TITLE:
Hystererectomy in a Tertiary Hospital in a Sub-Saharan Setting: A 20-Year Retrospective Review of the Indications, Types and Analysis of Technical Index
AUTHORS:
Théophile Njamen Nana, Robert Tchounzou, Fulbert Nkwele Mangala, Henri Essome, Fidelia Mbi Kobenge, Bongoe Adamo, Gregory Ekane Halle, Thomas Obinchemti Egbe, Charlotte Tchente Nguefack
KEYWORDS:
Hysterectomy, Indications, Surgical Methods, Complications, Douala General Hospital-Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.7,
July
21,
2021
ABSTRACT: Background: Hysterectomy is one of the most performed surgeries through the world, even in Sub Saharan setting where indications are not rare. Objective: To study the frequency, indications, surgical methods, and complications of hysterectomies
at the Douala General Hospital. Patients and methods: We carried out a cross-sectional study over a 20-year period, from the 1st January 2000 to 31st December 2019, in the department of Gynaecology and Obstetrics of the Douala General Hospital,
a tertiary health facility in Cameroon, central Africa. All patients who
underwent hysterectomies for gynaecological or obstetrical indications and whose files were complete were retained. Results: Out of a total of 7126 gynaecological and
obstetrical surgical cases 1007 were hysterectomies, giving a frequency of
14.21%. Meanwhile, 968 files fulfilled the inclusion criteria. The average age
of the patients was 45.75 ± 7.71 years (range 19 to 75 years). The indications
included symptomatic fibroids 64.15% (621 cases), gynaecological cancers 13.94% (135 cases), severe cervical
dysplasia 11.15% (108 cases), and endometrial hyperplasia with atypia 7.02% (68
cases), haemostatic hysterectomies 2.68%
(26 cases), uterine prolapse 0.82% (8 cases), a case of post abortion uterine necrosis (0.10%) and a case of uterine
endometriosis (0.10%). Laparotomy was the main surgical approach 86.05% (833
cases), followed by the vaginal route, 10.20% (97 cases) and then laparoscopy 3.92% (38 cases). The
average length of hospital stay was 6.07 ± 1.92 days following laparotomy, 3 ± 1.09
days following the vaginal route, and 3.6 ± 1.04 days following laparoscopy.
The main intra-operative complications included haemorrhage,
1.75% (17 cases), bladder injuries 0.82% (8 cases) and ureteral injuries 0.72% (7 patients). Post-operative complications mainly included: fever 3.61% (35
cases), anaemia 2.5% (24 cases) and abdominal wall sepsis 0.92% (9 cases). Conclusion: The frequency of hysterectomy was 14.21%. Uterine fibroid, gynaecological cancer and cervical dysplasia were the main indications. Intra-operative haemorrhage, bladder and ureteral injuries were the major complications. Increase in the practice of vaginal and
laparoscopic hysterectomies could contribute to the reduction of peri and post-operative complications and hospital stay.
Thus reinforcement of abilities is required.