Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery

Abstract

Objective:The aim of the study was to generate baseline data for indications of gynecological surgeries, and to assess route of surgery and histopathology correlation in women undergoing major gynecological surgery in a rural tertiary level teaching hospital in India.Materials and Methods:Surgical indications, route of surgery and histopathology findings were reviewed and analyzed retrospectively, in 922 patients (≥35 years age) who underwent gynecological surgery at Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India from January 1, 2011 to May 31, 2013.Results:Of 922 surgeries, 65 had malignancy (7%). Pelvic organ prolapse (POP) (32.3%) and leiomyoma uterus (29%) were two most common benign indications for hysterectomy. Ovarian tumors were present in 13% (25% of these were malignant). Postmenopausal bleeding (PMB) was seen in 5.5% (55% of these were malignant).Conclusions:All except 10% surgeries were done in the absence of definite histopathology diagnosis that is dysfunctional uterine bleeding (n = 42 [45%]), chronic pelvic pain/severe dysmenorrhea (n = 34 [36%]) and recurrent PMB (n = 17 [19%]). Majority of surgeries had histopathological correlation except for six cases (0.6%) of malignancy, which were missed on initial work-up. Majority of the surgeries were done abdominally. In rural areas of developing countries poverty, lack of regular follow-up, resource constraints and lack of technical skills (with respect to laparoscopic/robotic surgeries) pose major challenge in providing quality health care.

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

“…We observed that there was very little awareness about NDVH and its outcome among the subjects well comparable with the study by Sharma et al [12] and Amarjeet et al [13]. In our study out of 100 patients, ten were adamant and refused NDVH and underwent TAH.…”

Surgical Apgar score in prediction of post-operative complications in gynecological surgery

“…In many areas (especially, rural areas) here in India and in other developing countries, poverty, lack of regular follow-up, resource constraints and lack of technical skills pose major challenges in providing quality health care. 10 Therefore, results of this study cannot be generalized. Secondly, it is possible that both the SAS assigned and the patient's risk for postoperative outcomes per se were influenced by confounding factors such as the use of beta-blockers, intraoperative resuscitation and ascites.…”

Hysterectomy: still a treatment of choice for pelvic pathologies in rural India

“…16,[18][19][20][21] However, there has been controversy regarding indications for hysterectomy for benign gynecological diseases in Indian subcontinent. 22 Of total, only 6% surgeries were done for premalignant cervical lesions in the study which conclude that rural women with cervical malignancy usually present late due to lack of awareness, non availability of adequate screening tests and pathologists. Thus surgery for malignant disease is life-saving, whereas for that benign disease to improve the quality of life, hence hysterectomy is not only a cost-effective but also associated with excellent satisfaction as compared to conservative therapies.…”