarding whether finds on the above. or not
to remove the ovaries at the time of hysterectomy.
Complete blood count

MANAGEMENT

PRE-OPERATION
1. Interprets and upholds policies and procedures as
determined by administrative
body.
2. Identify knowledge and skills of peri- operative nursing.
Identifies nursing care problems through pre-operative visit
and assist in the solutions and

INTRA-OPERATION

1. Ensures quality of care through proper use of instruments,

equipments and
supplies.

2. Observes proper positioning of the patient and maintaining

the dignity of the
individual
As well, thus, providing maximum safety and comfort.

3. Identifies, prepares and send specimen obtained during

operation for
examination.
4. . Assess patients stability and should know to report to the
attending
physician/s.

5. Carries out doctors post-operative order diligently.

6. Observes checks and record patient assessment and refer

when necessary.

7. Administers post-operative care.

8. Submits sundry report and account for the supplies and

equipment used.

9. Responsible for the upkeep, Maintenance and care of

equipment and instrument.

10. Informs appropriate personnel when supplies are

needed or equipment and instruments are out of order.

POST-OPERATION

1. Responsible for all the safekeeping of patients personal

belongings endorse by OR nurse.

2. Responsible for endorsing such items to patients relatives or

floor nurse.

3. Diligently carries out doctors orders as soon as possible.

4. Check and record vital signs-blood pressure, pulse rate, O2

saturation,
respiratory rate, temperature, color and condition of skin, if
can move extremeties every 15 minutes (or as often as
possible or as indicated by the patients condition) on the
Nurses Post Anesthesia Record.
5. Observes and records neuro vital signs for neurological cases
on the
Neurological Vital Signs Form provided by the unit.

6. Observes keenly the patients who might undergo post-

operative complications
like bleeding, shock, respiratory distress, thyroid storm and
cardiac arrest.

6. Notifies the anesthesiologist/AMD immediately for any

unusual symptoms
manifested by the patient.

PROGNOSIS

The prognosis following an

uncomplicated hysterectomy is good, regardless of
the type of procedure performed. Symptoms are
usually relieved by the procedure, and a full return to
normal activities can be expected.

When hysterectomy is performed for cancer of the

cervix or uterus, the prognosis depends upon the
extent and severity of the cancer. Early-stage or low-
grade cancer has a generally good prognosis,
whereas more advanced stages or high-grade cancer
with extensive spreading (metastasis) has a poor
prognosis.
 The predicted outcome after salpingo-oophorectomy
doesnt depend on whether the procedure is
unilateral or bilateral usually does not affect the
outcome, because the effect of the procedure and the
healing from the surgery occur at much the same rate
for removal of one or both fallopian tubes and
ovaries. However, hormonal complications for
premenopausal women may arise if both ovaries are
removed. After bilateral oophorectomy, the woman
will be at increased risk for osteoporosis, coronary
heart disease, lung cancer, and cognitive impairment
(dementia) unless hormone replacement therapy is
implemented, and will become infertile.