An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India

Abstract

Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

Comparative Study of Ormeloxifene and Medroxyprogesterone Acetate in Abnormal Uterine Bleeding

“…In a study by Deeksha Pandey, AUB was the third most common indication of hysterectomy after fibroid and prolapse [7]. Hysterectomy has its own known complications as any other major surgery.…”

Minimally invasive hysterectomy for benign disease: our experience study

“…Mean age quoted by other studies is slightly higher than ours. 3 Most of our patients being from the lower socioeconomic status were in the average weight category which in fact facilitated our procedure laparoscopically. Laparoscopic route for overweight patients although poses operative difficulties, is a better option as it gives better operative vision and almost negates wound dehiscence which they are at risk.…”

“…Fibroids are quoted as the commonest indication for hysterectomies by most studies but were the second common in our sample as those with larger fibroid were excluded from our study as this was a pilot service, we did not include larger fibroids to give margin for safety and learning curve of the team. 3,10,11 In addition to this, we did not have a morcellator which limited our ability to take larger uterine specimens through vaginal route. With advancing time, we are sure hysterectomy for fibroids will be done more frequently by laparoscopic route in our setting.…”

“…[1][2][3] Hysterectomies for DUB with no or minimal uterine descent are mostly by abdominal route unless the surgeon is experienced to do these vaginally. Laparoscopic approach has the advantages of converting an abdominal route to minimally invasive route in cases unsuitable for vaginal route either due to lack of operator skill or operative complexities such as larger uterine size, adhesions, fibroids, previous surgeries etc.…”

Suture versus vessel sealer in vaginal hysterectomy: an observational study

“…This could be due to technical difficulties encountered during vaginal surgery. 13,14 Therefore, it is important to investigate alternatives in surgical technique so that more surgeons are encouraged to operate vaginally. Technological advances in haemostatic methodology have provided the surgeons with a number of alternative methods for achieving haemostasis.…”