A Review of indications and outcome of total abdominal hysterectomy at a tertiary public health facility in Southern Nigeria

Objective: Ours' is a major referral center in southern Nigeria which now offers an organized cervical cancer screening and treatment program. Total abdominal hysterectomy is a commonly performed procedure in this center, and this study is aimed at ascertaining its frequency, indications, and safety in line with current reproductive health best practice. Methodology: A descriptive study of consecutive patients who had total abdominal hysterectomy for various benign and malignant indications during the period from January 2009 to December 2013 was conducted. Data extracted from the case files included age, parity, indications for surgery, and postoperative complications. Data were analyzed using Computer Programs for EPIdemiologist (PEPI) and presented in frequency tables. Results: Total abdominal hysterectomy accounted for 13.4% of all major gynecological operations. Majority of the women were in their fifth decade of life (88.5%) and parity of 5 and above (50%). The most common indications were uterine fibroids (50.4%) and cervical intraepithelial neoplasia (17.1%). Postoperative morbidity was recorded in 46 (18.3%) cases, and these were significantly more in premalignant/malignant cases (P < 0.05). The most common postoperative complications were pyrexia (9.5%), wound infection (7.5%), and anemia (6.3%). There was no mortality. Conclusion: Total abdominal hysterectomy is a common procedure in this center; we can hypothesize that the triad of uterine fibroids, age ≥45, and a high parity increases its likelihood in this center. While the most common indication still remains uterine fibroids, we also note increasing cases of hysterectomy for cervical dysplasia/malignancy (courtesy cancer screening services). Although not complication free, overall the procedure is relatively safe and should be offered to selected patient as appropriate.