Abstract

Background: Hysterectomy is a major gynaecological operation for removal of the uterus with or without the cervix and adnexal structures for therapeutic purpose. There is paucity of data on gynaecological hysterectomy for benign disorders in our environment.

Objective: This study sought to determine the prevalence and indications for gynaecological hysterectomy for benign conditions, evaluate the surgical outcome and assess the associated factors in women.

Methodology: This was a retrospective review of gynaecological hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on maternal age, parity, indication for surgery, length of surgery, estimated blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using SPSS version 20. Categorical measurements were given as numbers and percentages, and numerical measurements as mean and standard deviation. The Chi-square test or Fisher exact test and analysis of variance test were used for statistical analysis of non-continuous and continuous variables as appropriate and statistical significance was set at p < 0.05.

Results: There were 1240 major gynaecological surgeries, of which 157 were hysterectomies for benign conditions, giving a prevalence of 12.7%, 112 (71.3%) were abdominal hysterectomies and 45 (28.7%) were vaginal hysterectomies, giving a ratio of 2.5:1. The mean age ± SD was 50.71 ± 10.46 years and median parity was 4. There was significant association between age (P = 0.00001) and parity (P = 0.0001) with the type of hysterectomy performed. The commonest indication was uterine fibroid 89 (56.6%), followed by uterovaginal prolapse 45 (28.7%). The commonest complication was anaemia in 29 (18.5%), followed by wound sepsis in 25 (15.9%). Intraoperative injury occurred in 5 (3.2%) and there was one maternal death (0.6%). There was significant association between duration of surgery with anaemia (P = 0.0001) and women < 49 years were 3x likely to have significant blood loss at hysterectomy than those ≥ 49 years.

Conclusion: The prevalence of benign hysterectomy of 12.7% shows it’s a common procedure and the complication rates shows it’s a relatively safe procedure. Uterine fibroid is the commonest indication for the abdominal route and utero-vaginal prolapse for the vaginal route. Age and parity were determinants for the route, while duration of surgery and blood loss were determinants for complication. Younger and low parity women, who mainly undergo abdominal hysterectomy, were likely to have significant blood loss at surgery.

Keywords: Benign Gynaecological Conditions, Abdominal Hysterectomy; Vaginal Hysterectomy; Uterine Fibroids; Utero-Vaginal Prolapse

References

1. Howard WJ. “Abdominal hysterectomy”. In: John AR, Howard WR. editors. Te Linde’s Operative Gynecology. 10th ed. Philadelphia; Lippincott Williams and Wilkins (2008): 727-733.
2. Umeora OU., et al. “Abdominal versus vaginal hysterectomy: Appraisal of indications and complications in a Nigerian federal medical center”. Nepal Journal of Obstetrics and Gynaecology 4 (2009): 25-29.
3. Onah HE and Ugona MC. “An audit of vaginal hysterectomy in Enugu, Nigeria”. The Journal is Official Publication of Society of Gynecology 21 (2004): 58-60.
4. Jain SB and Chandrakar KD. “Non-decent vaginal hysterectomy in rural setup of MP: A poor acceptance”. The Journal of Obstetrics and Gynecology of India 66 (2016): 499-504.
5. Domingo S and Pellicer A. “Overview of current trends in hysterectomy”. Expert Review of Obstetrics and Gynecology 4 (2009): 673-685.
6. Shiota M., et al. “Total abdominal hysterectomy versus laparoscopically assisted vaginal hysterectomy versus total vaginal hysterectomy”. Asian Journal of Endoscopic Surgery 4 (2011): 161-165.
7. Ikechebelu JI., et al. “Laparoscopically assisted vaginal hysterectomy in Southeast Nigeria – a case report”. Nigerian Medical Journal 18 (2009): 107-109.
8. Olusegun O., et al. “Total laparoscopic hysterectomy: a case report from ILE-IFE, Nigeria”. Nigerian Medical Journal4 (2012): 254-256.
9. Akintobi A., et al. “Laparoscopic supracervical hysterectomy and uterine morcellation: a case report from Asokoro District Hospital, Abuja, Nigeria”. Nigerian Journal of Clinical Practice6 (2015): 824-827.
10. Daru PH., et al. “Vaginal hysterectomy at Jos university teaching hospital, Jos, Nigeria”. Journal of the West African College of Surgeons3 (2011): 26-36.
11. Goolab BD. “Vaginal hysterectomy and relative merits over abdominal and laparoscopically assisted hysterectomy”. Best Practice and Research Clinical Obstetrics and Gynecology 27 (2013): 393-413.
12. Danielle DM and Amy JP. “The Challenging Vaginal Hysterectomy”. Postgraduate obstetrics and gynecology22 (2010): 1-7.
13. Choosing the Route of Hysterectomy for Benign Disease. ACOG Committee Opinion No. 444”. American College of Obstetricians and Gynecologists, Obstetrics and Gynecology 114 (2009): 1156-1158.
14. Andrew IB. “Hysterectomy in the 21ST Century: Different Approaches, Different Challenges”. Clinical Obstetrics and Gynecology4 (2006): 722-735.
15. Medhi P., et al. “A histopathological audit of hysterectomy: experience at a tertiary teaching hospital”. International Journal of Contemporary Medical Research4 (2016): 1226-1228.
16. Hammer A., et al. “Global epidemiology of hysterectomy: possible impact on gynecological cancer rates”. American Journal of Obstetrics and Gynecology1 (2015): 23-29.
17. Arowojolu AO. “Hysterectomy”. In: Okonofua F, Odunsi K (edition.) Contemporary Obstetrics and Gynaecology for Developing Countries. Benin City. Women’s Health and Action Research Centre (2003): 227-242.
18. Omokanye LO., et al. “Hysterectomy at the university of Ilorin teaching hospital, Ilorin, Nigeria: A ten year review”. The Nigerian Medical Practitioner 61 (2012): 104-108.
19. Roberts OA and Okunlola MA. “Abdominal hysterectomy for benign gynaecological conditions at Ibadan, Nigeria”. Tropical Journal of Obstetrics and Gynaecology 18 (2001): 19-23.
20. Shafi MI. “Premalignant and malignant diseases of the cervix”. In: Edmonds DK, editor. Dewhurst’s Textbook of Obstetrics and Gynaecology. 8TH edition. UK: Wiley-Blackwell Publishing Ltd (2012): 742-759.
21. Obilahi A., et al. “Hysterectomy in the Niger-Delta of Nigeria: A clinical study of indications and outcome”. Greener Journal of Medical Sciences 3 (2013): 160-165.
22. Rabiu A and Habib R. “Elective abdominal hysterectomy: Appraisal of indications and complications at Aminu Kano Teaching Hospital – An 8-year review”. Tropical Journal of Obstetrics and Gynaecology 34 (2017): 224-228.
23. Oseki C and Osaikhuwuomwan JA. “A review of indications and outcome of total abdominal hysterectomy at a tertiary public health facility in Southern Nigeria”. Nigerian Journal of Clinical Research 7 (2018): 21-24.
24. Bukar M., et al. “Hysterectomy for benign gynaecological conditions at Gombe, Northeastern Nigeria”. Nigerian Journal of Medicine1 (2010): 35-38.
25. Anzaku AS and Musa J. “Total abdominal hysterectomy for benign gynaecological conditions at a university Teaching Hospital in Nigeria”. Nigerian Journal of Medicine3 (2012): 326-330.
26. Abah MG and Olatunbosun OA. “An audit of gynaecological hysterectomies in the university of Uyo teaching hospital: Case for non-descent”. International Journal of Clinical Obstetrics and Gynecology5 (2019): 161-165.
27. Adenaya OR., et al. “Pattern of Gynaecological Total Abdominal Hysterectomy (TAH) in Abeokuta, Southwest Nigeria; a Five-Year Review”. Journal of Medical Science and Clinical Research5 (2020): 297-304.
28. Tinkishea EA., et al. “Prevalence, indication, type and complication of elective hysterectomy in a tertiary hospital in Ethiopia”. Ethiopian Journal of Reproductive Health3 (2019): 1-7.
29. Obiechina NJ., et al. “Vaginal hysterectomy in a Nigerian tertiary health facility”. Nigerian Journal of Medicine 19 (2010): 324-325.
30. Rasheed S., et al. “Frequency of Complications Among Total Abdominal Hysterectomy Patients in Rehman Medical Institute Hayatabad Peshawar”. The Jena School for Microbial Communication2 (2018): 138-142.