Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses

Abstract

Background: Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low-and middle-income countries including Tanzania is scare. Methods: This was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test. Results: A total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44-10.46), previous abdominal operations (OR 8.44; 95% CI 2.52-28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18-11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001). Conclusion: Bleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.

Histopathological span of diseases in patients going through hysterectomies: an audit of 190 consecutive hysterectomy specimens in Multan

“…(10) The mean age of women who underwent hysterectomy due to gynecological disorders in our study was 47.8 years in accordance with several studies conducted in Pakistan and abroad where the mean ages found were 48.8 years 46.86 years, 45.76years, 45 years, 43 years and 40.37years respectively. (2,11,12,13,14,15) Most (78/190) 41.1% of these women were between ages 41 to 50 years, comparable to the studies conducted by Shahid R, Egbe TO and Imam ZS. (15,13,16) Irregular excessive bleeding and pain were the most frequent presenting complaints in our study.…”

“…(9,16,19) However, leiomyomas and adenomyosis were the most frequent myometrial histopathological lesions and indication for hysterectomy in our study, in keeping with several other studies. (11,20,21) The most common type of hysterectomy was TAH without tubes and ovaries in our study. This is in accordance with several other studies where number of total abdominal hysterectomy was much more than vaginal hysterectomies.…”

Effect of an Educational Program on Gynecological Nurses′ Performance Pre and Post Hysterectomy Surgery

“…About 600,000 hysterectomies are performed annually in the United States (4)(5)(6) . In Nigeria, 28% of all major gynecological operations performed are hysterectomies.…”

Is abdominal hysterectomy still the surgery of choice in sub‐Saharan Africa?

“…3,4 Frequent use of the abdominal approach has been observed in many African countries, especially in parts of sub-Saharan Africa. [7][8][9][10] In these areas, surgery in this region. Little documentation exists in the literature to account for the role of minimally invasive surgery in the sub-Saharan Africa.…”

“…In Africa, vaginal hysterectomy for benign conditions has never been well established and the abdominal approach still dominates, although this approach has been associated with high complication rates, as demonstrated in several reviews 3,4 . Frequent use of the abdominal approach has been observed in many African countries, especially in parts of sub‐Saharan Africa 7‐10 . In these areas, health‐related resources are limited, and one would expect the vaginal approach to be dominant as abdominal hysterectomy is associated with higher cost in relation to longer in‐hospital stay, higher rate of infection etc.…”