Elective hysterectomy: A clinicopathological review from Abha catchment area of Saudi Arabia

Abstract

Objective: To review the major indications, types and clinicopathological features of elective hysterectomy managed in our locality. Material and methods: A retrospective study of 317 consecutive patients who had elective hysterectomy performed for various indications during the study period from January 1994-December 2001,(96 months) was conducted. The patients were divided into 3 groups: Group 1, total abdominal hysterectomy(TAH) 165 (52 %); Group 2: subtotal abdominal hysterectomy(STAH) 59(18.6 %) and Group 3: vaginal hysterectomy (VH),93 (28.4 %). Data extracted from the case files included age, parity, presenting symptoms and indication for hysterectomy. Others included relevant investigation results, type of hysterectomy, and histopathological diagnosis of the specimens Setting: Abha Maternity Hospital, Abha, Saudi Arabia. Results: No statistically significant trend was found in the annual number of hysterectomies performed during the study period (p>0.05). There was statistically significant difference in the mean age in the 3 groups of patients (p<0.05), but none in the parity (p>0.05). Menorrhagia and abnormal vaginal bleeding was the indication for hysterectomy in 123(38.8 %) patients, followed by uterine prolapse in 91(28.7 %), abdominopelvic mass, 48 (15.1 %) and pelvic mass in 46 (14.8 %). Histopathology of hysterectomy specimens and appendages were reported as abnormal in 179 (56.4%), with uterine fibroids the most common pathology in 82 specimens (25.8 %) followed by adenomyosis in 72 specimens(22.7 %). Conclusion: Uterine fibroids and adenomyosis were the most common benign conditions in hysterectomy specimens in our community with peak incidence at 41-50 years, while endometrial and ovarian cancers peaked at the same age group. At the same time, vaginal hysterectomy was performed exclusively for utero-vaginal prolapse.