THE OUTCOME OF SUBTOTAL ABDOMINAL HYSTERECTOMY

OBJECTIVE: To determine the effect of subtotal abdominal hysterectomy in conditions of intraoperative and postoperative complications in women with benign uterine conditions. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The sheikh zyed women hospital Chandka medical college, Shaheed Mohtarma Benazir Bhutto medical University Larkana from March, 2008 to February, 2009. PATIENTS AND METHODS: The study included 60 women, who underwent subtotal abdominal hysterectomy due to benign uterine diseases. Patients over 60 years of age, suspected cancer of cervix and uterine prolapse were excluded. Inclusion criteria were dysfunctional uterine bleeding, menorrhagia and repeated pelvic infection refractory to medical treatment, fibroid uterus and ovarian cyst with adenomyosis of uterus. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out. Subtotal hysterectomy was performed by clamp-cut and ligate manner. 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 15 (25%) cases, dysfuntional uterine bleeding in 18(30%), pelvic pain and menorrhagia in7(11.6%), ovarian cyst with adenomyosis in 12(20%). It seems to be that pelvic infections refractory to medical treatment in 8(13.4%) cases. Intraoperatively 5 (8.3%) had difficulty to separate the bladder and there was no injury to adjacent vicera during the procedure .Early complications like temperature was noted in 5(8.3%) and late complications like cyclical menstrual bleeding in 1 (1.6%) and vaginal discharge in 3(5%) patients. All patients were followed-for 3 and 6 monthly up to 1 year. There was no mortality connected with the procedure. The urinary, sexual and bowel functions were found to be unaffected during that period. The histopathology of specimen exposed fibroid and 2 nd most was adenomyosis to be the commonest pathology. CONCLUSION: The subtotal abdominal hysterectomy concluded less operative time, rapid recovery, some number of short-term complications while infrequently caused cyclical bleeding and vaginal discharge.