Hysteroscopic surgery at the Aga Khan Hospital, Nairobi

Abstract

Objectives: To determine the experience, acceptability and outcome of hysteroscopic surgery at the Aga Khan Hospital, Nairobi. Design: A retrospective study. Setting: Aga Khan Hospital, Nairobi. Patients: Between May 2000 and April, 2003, 463 cases of hysteroscopy were undertaken at the Aga Khan Hospital, Nairobi, of these 54 patients (11.7%) underwent various hysteroscopic surgical procedures. A review of these cases and their outcomes are analysed and presented. Results: In a thirty six month period 463 cases of Hysteroscopy were done at the Aga Khan Hospital, Nairobi. Of these 54 cases had operative intervention (11.7%). The case load of diagnostic hysteroscopy increased from 50 in the year 2000, to 206 and 159 respectively in the years 2001 and 2002. By this time, some consultants were performing diagnostic hysteroscopies on their own. The surgical procedures performed included hysterscopic retrieval of " lost "IUCD's, and intrauterine bone spicules and hysteroscopic resection of submucous fibroids (25.9% of the cases), resection of endometrial polyps (25.9%) hysteroscopic synechiolysis, (16.6%) and endometrial resection or ablation (cauterisation) (7.4%). All the patients were reviewed by the consultant pool after one week. Three cases of complications were encountered, two cases of uterine perforation and one case of fluid overload (TURP syndrome) following a resection of a submucous fibroid. Conclusion: Hysteroscopy and hysteroscopic surgery are the established gold standards for the management of intrauterine pathology. The procedures were well accepted amongst patients who had undergone these procedures. Recommendations: In Kenya, gynaecologists still have to embrace change and undergo adequate and sustained training in the various aspects of hysteroscopy, so as to make the proecdures acceptable and accessable to more patients.

A 3 Years Review of Hysteroscopy in a Private Hospital in Nigeria

“…This compares favorably with the 0.7% reported in Kenya 6 and 0.28% by Jansen et al 3 The patient in our study was a 33 years old para 1 +1 lady who had general anesthesia for combined hysteroscopy and laparoscopy. She developed apnea after the procedure for which she needed mouth to mouth resuscitation, cardiac massage and oxygen by face mask.…”

“…This was much higher than the 16.6% reported at the Aga Khan hospital in Kenya. 6 Majority of our patients (71.1%) had previously terminated one or more pregnancies and these are usually unsafe abortions, as abortion is still illegal in Nigeria. The result could be an increase in uterotubal infections and hence adhesions.…”

Laparoscopic assisted vaginal hysterectomy for benign uterine pathology: is it time to change?

“…In Kenya, Parkar et al reported the first cases of LAVH (11). The outcomes of 149 cases of locally performed LAVH were analysed, in this paper.…”

Minor Gynecologic Surgery: A Review of the Training Experience and Skill Building Opportunities for Providers in Low and Middle Income Countries

“…In Kenya, hysteroscopic surgery at a major regional hospital increased from 50 in year 2000 to 159 cases two years later. All surgeries were performed by senior faculty (consultants) and did not include doctors in training [21].…”