Hysterectomy in practice: a cross-sectional insight into indications incidence and surgical approaches

Shreya H. Phafat; Tushar T. Palve; Rajashree Thatikonda; Vijaymala S. Sherkhane

doi:10.18203/2320-1770.ijrcog20253081

Authors

Shreya H. Phafat Department of Obstetrics and Gynecology, Grant Government Medical College & J. J. Hospital, Mumbai, Maharashtra, India
Tushar T. Palve Department of Obstetrics and Gynecology, Grant Government Medical College & J. J. Hospital, Mumbai, Maharashtra, India
Rajashree Thatikonda Department of Obstetrics and Gynecology, Grant Government Medical College & J. J. Hospital, Mumbai, Maharashtra, India
Vijaymala S. Sherkhane Department of Obstetrics and Gynecology, Grant Government Medical College & J. J. Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253081

Keywords:

Hysterectomy, Uterine fibroid, Vaginal hysterectomy, Abdominal hysterectomy, Laparoscopic hysterectomy, Abnormal uterine bleeding

Abstract

Background: Hysterectomy is the second most commonly performed surgical procedure among women, following cesarean section. It is indicated for a variety of benign and malignant gynecological conditions. The choice of indication, surgical route, and associated outcomes varies significantly across clinical and demographic contexts. This study aims to evaluate the clinical patterns of hysterectomy performed at a tertiary care center over six months, with a focus on patient age, common indications, surgical approach, and the requirement for blood transfusion.

Methods: A retrospective, observational study was conducted in the Department of Obstetrics and Gynecology at Cama and Albless Hospital, Mumbai, in which latest fifty patients who underwent elective hysterectomy were included, based on defined inclusion and exclusion criteria. Data regarding patient demographics, indications, surgical routes, and intraoperative details were collected and analyzed using descriptive statistics.

Results: Among 50 patients, the most common age group was 36-45 years (50%). Abnormal uterine bleeding was the leading indication (60%), followed by uterine fibroids (32%) and uterovaginal prolapse (14%). The abdominal route was used in 52% of cases, while 28% underwent vaginal hysterectomy and 20% underwent laparoscopic hysterectomy. Blood transfusion was required in only 12% of patients.

Conclusions: Hysterectomy remains a significant gynecological intervention, most commonly indicated for abnormal uterine bleeding. It should be approached judiciously, with an emphasis on conservative and fertility-preserving alternatives where appropriate. When surgical intervention is necessary, the vaginal or minimally invasive route should be preferred whenever feasible.

Metrics

Metrics Loading ...

References

Einarsson JI, Matteson KA, Schulkin J, Chavan NR, Sangi-Haghpeykar H. Minimally invasive hysterectomies: a survey on attitudes and barriers among practicing gynecologists. J Minim Invasive Gynecol. 2010;17(2):167-75. DOI: https://doi.org/10.1016/j.jmig.2009.12.017

Sharma C, Sharma M, Raina R, Soni A, Chander B, Verma S. Gynecological diseases in rural India: a critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery. J Midlife Health. 2014;5(2):55-60. DOI: https://doi.org/10.4103/0976-7800.133988

Ayala-Yáñez R, Olaya-Guzmán EJ, Haghenbeck-Altamirano J. Robotics in gynecology: why is this technology worth pursuing? Clin Med Insights Reprod Health. 2013;7:71-7. DOI: https://doi.org/10.4137/CMRH.S10850

Yakasai IA. Complications of hysterectomy: a review. Br J Sci. 2013;9(2):78-87.

Farquhar CM, Sadler L, Harvey SA, Stewart AW. The association of hysterectomy and menopause: a prospective cohort study. BJOG. 2005;112(7):956-62. DOI: https://doi.org/10.1111/j.1471-0528.2005.00696.x

Desai S, Sinha T, Mahal A. Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India. Reprod Health Matters. 2011;19(37):42-51. DOI: https://doi.org/10.1016/S0968-8080(11)37553-2

Medhi P, Dowerah S, Borgohain D. A histopathological audit of hysterectomy: experience at a tertiary care teaching hospital. Int J Contemp Med Res. 2016;3(4):1226-8.

Pandey D, Sehgal K, Saxena A, Hebbar S, Nambiar J, Bhat RG. An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India. Int J Reprod Med. 2014;2014:279273. DOI: https://doi.org/10.1155/2014/279273

Sawke NG, Sawke GK, Jain H. Histopathology findings in patients presenting with menorrhagia: a study of 100 hysterectomy specimens. J Midlife Health. 2015;6(4):160–3. DOI: https://doi.org/10.4103/0976-7800.172299

Rather GR, Gupta Y, Bardhwaj S. Patterns of lesions in hysterectomy specimens: a prospective study. JK Sci. 2013;15(2):63–8.

Singh A, Arthur B, Agarwal V. LEEP versus cryotherapy in CIN. J ObstetGynaecol India. 2011;61(4):431–5. DOI: https://doi.org/10.1007/s13224-011-0048-1

Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease (Cochrane Review). Cochrane Database Syst Rev. 2006;(2):CD003677. DOI: https://doi.org/10.1002/14651858.CD003677.pub2

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 311: Appropriate use of laparoscopically assisted vaginal hysterectomy. Obstet Gynecol. 2005;105(4):929–30. DOI: https://doi.org/10.1097/00006250-200504000-00059

Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, et al. Evaluate Hysterectomy Trial: a multicenter randomized trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess. 2004;8(26):1–154. DOI: https://doi.org/10.3310/hta8260

Stovall TG. Hysterectomy. In: Berek JS, editor. Berek and Novak’s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 805–22.

Khandelwal K, Kabra SL, Ahmad SN, Mitra S. A comparative evaluation of clinical outcome of transabdominal hysterectomy, total laparoscopic hysterectomy and vaginal hysterectomy in non-descent cases. Int J ReprodContraceptObstet Gynecol. 2017;5:2346–51. DOI: https://doi.org/10.18203/2320-1770.ijrcog20162125

Bala R, Devi Pratima K, Singh CM. Trend of hysterectomy: a retrospective analysis in RIMS, Imphal. Int J GynaecolObstet India. 2013;29(1):4–7. DOI: https://doi.org/10.4103/0972-4958.158917

Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95–114. DOI: https://doi.org/10.2147/IJWH.S51083

Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–86. DOI: https://doi.org/10.1093/humupd/dmw023

Ranjan P, Saxena R, Bhattacharya S. Socioeconomic and geographic disparities in hysterectomy prevalence among Indian women: A national cross-sectional analysis. Indian J Public Health. 2022;66(3):256–60.

Gupta A, Kaur J, Verma R. Artificial intelligence in gynecology: emerging applications in surgical planning and risk prediction. J ObstetGynaecol India. 2023;73(1):15–20.

Deshmukh SP, Patil M, Kale S. Barriers to adoption of minimally invasive gynecologic surgery in public healthcare settings: a qualitative study from India. Int J Reprod Contracept Obstet Gynecol. 2023;12(5):1342–7.