Underutilization of Vaginal Hysterectomy and its Impact on Residency Training

Abstract

BACKGROUND: The advantages of vaginal hysterectomy over abdominal hysterectomy include lower morbidity, shorter hospital stay, and reduced cost to the patient. It is, therefore, important to pass the required skill for vaginal hysterectomy unto trainees. OBJECTIVE: To determine the proportion of vaginal hysterectomies done in a residency training institution in Nigeria and its possible impact on the proficiency of future gynaecologists in performing the procedure. METHODS: A chart review was done on all documented cases of hysterectomies for benign gynaecological conditions done in Jos University Teaching Hospital, over a four-year period (January 2002 to December 2005). Case files of patients who had hysterectomy during the study period were retrieved and the relevant information obtained for analysis of frequencies and percentages. RESULTS: A total of 94 hysterectomies for benign gynaecological conditions were done during the study period. Nine (~10%) vaginal hysterectomies were done. All the vaginal hysterectomies performed were for uterovaginal prolapse by consultants. However, 45 (53%) of the abdominal hysterectomies were performed by consultants and 40 (47%) by residents. CONCLUSION: This study suggests that residents' exposure and training on the act of vaginal hysterectomy is inadequate. This has potential implications on future gynaecologist proficiency to perform this method of surgery that has documented advantages and better outcome for patients. WAJM 2009; 28(5): 323-326.

Underexposure of Residents in Training in the Art of Vaginal Hysterectomy in Nigeria

“…The ratio of vaginal hysterectomy to abdominal hysterectomy in the United States is approximately 1:4 [6]. The ratio of vaginal hysterectomy to abdominal hysterectomy in Nigeria ranges from 1:4 [21] to 1:9 [12]. Nigerian figures are lower than what is obtainable in other advanced countries despite vaginal route as gynaecologist's route of choice for hysterectomy for benign gynaecological conditions.…”

“…Most centres hardly do up to five vaginal hysterectomies in a year. In most centres, residents in training hardly perform vaginal hysterectomy and by the time they finish the programme, no skill is acquired in performing vaginal hysterectomy [11,12]. In advanced countries a resident is expected to perform minimum of 25 vaginal hysterectomies during the residency training programme [31], however, in Nigeria a resident may not have watched or assisted in up to 10 vaginal hysterectomies before the residency programme is completed.…”

“…However, the cost, unavailability of the equipment with high incidence of pelvic adhesions often seen in Nigerian women and women with uterine fibroids more than 12weeks gestational size are the major drawbacks to this practice in our environment [10,11,12].…”

“…The reasons put forward for underexposure of residents in the art of vaginal hysterectomy in Nigeria are lack of well trained gynaecologists in the art of vaginal surgeries, absence of reviewed practice guidelines, absence of promotion of vaginal hysterectomy, surgeon's preference for abdominal approach because of wide open abdominal incision, high incidence of pelvic adhesions frequently seen in Nigerian women and finally cost of vaginal hysterectomy [7,9,11,12].…”

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

“…If learned properly, it instils confidence in surgeons to undertake this procedure routinely in all technically feasible cases. Ocheke et al [28] also concluded that resident's inadequate exposure and training of vaginal hysterectomy may have potential implications on future proficiency to perform this method of surgery that has documented advantages in the best interest of patients.…”