An abdominal hysterectomy is recommended when a vaginal approach is not considered suitable. This may be due to previous surgery, the presence of additional pathology, or the size of the uterus.

The incision is usually made along a previous caesarean section scar and is typically a low “bikini line” cut. In rare cases, a vertical incision below the belly button is necessary. The abdominal muscles are gently separated rather than cut, which helps preserve their strength and function. Most patients are able to resume core exercises, including sit-ups, approximately six weeks after surgery.

Once the abdominal cavity is accessed, careful attention is given to restoring the normal anatomy. This involves ensuring that the uterus and ovaries are correctly positioned and free from adhesions (scar tissue attaching them to surrounding organs). The uterus is then removed using sutures and/or electrocautery. The vaginal vault is securely sutured to the supporting ligaments to help prevent future prolapse or sagging.

In most cases, the ovaries are retained and secured to the pelvic sidewall. They are only removed if there is a medical concern, such as suspected cancer or extensive benign disease.

The abdomen is closed in three layers. First, the peritoneum (the inner lining of the abdomen) is repaired, followed by the muscle sheath. The skin is then closed with hidden sutures beneath the surface for a neat finish. A Comfeel dressing is applied, which acts like a second skin. This helps reduce movement at the incision site and supports optimal healing, while lowering the risk of prominent scarring.