Hysterectomy for Benign Gynaecological conditions at Gombe, North Eastern Nigeria

Abstract

Background: Hysterectomy is one of the commonest major gynaecological surgeries performed all over the world. This study is the first audit of hysterectomy in a relatively new centre in the North-eastern part of Nigeria. Aim: To determine the indications and outcome of hysterectomy in Gombe Methods: This is a retrospective study in a tertiary health facility in Gombe, an urban community in north eastern Nigeria. The study is a descriptive analysis of all cases of hysterectomy for benign disease over a 6year period (January 2001-December 2006). Information on socio-demographic characteristics, presenting symptoms, indication for surgery, type of hysterectomy, cadre of surgeon, operative findings, blood transfusion, pre-morbid condition, duration of hospital stay and post-operative morbidity were retrieved and analyzed.
Results: Hysterectomy for benign gynaecological conditions accounted for 10.7% of all major gynaecological operations during the study period. The leading indications for hysterectomy were uterine fibroid 36(39.1%), dysfunctional uterine bleeding (DUB) 21(22.8%), and uterovaginal prolapse 19 (20.7%).The mean age and parity were 45.7+11.1years and
5.5+3.7 respectively. Abdominal hysterectomy with either unilateral or bilateral salpingo-oophorectomy accounted for 73(79.3%) and vaginal hysterectomy contributed 19(20.7%) of cases. The majority of the patients 55(59.8%) were not transfused. Thirty four (37%) were found to be hypertensive. The crude morbidity rate was 29 (31.5%) with wound infection 7(24.1%) being the commonest complication. There was no mortality associated with hysterectomy during the period under review.
There was no significant difference in blood transfusion rate between abdominal and vaginal hysterectomies (P= 0.168).The cadre of surgeon (consultant or senior registrar) had no significant influence on morbidity rate (P= 0.132) and overall there was no significant difference between route of hysterectomy (abdominal or vaginal) and morbidity rate (P =0.577).The duration of hospital stay was however significantly lower in those who had vaginal hysterectomy (P=0.019) Conclusion: Hysterectomy appears to be a safe procedure but the high morbidity rate is worrisome. There might therefore be the need to review antibiotic prophylaxis and the policy of asepsis and antisepsis during hysterectomies. The shorter
duration of hospital stay following vaginal hysterectomy has an economic appeal and therefore should be resorted to whenever feasible.

Key words: Indication, hysterectomy, outcome, Gombe