Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a Teaching Hospital in Peshawar, Pakistan

Objective: To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients.

Methodology: As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1st January, 2010 and 1st Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present.

Results: A total of 123 hysterectomies were performed during this period. Eleven (8.9%) patients’ results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88 (71.5%) patients, vaginally in 35 patients (28.4%). The most common indication for hysterectomy was fibroid related menorrhagia n=40(32.5%), followed by third degree uterovaginal prolapse n=30(24.4%), and dysfunctional uterine bleeding 29(23.6%) patients. Fever was the most common 7(5.7%) post operative complication followed by urinary tract infection 5(4.9%) The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy (P=0.370).

Conclusion: Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints (p=0.000) and were confirmed by histopathogic findings (p=0.000). Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse.