Current trends in hysterectomies at a Nigerian tertiary center

Objective: The aim of this work was to determine the current indications, outcomes, and complications of gynecologic and peripartum hysterectomies in a Nigerian tertiary hospital. Design: A 5-year retrospective study of women managed at Nnamdi Azikiwe University Teaching Hospital (Nnewi, Nigeria) between January 1, 2002 and December 31, 2006 who had hysterectomies for gynecologic and obstetric indications. Methods: The theater, ward, and histopathologic records and case notes of all women who had hysterectomy from 2002 to 2006 were retrieved, and sociodemographic characteristics, indications, complications, route, types, and grades of surgeons were retrieved and analyzed. chi-square and the Student's t-test at the 95% confidence level were used for analysis. Results: In total, 72 hysterectomies were performed during this period. Overall, 10 cases were peripartum hysterectomies, with an incidence of 0.38%. Further, 54 (74.9%) were abdominal hysterectomies, while 18 (25.1%) were vaginal hysterectomies. Subtotal abdominal hysterectomies were done in 12.9% of the abdominal cases. Residents did most of the subtotal hysterectomies. The most common gynecologic indications for the operation were uterine fibroid 24 (38.7%) and uterovaginal prolapse 18 (30.29%). Postpartum hemorrhage from uterine atony 7 (70%) and ruptured uterus 3 (30%) were the major indications for peripartum hysterectomy. Uterovaginal prolapse was the only indication for vaginal hysterectomy. More complications occurred with abdominal hysterectomy. The more common complications were anemia (39; 54.4%) and postoperative hemorrhage (20; 27.8%). The mean duration of hospital stay was 8.82 + 2.46 days. The mortality rate was 4.2%. Conclusions: Hysterectomy is a major gynecologic operation. More cases of hysterectomy should be performed vaginally, considering the numerous benefits it has over the abdominal route. (J GYNECOL SURG 26:7)