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.
Highlights
Hysterectomy is amongst the most performed surgical interventions in Gynaecology [1]
The main indications of hysterectomies reported in the literature are benign pathologies of uterus like leiomyomas [1] [2]
Development and popularisation of minimally invasive approaches and alternatives like endometrectomy in recent years have enabled the reduction of complications, morbidity and hospital stay linked to abdominal approach
Summary
Hysterectomy is amongst the most performed surgical interventions in Gynaecology [1]. The main indications of hysterectomies reported in the literature are benign pathologies of uterus like leiomyomas [1] [2]. Abdominal hysterectomy has remained the main type followed by vaginal route especially in developing countries. The first laparoscopic hysterectomy is reported to have been performed in 1989 and demonstrated several advantages as compared to the traditional abdominal route like less post-operative pains, better cosmetics, shorter hospital stay, early recovery time [4] [5] [6] and [7]. Objective: To study the frequency, indications, surgical methods, and complications of hysterectomies at the Douala General Hospital. All patients who underwent hysterectomies for gynaecological or obstetrical indications and whose files were complete were retained.
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