Vaginal hysterectomy as the primary approach in managing benign gynaecological conditions: a review of local practice

Abstract

Background: Hysterectomy is the commonest major gynaecological surgery performed. Traditionally this has been done abdominally, although the vaginal route could confer more benefits if well performed.

Objective: To determine the outcome of vaginal hysterectomies done at the Kapenguria County Hospital in West Pokot County, Northern Kenya.

Methods: A cross sectional study was undertaken between May 2013 and August 2016. A total of 50 vaginal hysterectomies were revised during this period.

Results: Approximately 40% of all hysterectomies were performed vaginally. More than half of these patients were aged 36 to 45 years. The indications for surgery were symptomatic uterine fibroids (36%), adenomyosis (20%) and uterine prolapse (24%). In more than half of the patients (54%) of the patients, the uterus was palpable above the sypmphisis pubis. There were 4 patients with peri-operative complications; 2 fistulas, 1 torn ovarian pedicle and one laparotomy. None of the patients required post-operative blood transfusion. Total hospital stay was 48 hours post-surgery in 78% of the patients.

Conclusion: Vaginal hysterectomy reduced patient morbidity, reduced hospital stay and was cost effective. We concluded that although the use of vaginal hysterectomy is unpopular in Kenya, the technique would improve surgical outcomes in public hospitals.

Keywords: Vaginal hysterectomy, Hysterectomy outcomes, Abdominal incision free hysterectomy