The outcome of subtotal abdominal hysterectomy.

OBJECTIVE: To determine the outcome of subtotal abdominal hysterectomy in terms of intraoperative and postoperative complications in women with benign uterine conditions. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Jinnah Medical and Dental College and Hospital, Karachi from March, 2003 to March, 2004. PATIENTS AND METHODS: The study included 50 women, who underwent subtotal abdominal hysterectomy due to technical difficulties during surgery in benign uterine diseases. Inclusion criteria were menorrhagia and pelvic pain, dysfunctional uterine bleeding, repeated pelvic infection refractory to medical treatment, fibroid uterus and ovarian cyst with adenomyosis of uterus. Patients over 60 years of age, uterine prolapse and suspected cancer of cervix were excluded. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out. Subtotal hysterectomy was performed by clamp-cut and ligate method. RESULTS: The mean age of patients undergoing hysterectomy was 44 years and parity between 4 - 10. Most common complaint was excessive menstrual loss. Fibroid was found in 10 (20%) cases, dysfuntional uterine bleeding in 15 (30%), pelvic pain and menorrhagia in 5 (10%), ovarian cyst with adenomyosis in 13 (26%) and repeated pelvic infections refractory to medical treatment in 7 (14%).There was no injury to adjacent vicera during the procedure. Early complications like temperature was noted in 5 (10%) and late complications like cyclical menstrual bleeding in 1 (2%) and vaginal discharge in 2 (4%) patients. All cases were followed-up 3 and 6 monthly and urinary, sexual and bowel functions were found to be unaffected during this period. There was no mortality associated with the procedure. The histopathology of specimen revealed fibroid followed by adenomyosis to be the commonest pathology. CONCLUSION: Subtotal abdominal hysterectomy resulted in less operative time, rapid recovery, fewer short-term complications but infrequently caused cyclical bleeding and vaginal discharge.