Hysterectomies in the United States

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020

Background: Diseases of the female genital tract are commonly encountered in clinical practice. Hysterectomy is the definite treatment for many of the pelvic pathologies. The present study is aimed at analysis of age and types of hysterectomy and evaluation of histopathological reports of the hysterectomy specimens.Methods: A total of 476 consecutive hysterectomy were studied over a period of two years from January 2016 to December 2017.Results: The peak age group of hysterectomy was 41-50 years with 221 (46.43%) cases. The commonest type of hysterectomy was abdominal. The most common endometrial pathology was atrophic endometrium, seen in 131 (27.52%) cases. In myometrium, the most common pathology was leiomyoma in 179 (37.61%) cases. Among cervical lesions, chronic cervicitis was the most common finding, seen in 274 (57.56%) cases.Conclusions: The experience with various types of hysterectomies at our institution has been reviewed. A wide spectrum of lesions were observed when his...

Asian Journal of Pharmaceutical and Clinical Research , 2024

Objectives: To study the age distribution, indications, modes of hysterectomy, concurrent surgery done along with hysterectomy, and histopathological analysis of hysterectomized specimens. Methods: This study was conducted in the Department of Obstetrics and Gynecology, Mediciti Institute of Medical Sciences, a tertiary teaching hospital at Medchal. Medical records of 240 cases of hysterectomy performed from January 2015 to December 2021 were retrieved from the Medical Record Department. The age distribution, indications of hysterectomy, mode of hysterectomy, concurrent oophorectomy, and histopathological reports of hysterectomy specimens were analyzed in this study. Results: Out of the total 240 hysterectomies, 51.25% were in the age group of 40-49 years, followed by the age group of 50-59 years, i.e., 19.5%. Common indications for hysterectomy were AUB (36.25%), fibroids (34.58%), and UV prolapse (29.16%). Abdominal hysterectomy (62.5%) was performed more commonly than vaginal hysterectomy (29.16%). Histopathological analysis showed the most common pathologies as atrophic endometrium, leiomyoma in the myometrium, and inflammation in the cervix. Concurrent bilateral oophorectomy was done in 51.66%, unilateral oophorectomy was done in 10%, and ovaries were conserved in 38.33%. Conclusion: Hysterectomy is a common major gynecological surgery performed, most commonly in the perimenopausal age group. Although there is an increased trend toward the laparoscopic route, the abdominal route is still the preferred route. Leiomyoma is the most common pathology found in hysterectomized specimens. AUB being the most common indication for hysterectomy, there should be increased use of medical management, and patients should be counseled for conservative management in order to prevent increased surgical interventions.

Cureus, 2020

Introduction Hysterectomy is a common surgical procedure in women, and oophorectomy may also be performed with the hysterectomy. The objective of this study was to identify clinical indications and pathological findings in hysterectomies, performed for gynecological causes, in women of reproductive age (15-49 years) and to determine if oophorectomy or ovarian conservation was performed with the hysterectomy as well as the pathological findings in the ovaries. Methods This cross-sectional study was conducted in the department of Pathology at Dow Medical College in Karachi, Pakistan, from September 2017 to December 2018. Data were recorded from the pathology reports of hysterectomy specimens received in the department. Data of hysterectomies performed for gynecological causes in women of reproductive age group were selected and analyzed, using Microsoft Excel (Microsoft, Redmond, Washington) and SPSS version 20 (IBM Corp., Armonk, New York). Data of women more than 49 years and obstetric hysterectomies were excluded. Results Three hundred sixty-one hysterectomies were received; 157 of which were hysterectomies performed in women of reproductive age for gynecological reasons. The mean age of the women was 40.37 (± 5.47) years. Abnormal uterine bleeding was the most frequent clinical indication for hysterectomy in 81 (51.59%) women, followed by uterine prolapse in 29 (18.47%) and leiomyoma in 22 (14.01%). Common pathologies in the endometrium were endometritis in 14 (8.92%) and endometrial polyp in nine (5.73%). In the myometrium, leiomyoma was reported in 52 (33.12%) cases, adenomyosis in 37 (23.57%), and both leiomyoma and adenomyosis in 37 (23.57%) women. Uterine prolapse was histologically identified in 38 (24.20%) women. Oophorectomy was performed on 107 (68.15%) women, and out of these, 83 (77.59%) women's ovaries showed either normal histology or functional cysts. Ovarian pathologies reported were endometriosis, serous cystadenomas and oophoritis in five patients each (4.81%), ovarian serous carcinoma in three (2.88%), and mucinous carcinoma in one (0.96%) patient. Conclusion Abnormal uterine bleeding was the most common clinical indication for hysterectomy in women of reproductive age. The common pathologies in the hysterectomies were endometritis, endometrial polyp, leiomyoma, adenomyosis, and uterine prolapse. Most of the ovaries removed with the hysterectomy did not show any significant pathology, therefore, further studies in this direction are recommended for confirmation of this finding. Ovarian conservation may be considered in women undergoing hysterectomy for abnormal uterine bleeding or other uterine causes and with no radiological or surgical indication for oophorectomy.

Scholars International Journal of Obstetrics and Gynecology, 2021

Background: Hysterectomy is the removal of the uterus with or without cervix. 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 bleeding, uterine leiomyoma, prolapse, endometriosis & adenomyosis, pelvic pain, premalignant conditions and cancer. Objective: The purpose of the study was to find out the common indications of hysterectomy. Methods: The Study was conducted in the department of obstetrics and gynaecology of Dhaka Medical College Hospital, Dhaka, Bangladesh to find out the common indications of hysterectomy. 100 cases were randomly selected for the study whose common indication of hysterectomy. Clinical examination and evaluation were done from October 2004 to February 2005. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Majority of cases who underwent hysterectomy were 31-40 years (52%) of age. Out of 100 cases most of patients (70%) underwent abdominal hysterectomy and only 30 (30%) cases underwent vaginal hysterectomy. Out of 33 cases, clinically diagnosed as leiomyoma of the uterus histopathology revealed leiomyoma in 24 cases. In uncomplicated abdominal and vaginal hysterectomy, the duration of surgery was almost same, vaginal hysterectomies needs slightly longer time. Average hospital stay after operation was same. Conclusion: For a woman with severe pelvic pain or heavy irregular periods a hysterectomy often means relief from troublesome symptoms. Hysterectomy is offered as a definitive treatment and is associated with high level of satisfaction.

Journal of South Asian Federation of Obstetrics and Gynaecology, 2021

Aim: To study the indications and clinical profile of patients undergoing hysterectomy in Jawaharlal Nehru Institute of Medical Sciences (JNIMS). Materials and methods: A chart review of 132 hysterectomy cases in JNIMS, from January 2016 to January 2017, was done. Peripartum hysterectomy was excluded. The data regarding age, parity, indications of hysterectomy, length of hospital stay (LOHS), and additional surgical procedures were collected and analyzed. Results: Age distribution ranged from 34 to 73 years. The most common age-group was 41 to 50 years (57 patients, 43.18%), and multiparas (>2 parity) had maximal rate (68 patients, 51.52%) of hysterectomies. The most common indication for hysterectomy was abnormal uterine bleeding (AUB) (56 patients, 4242%). The abdominal route (75.76%) was more common than the vaginal route (23.48%) and minimal access surgery (MAS) (0.76%). Eighty-seven patients (65.91%) underwent bilateral salpingo-oophorectomy. The most noted frequency of hospital stay was 4 days (29 patients, 21.97%). Eleven appendectomies and one cholecystectomy were done as an additional surgical procedure. Conclusion: Nondescent vaginal hysterectomy (NDVH) is an established safe surgical procedure but such route is lesser used. The reason may be due to less exposure to such a procedure. Additional surgical procedure is an advantage in the abdominal route, but studies of the plausible risks that may be associated with such procedures are also lacking. The impact of preservation of the ovary is also a lesser-explored area. Hysterectomy seems to be the first option in treatment where resources are limited. It is time to review our approach to benign conditions before considering surgery as the first option. Clinical significance: Symptomatic relief is palpable by hysterectomy, but lack of studies involving the impact of hysterectomy, for example, psychological, social, economical, etc., is a cause of concern. More prospective data comparing indications of hysterectomy with its impact may be helpful in streamlining absolute indications, and patients may be benefitted from the adverse effects of surgical interventions.

Human Reproduction, 2009

background: In Finland, the number of hysterectomies during one decade has decreased by 34%. The national prospective FINHYST study in 1996 showed abdominal hysterectomy (AH) as being most common: 58%. In Finland since 2002, vaginal hysterectomy (VH) has been most preferred, with laparoscopic hysterectomy (LH) surpassing AH in 2005. methods: FINHYST 2006 is a national prospective hysterectomy study in which all hospitals collaborated from 1 January to 31 December 2006. Questionnaires, completed by gynaecologists, covered their experience, patient characteristics and surgical data.

Human Reproduction, 2001

BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed ≤30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies.

Journal of Minimally Invasive Gynecology, 2014

OBJECTIVE: We sought to analyze use of alternative treatments and pathology among women who underwent hysterectomy in the Michigan Surgical Quality Collaborative.

Objective: Hysterectomy has become one of the commonest surgery, even the general surgeons are doing the surgery by the patient’s wish without surgical indication. The retrospective study was carried out in patients, who had come with complaints after hysterectomy and required admissions. Study also included referred cases of post hysterectomy. Their indications, complications, and follow up period were noted. Analysis done. Material and Methods: 75 patients study with history of hysterectomy were studied and analysed. Results: 60% of patients were operated for benign conditions which could have been treated conservatively. 20% patients had post hysterectomy ovarian tumours followed by infection, urinary symptoms, psychological disturbances and carcinoma of vault /stump accounting for 12 % each. Conclusion: Hysterectomy surgery is not the ultimate treatment for most of conditions.

Pakistan Journal of Medical and Health Sciences

Background: Hysterectomy is one of the most common gynecological surgeries regardless of the surgeon’s approach. Purpose: This study was conducted to compare three hysterectomy techniques, viz abdominal, vaginal and laparoscopic hysterectomy, in terms of their effectiveness and low post-op complications. Methods: The study's cohort included 631 women who underwent benign hysterectomies between 2018 and 2022 in tertiary care hospitals in three areas of Pakistan. The patients in Groups A, B, and C comprised 277, 43 and 311 patients, who were surgically operated by LHs, VHs, and AHs, respectively. Findings: Most of the patients with BH were of age 39-50 years and multiparous with an average weight of 71.4+15 Kg. The major (p<0.05) underlying medical conditions were endometriosis, followed by uterine bleeding, fibroids, pelvic prolapse, adenomyosis and gynecological cancer having an incidence of 44.05, 36.45, 11.88, 5.38, 1.26 and 0.95%, respectively. The AH and VH had the highes...

Clinical and Experimental Obstetrics & Gynecology, 2018

The average age of patients who underwent hysterectomy due to benign pathology, was 55 ± 12 years; minimal age: 24 years, maximum age: 90 years. Patients, who belonged to vaginal hysterectomies group, statistically, were significantly older than patients in laparoscopic hysterectomy group (p < 0.05). The main indications of hysterectomies

Journal of Nepal Medical Association

Introduction: Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. Methods: A descriptive cross-sectional study was done at a tertiary care hospital among 1912 patients who had major gynecological surgeries from January 2017 to December 2019. Ethical clearance was obtained from the institutional review committee (ref. no. ACD 935/076/077). Convenient sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. R...

Annals of Saudi Medicine, 2008

BACKGROUND AND OBJECTIVE: Hysterectomy is a common surgical procedure among women with a lifet t time prevalence of 10%. The indications and complications of this procedure have not been previously reported from a teaching institution in Saudi Arabia. We examined the indications for hysterectomy and the surgical morbidity for women undergoing hysterectomy at a university hospital in Saudi Arabia. PATIENTS AND METHODS: We reviewed the records of women who underwent hysterectomies for benign gynecological conditions between January 1990 and December 2002, at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, comparing patient characteristics, indications for hysterectomy and the rate of complications in women undergoing abdominal hysterectomy (AH) versus vaginal hysterectomy (VH). RESULTS: Of 251 women, 199 (79%) underwent AH and 52 (21%) underwent VH. An estimated blood loss of ≥500 mL occurred in 104 patients (52.3%) in the AH group and in 20 patients (38.5%) in the VH group (differt t ence not statistically significant). The most common indications for hysterectomy were uterine fibroids (n=107, 41.6%) and dysfunctional uterine bleeding (n=68, 27.1%). The most common indication for VH was uterine prot t lapse (n=45, 86.5%). The overall complication rates were 33.5%, 15.4% and 30.4% in women who underwent AH, VH and both, respectively. Intraoperative and postoperative complications occurred in 24 (9.7%) patients in the AH group and in 51 patients in the VH group (20.3%). Postoperative infection occurred in 42/199 (21.6%) in the AH group and 5/52 (9.6%) in the VH group (difference not statistically significant). CONCLUSIONS: We describe a large series of hysterectomies, which provides information for surgeons on the expected rate of complications following hysterectomy for benign conditions. We found that the rate of complit t cations was not significantly higher than other centers internationally.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Background: This retrospective descriptive cross-sectional study was aimed at determining indications, surgical outcomes, complications and challenges of elective non-oncological hysterectomies performed at a tertiary referral centre over a 2-year period (1st December 2018 to 31st December 2019).Methods: With ethical approval, the medical records of all eligible women were retrieved, reviewed and analyzed. Measures of central tendencies, frequencies and percentages were used to compute the variables.Results: During the 2-year study period, a total of 245 elective non-oncological hysterectomies were performed. The age of the women ranged from 33 to 80 years with a mean age of 49.08 years; [standard deviation (SD): 8.88]. Women in the 40-49 year-old-age group constituted the majority 55.51% (n=136/245). Main indications were multinodular fibroid uterus (without menorrhagia), fibroid uterus with menorrhagia and genital prolapse. There was no case of laparoscopic hysterectomy. Majority ...

Current Obstetrics & Gynaecology, 2006

Hysterectomy, the commonest major gynaecological operation, is the only definitive cure for dysfunctional uterine bleeding, rates highest in satisfaction scores compared with other treatments, and improves quality of life. Although research indicates that vaginal hysterectomy is safer and cheaper than total abdominal hysterectomy, the latter still accounts for 60-80% of all hysterectomies in the UK and the USA, and at least 95% of these are total rather than subtotal. Although recent research also shows that subtotal hysterectomy confers no advantages over the total procedure, with respect to pelvic organ function, subtotal hysterectomy is the quicker and safer operation, and the risk of cervical stump carcinoma in a woman who has previously had normal smears is negligible. Overall mortality rates from hysterectomy are 0.5-2 per 1000, and rates of visceral damage are 0.5-2%. Complications are most common in women treated for uterine fibroids, and overall rates decrease with increasing age of women. Cost-effective analysis shows hysterectomy to be an effective and cost-effective intervention across a variety of indications. Conservative alternatives to hysterectomy, including endometrial ablative techniques, the Mirena intrauterine system (IUS), and uterine artery embolization for fibroids, have not yet greatly reduced hysterectomy rates, which vary widely between regions, and within the same geographical area. A major challenge is to establish the reasons for this variation in rates.