Major gynaecological surgery in the Ghanaian adolescent

Abstract

Objective: To determine the indications for, findings, procedures performed and outcomes in major gynaecological operations performed on patients nineteen years old or younger. Design: Retrospective observational study. Setting: Korle Bu Teaching Hospital, Accra, Ghana. Subjects: Cases of major gynaecological surgery in patients aged 19 years or younger in a six-year period. Results: There were 245 patients, whose mean age was 17.3(SD 1.7) years. Sixty eight (27.8%) were less than seventeen years old and 177(72.2%) were 17-19 years old. Ruptured ectopic pregnancy, ovarian tumour, pelvic abscess and perforated uterus constituted 91% of indications. Ruptured ectopic pregnancy was confirmed in 106(43.3%), most of whom had salpingectomy performed. Five (13.9%) of 36 ovarian tumours were malignant, all in advanced stages of disease. Thirty six had pelvic abscesses; another 29 had uterine perforations, twelve of whom had hysterectomy performed. Five patients had congenital developmental anomalies of the genital or urinary tract. Non concordance between pre- and post-operative diagnoses occurred in 29(11.8%). Mean duration of post-operative hospital stay was 13.0(SD 8.9) days and the mortality rate was 3.8%. One hundred and eighty four (75.1%) of post-operative diagnoses were related to sexual activity or pregnancy. Conclusion: Most of the gynaecological problems requiring major surgery in the Ghanaian adolescent may be prevented by adequately addressing issues regarding adolescent sexuality. Sex education, as part of family life education, should be incorporated into the school curriculum. This should aim at providing appropriate level of knowledge and promoting the development of attitudes and skills that will lead to the adoption of desired behaviours.