Comparative study on specimen of Hysterectomy

Background: Hysterectomy is by far most common gynecological procedure. It is performed in our country for more or less similar indication as those performed in advanced countries. Sometimes clinical diagnosis does not correlate with histopathological findings. Objective: To find out the common indication of hysterectomy in tertiary level hospital, to detect the patterns of clinical presentation and to find out the correlation between pre and per operative findings with histopathology reports of specimen. Method: This is a cross sectional type of comparative study which was carried out on 150 cases from January 2013 to October 2013 in inpatient department of CMH Dhaka. Cases were randomly selected who were admitted for operative treatment. Result: The incidence of total abdominal hysterectomy was 73.33% and vaginal hysterectomy 26.67%. Highest incidence observed among the age group 35-40 year which was 46.66% in the study. The commonest indication of abdominal hysterectomy was Leiomyoma uterus 42.73% and most common symptom was Menorrhagia which was about 44.67% in the study. Leiomyoma uterus hispathologically correlated about 91.49% with clinical diagnosis. During examination it was found that least correlated diagnosis were DUB and PID respectively 70.83% and 73.33%. Ovarian tumor, CIN and chronic cervicitis correlated 100%. In this study, clinical diagnosis, pre-operative finding similar with histopathology finding in 86.36%. Conclusion: The indication of hysterectomy in any case must be clearly defined and should be done for which conservative treatment is not likely to be efficacious. But advent of conservative treatment like ablation, mirena IUS are as effective as hysterectomy which can offer the young age group of 35-40 year. Keyword: Hysterectomy, Histopathology Corresponds to: Lt Col Amena Begum, Gynaeocologist Border Guard Hospital E-mail: amena_lipi@yahoo.com 1. Lt Col Amena Begum, Gynaeocologist Border Guard Hospital 2. Col Rokeya Khan, Gynecologist, CMH, Dhaka 3. Dr. Nazlima Nargis, Associate Professor, Gynae and obs, ISMC Introduction Hysterectomy is the complete removal of uterus. When this is done through an abdominal incision it is called abdominal hysterectomy. When the approach is through vaginal vault it is called vaginal hysterectomy. Hysterectomy is a major gynecological operative procedure, commonly indicated for women with dysfunctional uterine bleeding, uterine leiomyoma, prolapse, endometriosis and adenomyosis, pelvic pain, premalignant condition and cancer1. Hysterectomy is the forth most common operation in the western world, with about 6,50,000 being performed annually in the USA, of which 70% are performed abdominally and 30% by the vaginal route2. The vaginal route has increasingly become the method of choice for hysterectomy. Contraindication of vaginal hysterectomy was usually considered as nulliparity, history of pelvic surgery and excessive uterine size. These criteria have greatly impeded the use of vaginal route and supported a high frequency of abdominal and laparoscopically assisted hysterectomy in women without prolapse3. The improved hospital care, availability of blood transfusion, advanced anesthesia and above all the advent of antibiotics has opened up a new era and there by broadened the indications for hysterectomy with minimum post operative morbidity and mortality. However hysterectomy must never be done without proper indication. According to Taylor, hysterectomy should be done when the risk Bangladesh Journal of Medical Science Vol. 15 No. 03 July’16. Page : 352-356


Introduction
Hysterectomy is the complete removal of uterus.When this is done through an abdominal incision it is called abdominal hysterectomy.When the approach is through vaginal vault it is called vaginal hysterectomy.Hysterectomy is a major gynecological operative procedure, commonly indicated for women with dysfunctional uterine bleeding, uterine leiomyoma, prolapse, endometriosis and adenomyosis, pelvic pain, premalignant condition and cancer 1 .Hysterectomy is the forth most common operation in the western world, with about 6,50,000 being performed annually in the USA, of which 70% are performed abdominally and 30% by the vaginal route 2 .
The vaginal route has increasingly become the method of choice for hysterectomy.Contraindication of vaginal hysterectomy was usually considered as nulliparity, history of pelvic surgery and excessive uterine size.These criteria have greatly impeded the use of vaginal route and supported a high frequency of abdominal and laparoscopically assisted hysterectomy in women without prolapse 3 .The improved hospital care, availability of blood transfusion, advanced anesthesia and above all the advent of antibiotics has opened up a new era and there by broadened the indications for hysterectomy with minimum post operative morbidity and mortality.However hysterectomy must never be done without proper indication.According to Taylor, hysterectomy should be done when the risk of preserving the uterus is greater than the risk of removal or when there are disabling symptoms for which, there are no successful medical treatment.Vaginal hysterectomy is advantageous over abdominal hysterectomy in removing uterus weighing <500gm with comparable operating time, less post operative pain and shorter recovery LAVH showed a shorter recovery longer operating time than TAH and a 27% rate of conversion to laparotomy 4 .In our country, hysterectomies are performed for more or less similar indication as those performed in advance countries, the only difference being in the evaluation of the patient pre-operatively.We have to diagnose the cases more on the clinical ground rather than modern investigations because of the limited facilities and economical constraint.Even in the clinical assessment there are considerable problem as the patients are mostly illiterate and ignorant.They do not understand the gravidity of their symptoms, often attend the doctor late and can not explain their problems without leading questions.As a result the finding often does not correlate with their complaints.
The study has been undertaken to find out the common indications of hysterectomy in our country, to detect the patterns of clinical presentation and to find out the correlation between pre and per-operative findings with histopathology reports of the 150 case studied.

Data analysis:
Data analysis were done using SPSS programme in computer.

Aim and objective
General: • To study the pre-operative presentation and per-operative findings of the cases undergoing hysterectomy operation.And to correlate there findings with those of histopathology Specific: • To enroll the cases admitted for hysterectomy operation.
• To study the pre operative presentation of these cases.
• To record the per-operative findings of these cases.
• To record the histopathological diagnosis of these cases.

Conclusion
The indication of hysterectomy in any case must be clearly defined and should be done for which more conservative treatment is not likely to be efficacious.It should not be performed merely at the request as demand of the patient.It should be the last resort.
For women with severe pelvic pain or irregular periods, dysmenorrhoea etc. hysterectomy is a blessing to them as it removes the diseased organ and their entire symptoms are alleviated.
While performing hysterectomy the patient should be counseled properly about the consequences of such procedure, then they accept the cessation of menstruation as normal.Otherwise new complain will arise and the success of operation is to some extent rendered fruitless.
Several recent therapies such as endometrial ablation with endoscopic technique, myoma coagulation or embolo therapy have been introduced.They are advantageous thus; the need for hysterectomy is declining.All these procedure are alternative to hysterectomy.But where salpingo -ophorectomy is intended, hysterectomy is the choice of treatment.Abdominal hysterectomy could be replaced by vaginal hysterectomy with or without laparoscopic assistance in a number of cases, if there is no contraindication of vaginal hysterectomy, LAVH are advantageous by short period of convalescence and early ambulation.Vaginal hysterectomy is least costly and for LAVH, the indirect cost is less.

Methodology • Study design: Cross sectional study • Study place: CMH, Dhaka. • Study period: Jan
(b) Patients undergoing hysterectomy due to CIN, carcinoma in-situ, ovarian malignancy and uterine malignancy.• Exclusion criteria: (a) Patients undergoing radical hysterectomy for

Table - I
: Indications of hysterectomy

•
To correlate the pre operative and per operative findings with the findings of histopathology

Table IV :
Comparison between clinical diagnosis and histopathology findings: (n=150)

Table III :
Comparison between clinical diagnosis and histopathology findings: (n=150)