Objectives

1. Hysterectomy for benign gynaecological conditions: Our experience in a teaching hospital O. Olowu, T. Palamarchvk, Q. S. Naquib, N. Agarwal, F Odejinmi Department of Obstetrics and Gynaecology. Whipps Cross University Hospital, London, Uk OPTIONALLOGO HERE Barts Health NHS Trust Methods Results Objectives Conclusions • This was a retrospective cohort data analysis of all women who presented with menorrhagia and or pelvic pain that resulted to hysterectomy, from January 2008 to December 2010 in a multi-cultural community. • Patient’s characteristics, indication for hysterectomy, previous treatment(s) offered, patient counselling, provision of information leaflet, route of hysterectomy, histological findings, and post operative complications were analysed. • Patient information was extracted from the theatre database and notes. • All hysterectomies performed for suspected malignancies and vaginal prolapse were excluded. • A total of 186 women underwent hysterectomy during the 2 year period. • The median age was 45 years old. • Indication for Hysterectomy were; • A failed or combined failure of medical and mirena or ablation technique • Recurrent symptoms after myomectomy or uterine artery embolisation. • Ultrasound scan showed fibroids in 77% of cases. • Table 1 showed route of hysterectomy • A total of 48 (25%) oophorectomies were performed. • Histology reports confirmed • 78% fibroids, • 10% Adenomyosis • 12% normal uterus. • There were 5% (10) conversion rate to open hysterectomies: • Laparoscopic (3) • Vaginal (7). • There was no major complication • Twenty (11%) women required blood transfusion. • The estimated blood loss range was 800 - 2000mls • Specimen weight range from 500 to 7800 grams • Length of hospital stay range from 5 to 9 days. • Our study demonstrates that more women could be offered the laparoscopic route of surgery for benign condition such as dysfunction uterine bleeding, fibroid uterus less than 14 weeks size. • Conversion rate was higher with vaginal route secondary to fibroid uterus. • Laparoscopic approach represents the best option among possible routes for an improvement in the patient's quality of life. To assess the route of surgery as a final option in the management of women presented with menorrhagia, proportion of pre-operative treatment offered and postoperative complications • Background • Hysterectomy is the most prevalent gynaecological surgeries worldwide • Over 90% of hysterectomies are performed for benign conditions that are not life threatening but have a negative impact on quality of life • Menorrhagia is the primary indication and is not always a response to an anatomical uterine disease. • Many institutions recommend abdominal hysterectomy (AH) only when the vaginal or laparoscopic route is ruled out [1] • Scientific evidence favours Vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH), which have lower complication rates, produce less postoperative pain and shorter hospital stays, and allow a more rapid return to normal activity, thereby resulting in a better quality of life [2-4] Reference • Kovac SR. Guidelines to determine the route the route of hysterectomy. Obstet. Gynecol. 85,18–23 (1995). • SummittRL Jr, Stovall TG, Steege JF, Lipscomb GH. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates. Obstet. Gynecol. 92,321–326 (1998). • KovacSR. Hysterectomy outcomes in patients with similar indications. Obstet. Gynecol. 95,787–793 (2000). • Van den Eeden SK, Glasser M, Mathias SD, Colwell HH, Pasta DJ, Kunz K. Quality of life, health care utilization, and cost among women undergoing hysterectomy in a managed-care setting. Am. J. Obstet. Gynecol. 178,91–100 (1998). Table 1: Type of hysterectomies N=186