Title: Hysterectomy for Gynaecological Conditions At Nguru, North Eastern Nigeria: A Retrospective Study
Authors: Hadiza A. Usman*, Ibrahim M.Sanusi, Abubakar A. Kullima, Mohammed B. Kawuwa
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.143
Abstract
Objective: To determine the incidence, indications and outcome of hysterectomy in Nguru, a reference center in Northeast Nigeria.
Design: Retrospective cohort study
Setting: Federal medical center Nguru, Northeast Nigeria.
Population: All cases of hysterectomy for gynaecological indications
Methods: This study is a descriptive analysis of cases of gynaecological hysterectomies performed over a 5 year period (1st January, 2010-31st December 2014). Information on socio-demographic characteristics, indication for and type of hysterectomy, intra and post-operative morbidities including the need for blood transfusion, cadre of surgeon and duration of hospital stay were retrieved and analyzed.
Main outcome measured: The commonest indications, route of hysterectomy, and complications in relation to the experience of the gynaecologist.
Results: Elective hysterectomy for gynaecological conditions accounted for 25% of all major gynaecological operations during the period of study. Abdominal to vaginal hysterectomy ratio is 5.6: 1 with 56 (84.8%) abdominal and 10 (15.2%) vaginal hysterectomies. Hysterectomy on account of uterine fibroid was the commonest indication seen in 40 (60.6%) of the abdominal hysterectomies while all the 10 vaginal hysterectomies were on account of utero-vaginal prolapse. Majority 41(62.1%) had bilateral salpingo-oophorectomy. The age range was between 20 and 76 years while the parity was between 0 and 14.There was no statistically significant difference between the age of the subjects and the indications for the hysterectomy (P=0.66).However, there was statistically significant difference between the type of hysterectomy (abdominal or vaginal) and the morbidity rate (P=0.009).The overall morbidity rate in this review was 17(25.8%) with haemorrhage accounting for most (n=10; 59%) of the total morbidities. Fifty per cent (50%) of the morbidity in the vaginal route were urinary tract injuries. There was no mortality directly related to hysterectomy .during the period of the study.
Conclusion: Hysterectomy is a common major Gynaecological surgery in this center and the common indications are uterine fibroid and utero-vaginal prolapse. It is a relatively safe procedure. However, it is apparent from this study that there is need to train resident doctors on vaginal hysterectomy to minimize complications of bladder and ureteric injuries seen with vaginal hysterectomy in this study.
Keywords: Hysterectomy, Gynaecological condition, indication, Morbidities
References
111. Centers for Disease Control and Prevention Website, Key Statistics from the National Survey of Family Growth, Atlanta, GA: Centers for Disease Control and Prevention 2015. Retrieved on May 15, 2016 from: http://www.cdc.gov/nchs-/nsfg/key_statistics/h.htm#hysterectomy.
2. Ikram M. Abdominal versus vaginal hysterectomy: An audit. Professional Med J 2008; 15(4); 486-491
3. Desai S, Sinha T, Mahal A. Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India. Reprod Health Matters. 2011; 19 (37):42–51. [PubMed]
4. Okogbenin SA, Gharoro EP, Otoide VO, Okonta PI. Obstetric hysterectomy: Fifteen years’ experience in a Nigerian tertiary centre. J Obstet Gynaecol 2003; 23: 356.
5. Okafor CI, Ukanwa U, Nwankwo ME, Ezeigwe CO. Review of Gynaecological Hysterectomies in a Private Specialist Hospital in Nigeria. Orient Journal of Medicine 2012; 24: 3-4.
6. Ahmed, Z. and Taiwo, N. Indications and Outcome of Gynaecological Hysterectomy at Aminu Kano Teaching Hospital, Kano: A 5-Year Review. Open Journal of Obst-etrics and Gynecology 2015; 5: 298-304.
7. Bukar M, Audu B M, Yahaya U R. Hysterectomy for benign gynaecological conditions at Gombe, north eastern Nigeria. Niger Med J 2010; 51:35-8.
8. , , , , , . Effectiveness of hysterectomy. Obstet Gynecol 2000;95:319-326
9. Wright, JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS et al. “Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States.” Obstet Gynecol. 2013; 122 (2 Pt 1): 233–241.
10. Geidam DA, Audu BM, Bukar MB. Morbidity of total abdominal hysterectomy at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Niger J Med 2010; 9(4):467-70.
11. Ezenwafor G and Jimoh AG. Abdominal Hysterectomy at the University of Ilorin Teaching Hospital, Ilorin-A 5-year Review. Nigerian Hospital Practice 2007;1(2):45-49.
12. Magon N, Divakar H, and Kriplani A, “Editorial: the use, misuse, and abuse of hysterectomy,” J Midlife Health 2013; 4(1).View at Google Scholar.
13. Mukhopadhya N and Manyonda I, “The hysterectomy story in the United Kingdom,” J Midlife Health 2013; 4(1), 40–41.
14. Pandey D, Sehgal K, Saxena A, Hebbar S, Nambiar J, and Bhat RG.An Audit of Indications, Complications, and Justific-ation of Hysterectomies at a Teaching Hospital in India. Int J Reprod Med. 2014; 279273. Published online 2014 January. Accessed at http://europep-mc.org/search. Accessed on 12th June, 2016.
15. James, G. and Isiugo-Abanihe, U.C. Adolescents’ Reproductive Motivations and Family Size Preferences in North-Western Nigeria. Asian Journal of Medical Sciences 2010; 2(5): 218-226.
16. Obilahi A, Ibrahim IA, Omoregie OB. Hysterectomy in the Niger Delta of Nigeria: A Clinical Study of Indications and Outcome. Greener Journal of Medical Sciences 2013; 3 (5): 160-165
17. Daru PH, , Magaji A, Nyango D, Karshima J, Pam IC, Shambe I. Vaginal Hysterectomy at Jos University Teaching Hospital, Jos, Nigeria. J West Afr Coll Surg 2011; 1 (3):26-36.
18. ACOG Committee Opinion. Number 311, April 2005. Appropriate use of laparosco-pically assisted vaginal hysterectomy. Obstet Gynecol.2005; 105:929-30.
19. Leung PL, Tsang SW, Yuen PM. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. Hong Kong Medical Journal. 2007; 13 (3):187–193.
20. Okeke TC, Ikeako LC, and Ezenyeaku CCT. ”Under exposure of Residents in Training in the art of Vaginal Hystere-ctomy in Nigeria.” American Journal of Clinical Medicine Research.2014; 2(1) 22-25.
21. Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstetrics and Gynecology. 2000; 95 (2):199–205. [PubMed]
22. Butt JL, Jeffery ST, Van Der Spuy ZM. An audit of indications and complications associated with elective hysterectomy at a public service hospital in South Africa. International Journal of Gynecology and Obstetrics. 2012; 116 (2):112–116. [PubMed].
23. Anzaku AS, Musa J . Total abdominal hysterectomy for benign gynaecological conditions at a University Teaching Hospital in Nigeria. Niger J Med.2012; Jul-Sep; 21 (3):326-30.
24. Kawuwa MB, Mairiga AG, Audu BM. Indications and complications of hysterectomy in Maiduguri, North Eastern Nigeria. Kanem Journal of medical sciences. 2007; 1(1): 20-25.
25. Doyen Cited in Green-Armytage VB. Vaginal hysterectomy: new technique-follow-up of 500 consecutive operations. J. Obstet Gynaecol Br. Empire 1939; 46: 848-856.