RETROSPECTIVE STUDY ON THE REVIEW

OF ELECTIVE GYNAECOLOGIC SURGERIES AT JUMC; SOUTH

WEST ETHIOPIA.

BY: HAWI HAILU

A RESEARCH PAPER SUBMITTED TO INSTITUTE OF HEALTH,

FACULITY OF MEDICINE, DEPARTEMENT OF ANETHESIA IN
PARTIAL FULILLMENT OF THE REQUIREMENT FOR THE
BACHELOR OF SCIENCE DEGREE IN ANESTHESIOLOGY.

JIMMA, ETHIOPIA

FEB, 2021
 JIMMA UNIVERSITY

COLLEGE OF MEDICAL SCIENCES, DEPARTMENT OF ANESTHESIA

RETROSPECTIVE REVIEW OF ELECTIVE GYNAECOLOGIC

SURGERIES AT JUMC; JIMMA, SOUTH WEST ETHIOPIA

BY: HAWI HAILU

ADVISORS:

1. Dr. Teshome (Assistant Professor)

2. Zemenu Muluken (Msc In Anesthesia)

JIMMA, ETHIOPIA
FEB, 2021
Abstract
Background: Elective gynaecologic surgeries are planned surgeries that are not urgently
required due to an emergency. The most common elective gynecologic operations are UVP,
myoma, uterine fibroids, dysfunctional uterine bleeding, pelvic organ prolapse, endometrial
cancer, ovarian cancer and cervical cancer.

Objective: to determine common elective gynecologic surgeries, common indications and

encountered intra operative and postoperative complications at JUMC.

Methods: A retrospective cross-sectional study design was employed to review elective

gynecologic surgeries performed at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C

Data was collected using structured questionnaire by extracting all the necessary information
from the patients’ card.

Result: A total of 256 were found out of which 96 have incomplete information. Majority of the
patients’ age were between 31&40, 83(32.00%) and 21&30,65(25.00%) years of age. The
common elective gynecologic operations done were hysterectomy 131(51.00%), myomectomy
51(20.00%) and cystectomy 26(10.00%).The leading indications were pelvic organ prolapse
110(43.00%), myoma 51(20.00%) and ovarian tumors 32(12.50%). In most of the cases no
intraoperative complications were found. Urinary tract infections and Sepsis were the most
common postoperative complications. The majority of the patients 117(45.70%) were stayed in
the hospital for more than one week.

Conclusion: In this study hysterectomy was the most common elective gynecologic surgery
performed and pelvic organ prolapse was the most common indication for hysterectomy.

Recommendation: Further study concerning this topic should be done and all the necessary
information regarding the patient’s condition should be kept properly.

I
 ACKNOWLEDGEMENT
I express my deepest gratitude to my advisers Dr.Teshome (Assistant Professor) and Mr.
Zemenu Muluken (Bsc, Msc in Anesthesia) for their kind assistance and guide to do this research
paper on Two Years Retrospective Review Of Elective Gynecologic Surgeries At JUMC and
Jimma University college of medical science department of anesthesia for giving the opportunity
to do this research. And also I would like to express my thanks to JUMC Card Office workers
providing me the patients cards and the patients whose cards are used for the study purpose.
Finally, I would like to thank Jimma university computer lab workers for helping me in computer
skills.

Table contents page

Abstract........................................................................................................................................................I
II
ACKNOWLEDGEMENT...........................................................................................................................II

List Of Tables.............................................................................................................................................IV

Abbreviations and acronyms.......................................................................................................................V

CHAPTER ONE..........................................................................................................................................1

INTRODUCTION.......................................................................................................................................1

1.1 BACK GROUND..................................................................................................................................1

1.2 Statement of the problem...................................................................................................................3

1.3 Significance of the study................................................................................................................4

CHAPTER TWO.........................................................................................................................................5

LITERATURE REVIEW............................................................................................................................5

CHAPTER THREE.....................................................................................................................................9

OBJECTIVES.............................................................................................................................................9

3.1 General Objective..............................................................................................................................9

3.2 Specific Objectives............................................................................................................................9

CHAPTER FOUR.....................................................................................................................................10

METHODS AND MATERIALS...............................................................................................................10

4.1 Study Area and Period.....................................................................................................................10

4.2 Study Design...................................................................................................................................10

4.3 Population........................................................................................................................................10

4.3.1 Source population.....................................................................................................................10

4.3.2 Study population.......................................................................................................................10

4.4 Sample size and sampling technique................................................................................................10

4.5 Study variables................................................................................................................................11

4.5.1 Independent variables...............................................................................................................11

4.5.2 Dependent variables..................................................................................................................11

III
 4.6 Data collection method....................................................................................................................12

4.7 Plan for data processing and analysis...............................................................................................12

4.8 Operational Definitions...................................................................................................................12

4.9 Ethical consideration.......................................................................................................................13

CHAPTER FIVE.......................................................................................................................................14

RESULT....................................................................................................................................................14

CHAPTER SIX.........................................................................................................................................18

DISCUSSION...........................................................................................................................................18

CHAPTER SEVEN...................................................................................................................................20

CONCLUSION AND RECOMMENDATION.........................................................................................20

7.1 Conclusion.......................................................................................................................................20

7.2 Recommendations...........................................................................................................................20

REFERENCES..........................................................................................................................................21

QUESTIONNAIRE...................................................................................................................................23

List Of Tables

Table 1: Socio demographic distribution of patients who undergone elective gynaecologic

Surgeries at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C………………………………….15

Table 2: Types of elective gynecologic operations done at JUMC, from Yekatit 1, 2011- Tir
30,2012 E.C …………..……………………………………………………………...…………16
IV
Table 3: Common indications for elective gynecologic surgeries done at JUMC, from Yekatit 1,
2008- Tir 30,2010 E.C…………………………………………………………………………..16

Table 4: Intraoperative complications in patients who undergone elective gynecologic

Operations done at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C ……………………………17

Table 5: Postoperative complications in patients who undergone elective gynaecologic

Operations done at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C ………………………..…..17

Table 6: Distribution of duration of hospital stay of patients who undergone elective gynecologic

Operation at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C ………….………..……………...17

Abbreviations and acronyms

DVT: Deep Vein thrombosis

GTD: Gestational Trophoblastic Disease

JUMC: Jimma University Medical Center

LAVH: Laparascopically Assisted vaginal hysterectomy

OPD: Outpatient department

V
OR: Operating Room

PID: Pelvic Inflammatory Disease

SRP: Students Research Program

TAH: Total abdominal hysterectomy

TLH: Total Laparoscopic Hysterectomy

UTI: Urinary tract infection

UVP: Uterovaginal Prolapse

VH: Vaginal hysterectomy.

VI
 CHAPTER ONE

INTRODUCTION

1.1 BACK GROUND

Elective gynecological operations including Laparoscopy with dye test, Myomectomy,
Salpingectomy, Hysterectomy, Manual vacuum aspiration, Obstetric fistula, Marsupialization,
Cystectomy, Colpoperineorrhaphy, Polpectomy Laparotomy for pelvic abscess, Minilaparotomy
Debulking surgery Hysteroscopy, Vulvovaginoplasty, Excision of transverse vaginal septum,
Cervical cerclage insertion hysterectomy, laparoscopies are thus the commonest procedures in
medical practice. Gynecological procedures are performed on the female reproductive system in
nongravid women, whereas in gravid women it is performed during periods of pregnancy before
viability of the fetus. They are performed for emergency or elective purposes.

Emergency procedures are indicated for ruptured ectopic pregnancy and Bartholin’s abscesses
amongst others, while elective ones can be performed for genital prolapse, obstetric fistulae, or
even cancerous conditions. A number of factors come into play in determining the timing of an
elective surgical intervention, particularly in the developing world. The present study explores
the factors that contribute to the timing of elective surgery and patients' opinions on their quality
of life as they wait for surgery. The common gynecological procedures reported in Nigerian
literatures include myomectomy (41.9%), salpingectomy (26.0%), MVA (21.5%), hysterectomy
(10.6%), and laparoscopy (2.8%). They are performed for various indications, as reported from
various studies. In Abujaand Kano,Nigeria, the major indication for laparoscopy was infertility
in 88.9 and 90.5% of patients who underwent the procedure, respectively.

The commonest indication for hysterectomy was uterine fibroid with completion of family size
in 53.94% in Sokoto, Nigeria and 90.37% in Jos study. It was 73.7% in Hong Kong; however, in
Peshawar, Pakistan, dysfunctional uterine bleeding was noted to be the commonest indication.
Incomplete abortion was the commonest indication for MVA, as reported in Jos (85.3%) and
Maiduguri (88.1%).For salpingectomy, the commonest indication was ruptured ectopic (80.3%)
in Benin. For obstetric fistula, studies from northernand eastern parts of Nigeria showed that the
commonest indication was vesicovaginal fistula (VVF) in over 90% of cases. Menorrhagia was
the most common indication for myomectomies done at Kano (86.7%).

1
Surgical procedures in obstetrics and gynecology have witnessed significant improvements in
terms of morbidity and mortality. This is not unrelated to advancement in asepsis and anesthesia
over the years. This study aimed at describing the pattern of surgical procedures in obstetrics and
gynecology at a tertiary health center in Northern Nigeria. This study has done on patients who
had surgical procedures in Obstetrics and Gynecology at Aminu Kano Teaching Hospital,
Nigeria. The Information extracted were age, type of surgery and anesthesia used. A total of
2741 operations were done within the period under view.

The mean age of the patients was 29.95 ±8.26 years. Emergency surgeries were
performedin1643 (59.9%) patients while the remaining 1098(40.1%) were elective. General
anesthesia was used for the majority 2093 (76.4%) of the cases. Cesarean section accounted for
the majority (62.6%) of the procedures performed. Other surgeries include Myomectomy (4.2%),
total abdominal hysterectomy (4.7%), and laparotomy (9.3%) among others. Obstetric cases
accounted for 1510 (55.1%) of the surgeries conducted while 1231 (44.9%) were gynecological
cases. Most of the procedures were elective surgeries performed under general anesthesia.

1.2 Statement of the problem

Elective gynecologic surgeries are planned surgeries that are not urgently required due to an
emergency. It allows a patient time to get mentally prepared for the procedure. Most of these
2
surgeries go through smoothly without undue consequences and the woman recovers fast. Some
of the most common elective operations that gynecologists perform are hysterectomy,
myomectomy, oophorectomy, Diagnostic laparoscopy and tubal ligation.(1, 2)

The most common causes of elective gynecologic operations are uterine fibroids, dysfunctional
uterine bleeding, Pelvic organ prolapses, endometrial cancer, cervical cancer, ovarian cancer and
chronic pelvic pain. Uterine leiomyomas account for majority of elective gynecologic surgeries.
It accounts approximately 30% of hysterectomies. The main presenting symptoms in patients
with uterine leiomyomas include excessive bleeding, pelvic pain, back pain and urinary
complaint and in patients with genital prolapse include pelvic pressure, urinary incontinence and
rectal discomfort while in endometriosis pelvic pain, dysmenorrhea and irregular bleeding. (3, 4)

The intimate anatomic relationship of the genital tract with urologic, gastrointestinal, vascular
and neurologic structures makes occasional injuries during gynecologic surgery. Of 1828
elective gynecological surgeries done at the University of Ilorin teaching hospital, Ilorin Nigeria
from 1984- 1988 there were 155 elective hysterectomies with a prevalence rate of 8.5% an
analysis. Of 128 cases notes available for review revealed that 100(78%) of patients had TAH
while the remaining 28(22%) had vaginal hysterectomy. According to this study uterine fibroids
were the leading indications for TAH which all the vaginal hysterectomy was for UVP(11).

Urethral damage, bladder injury, bowel injury , nerve injury, hemorrhage and anesthetic
complications are the most common intra operative complications while nausea and vomiting,
DVT, pulmonary embolism, pulmonary edema are possible postoperative complications of
gynecologic surgeries.(5)

This study will provide a base line data for further study since there is no enough study done
previously in this hospital about this issue. So, it is important to do this study in this hospital to
provide the current information about the magnitude of the problem in a good manner.

3
1.3 Significance of the study
Elective gynecological surgeries are one of the major surgeries performed in JUMC and can be
associated with significant morbidity and mortality. As there is scarcity of similar studies done
in this hospital this study will help to identify common elective gynecologic surgeries and
complication related to these surgeries. In addition to this the result of the study area as well as
for the rest part of country as our country, Ethiopia being one of the developing countries where
there is a limited data.

4
 CHAPTER TWO

LITERATURE REVIEW
A 10 year audit of gynecological surgeries performed in the pediatric age group at the Jos
University Teaching Hospital shows that a total of 89 surgeries where performed below the age
of 11. The most common surgical procedure was for the management of septic abortion (21.3%)
correction of congenital mal formation of the genital tract accounted for 21.4% of the surgeries
performed fourteen (15.7%) laparotomies were performed for ovarian cyst. (6).

Laparoscopic single site surgery is the least innovation in minimally invasive surgery and
appears to be feasible and safe to perform for a variety of gynecologic conditions. This approach
may result in a “scar less” effect because the healed incision remains concealed at the base of the
navel while initial series in the urological , general surgery and gynecological literatures have
demonstrated , the safety anesthetic superiority and potentially improved pain profit of a single
part approach when compared with conventional laparoscopy ,these early findings must be
further validated. (7).

More than 90% of gyanecological surgery is performed for non-malignant conditions with a
major objective of improving the patients’ health related quality of life. Uterine fibroids are
common benign tumors which arise from the muscle tissue of the uterus. About 25% of all
women over the age of 35 years have fibroid. These tumors may grow into the uterine cavity
(submucous fibroids), in the uterine wall (mural fibroids), or protrude out of the uterine wall (sub
serous fibroids). (1,3)

A 10 year cohort study of women living in the Eastern region of Quebec identified 2521 women;
with endometriosis 292 women, with ovarian cancer 41, and women with ovarian cancer and
endometriosis 38.

This study shows that the number of classes of ovarian cancer has been steadily increasing over
the last 10 years and that endometriosis represents a serious risk factor that accelerates its
development by about 5.5 years (8).

5
Every year over 550,000 American women under go hysterectomies the majority for non-life
threatening condition. In 33% of all hysterectomies the reasons were problem related to fibroid
tumors. (1,3)

A hysterectomy is a procedure where the uterus is surgically removed. It is a relatively common

procedure and estimated that 20% of women will have a hysterectomy by the time they are 55
years of age. Reasons why hysterectomies may be recommended fall in to three categories, these
include to save life, to correct serious problems that interacted with normal function and to
improve quality of life (1,4).

Study done in Finland shows that, approximately 9000 hysterectomies are done annually. The
annual incidence was 348/100,000 in women’s between the age of 45 and 49 years of age. The
most common indication was leiomyoma (50%) and endometriosis (11%). Genital prolapse,
menstrual disorders and cancer each accounted for 7-8% of all hysterectomies. The most
common surgical approach was TAH (36%) hysterectomy with bilateral oophorectomy and
partial hysterectomy each accounted 20% of operations (4).

Between January 1995 and December 2003,219 patients were treated by radical hysterectomy
plus pelvic lymphadenectomy in Peking union medical college Beijing, China. A total of 49
patients (22.4%) developed post-operative complications. The major complications include
bladder dysfunction (10%), formation of lymphocysts (7.8%), wound infection (6.8%),
hydronephrosis (1.4%) and formation of urethral fistulas (0.5%).

According to this study the patients in the group treated with radical hysterectomy plus pelvic
lymphadenectomy was likely to develop post-operative complications compared with the
patients in the group by modified radical hysterectomy plus pelvic lymphadenectomy (24%vs 0).
(9)

Over a five year period 197 hysterectomies were performed at King Khalid university hospital.
Indications for the procedures vary from menstrual disorders and symptomatic fibroids to
ovarian malignancy. The most common indication was found to be menorrhagia.

There were 45 abdominal and 52 vaginal hysterectomies and all were elective, majority of which
were performed on women on their fourth and fifth decades of life. (10)
6
In USA uterine leomyomes, dysfunctional uterine bleeding and endometriosis account about
30%,20% and 20% of hysterectomies respectively. UVP, PID, or endometrial hyperplasia
accounts for 20% of hysterectomies and the rest 10% of hysterectomies are performed to treat
cancer of the cervix, ovaries, or uterus. (3)

In Tikur Anbessa Teaching hospital, Addis Ababa, Ethiopia elective hysterectomies accounted
78.3% of hysterectomies done at the unit. Abdominal approach in 77.3% and vaginal
hysterectomy in 22.7% of cases. The three major indications for elective hysterectomies were
leiomyoma (41.1%) UVP (23%) and ovarian Tumors (19.5%) of cases.

In 30.2% of the operations intra operative adhesions requiring adhesinolysis were encountered.
There was a significantly increased risk of urinary tract infection in vaginal hysterectomies and
unexplained fever in abdominal hysterectomies (12).

In japan epithelial ovarian cancer is the most devastating of all gynecological malignancies. It is
estimated that 9384 new cases epithelial ovarian cancer occurred in 2012 and there were 4840
deaths from this cancer in 2014. (14)

In japan clear cell carcinoma accounts for around 25% of ovarian cancer, which very different
from USA and EU. Therefore, performing prophylactic opportunistic bilateral salpingectomy or
tubal ligation during another surgical procedures (e.g., hysterectomy or caesarean section) may
be effective for reducing the risk of ovarian cancer among Japanese women. (15, 16 )

There is no known benefit to retaining the fallopian tubes in the post reproductive period and the
tubes have no known physiological role after hysterectomy or tubal ligation. For this reason,
recognition of the malignant potential of the fallopian tube has led to changes in surgical
practice, particularly in Canada and USA. (18 )

The study that took place on 249 women at the “Instituto de medicina Integral professor
Fernando Figueira” from January to May 2007 shows at 24 hours after catheter removal, 23.6%
of the urocultures collected were positive, while on days 7 to 10 this was reduced to 11.1%. of all
participants studied only 2.4% had symptomatic bacteriuria. (17)

7
 CHAPTER THREE

OBJECTIVES

3.1 General Objective

To assess two years retrospective analysis or review of elective gynecologic operations at JUMC
from Yekatit 1, 2011- Tir 30,2012 E.C.

3.2 Specific Objectives

 To determine common elective gynecologic operations.
 To identify common indications of elective gynecologic surgeries.
8
  To determine common complications faced intraoperatively and postoperatively
following elective gynecologic surgeries.

CHAPTER FOUR

METHODS AND MATERIALS

4.1 Study Area and Period

This study will conducted in Jimma University Medical Center (JUMC), Jimma town 352km
south west of Addis Ababa. This hospital is one of the teaching hospitals in Ethiopia which
provides services in surgery, gynecology and obstetrics, medicine, pediatrics, OPD, major
operation rooms and diagnostic facilities. The study will conducted from Yekatit 1, 2011- Tir
30,2012 E.C (13)

4.2 Study Design

Retrospective cross sectional descriptive study design was employed to review elective
gynecologic operations done at JUMC from Yekatit 1, 2011- Tir 30,2012 E.C.
9
4.3 Population

4.3.1 Source population

All patients who were operated for gynaecological problems in JUMC from Yekatit 1, 2011-
Tir 30,2012 E.C.

4.3.2 Study population

Sampled patients who were operated on elective bases during the study period

4.4 Sample size and sampling technique.

The sample size is determined by the following formula:

n= (Z) 2p (1-p)/w2

Where, n= Sample size

Z= level of confidence (95%)

P= Anticipated Prevalence (0.5)

q= 1 – P

w= Margin of error (0.05)

n= (1.96)2(0.5)(1-0.5)/(0.05)2

=384

Since N<10,000 correction formula is applied, where N is total study population which is 768.

nf=ni/(1+ni/N)

=384/1+384/768

=256

Therefore the sample size will be 256.

10
4.5 Study variables

4.5.1 Independent variables

 Age
 Address
 Type of surgical procedure
 Causes of surgery
 Outcomes of surgical interventions
 Hospital stays after surgery

4.5.2 Dependent variables

 Indications for surgery
 Encountered complications during surgical intervention

4.6 Data collection method

After the questionnaire was prepared, patients cards were collected by using card number of the
patients chart and the card number is selected from the registration log book in the operating
room (OR). After cards have selected the questionnaire was filled from the cards depending on
each variable.

4.7 Plan for data processing and analysis

Data were collected and properly filled on the proposed format, summarized, tallied and then
analyzed manually using calculator for determination of frequency percentage and cross
tabulation with deferent variables. The analyzed compiled and organized data were used in
discussing the result using international and national figure. The result was composed, discussed
and finally a conclusion and recommendations are forwarded.

4.8 Operational Definitions

Elective gynecologic surgeries: are planned surgeries that are not urgently required due to an
emergency.

Hysterectomy: is a procedure by which the uterus is surgically removed.

11
Uterine fibroids: are common benign tumors which arise from the muscle tissue of the uterus.
They may be single or multiple.

Dysfunctional uterine bleeding: It is excessive uterine bleeding after ruling out all possible
causes of uterine bleeding.

Pelvic organ prolapse: Down ward descent of genitalia from their normal pelvic position due to
defects in the pelvic supporting structures.

Intraoperative: During operation

Postoperative: After the operation is completed

Menorrhagia: is heavy or prolonged menstrual flow

Metrorrhagia (intramenstrual bleeding): is bleeding that occurs of any time between

menstrual periods.

4.9 Ethical consideration

Prior to the study the Clinical Director and hospital administrator was informed about the study
by a formal written letter from school of Anesthesia.

Everything concerning patients matter kept confidentially and names of patients and card
numbers were not used. After necessary information was extracted the cards are returned back to
the card office.

4.10 Dissemination plan

The result of study will be disseminated to the Authority of JUMC by the principal investigator
besides submitting to Jimma University Students research (SRP) office and school of Anesthesia
and used as reference.

12
 CHAPTER FIVE
RESULT
A total of 256 elective gynecologic cases were found out of which 96 have incomplete
information. patients’ cards were reviewed and information regarding to complications, hospital
stays, transfusion and address of the patients were obtained from these cards. Of 256 cases
83(32%) of women were between the age of 31 & 40, 65 (25%) were between the age of 21 &
30, 46 (18%) were between 41& 50 years of age while 17(6.6%), 26(10%) and 19(7.5%) were in
the second, fifth and sixth decades of their life respectively. (Table 1) fifty nine percent of the
patients were from outside of Jimma and the rest 41% were from Jimma. (Table 1)

The commonest elective gynecologic surgery done in this hospital was hysterectomy which
accounts for 131(51%) followed by myomectomy 51(20%) and cystectomy 26(10%). The others
like fistula repair, suction and curettage, biopsy, exploratory laparotomy, and oophorectomy
accounted 48(19%) of the total elective gynecologic surgeries done in this hospital. (Table 2).
TAH and VH were the common hysterectomies done in this hospital. TAH was done for 94
(71.8%) of the patients, while 37 (28.00%) of patients undergone VH. (Table2)

The most common indications for elective gynecologic surgeries in this study were pelvic organ
prolapse 110(43.00%), myoma 51(20.00%) and ovarian tumors 32(12.5%). Cervical cancer and
endometrial cancer accounts for 18(7%) and 16(6.20%) of the cases respectively. Others like
VVF, GTD, ectopic pregnancies accounts for 29(11.00%) of indications of cases. (Table 3)

The two most common indications for TAH were pelvic organ prolapse 59(62.70%)and ovarian
tumor 24(25.50%). Other indications were myoma, cervical cancer, endometrial hyperplasia,
chronic ectopic pregnancy and GTD which accounted 11.80%.

13
In majority of the cases there was no Intraoperative complication found, but hemorrhage was
occurred in 10 patients and bowel injury in three patients, bladder injury in two patients, and
nerve injury was found in one patients. (Table 4)

The most common postoperative complications encountered were UTI in 15 (46.80%) of patients
and sepsis in 12 (37.50%) of patients. (Table 5)

Of all patients 37 patients were transfused and hysterectomy accounted for most of the
transfusion (72.9%) and the rest accounted for 27.1% of the transfusion.

Concerning the duration of hospital stay after the operation 117(45.70%) of patients were
discharged after 7 days stay and 111(43.3%) were discharged in the days between 4 & 7 while
only 28(11%) patients were discharged before 4 days stay in the hospital. (Table 6)

Table 1: Socio-demographic distribution of patients who undergone elective gynecologic

surgeries at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C.

Age Frequency Percent

<20 17 6.6

21-30 65 25

31-40 83 32

41-50 46 18

51-60 26 10

>60 19 7.5

Total 256 100

14
 Address

Jimma 104 40.6

Out of Jimma 152 59.4

Total 256 100

Table 2: Type of elective gynecologic operations at JUMC, from Yekatit 1, 2011- Tir 30, 2012
E.C

Type of Gynecologic operation Frequency Percent

Hysterectomy 131 51

Myomectomy 51 20

Cystectomy 26 10

Other 48 19

Total 256 100

Table 3: Common indications for elective gynecologic surgeries at JUMC, from Yekatit 1,
2011- Tir 30, 2012 E.C

15
 Indication Frequency Percent

Pelvic organ prolapse 110 43

Myoma 51 20

Ovarian Tumors 32 12.5

Endometrial cancer 16 6.2

Cervical cancer 18 7

Others 29 11

Total 256 100

Table 4: Intra operative complications in patients who undergone elective gynecologic

operations at JUMC, from Yekatit 1, 2011- Tir 30, 2012 E.C

Intra operative Frequency Percent

Complications

Hemorrhage 10 62.5

16
 Bladder injury 2 12.5

Nerve injury 1 6.25

Bowel injury 3 18.75

Total 16 100

Table 5: Postoperative complication among patients who undergone elective gynecologic

operations at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C

Post of Frequency Percent

complications

Urinary tract infection 15 46.8

Sepsis 12 37.5

Surgical site infection 5 15.7

Total 32 100

Table 6: Distribution of hospital stay of patients who undergone elective gynecologic operations
at JUMC, from Yekatit 1, 2011- Tir 30,2012 E.C

Duration of stay in hospital in days Number Percent

<4 28 11

17
 4-7 111 43.3

>7 117 45.7

Total 256 100

CHAPTER SIX

DISCUSSION
During the study period 256 elective gynecologic cases were reviewed of which 96 have
incomplete information. This incomplete information was due to loss of cards, loss of operation
notes from the cards, loss of discharge notes and other papers from the patient’s cards. Majority
of the patients were in the third and fourth decades of their life.

In comparable to study done at Tikur Anbessa Teaching hospital, Addis Ababa, the rate of
hysterectomy was relatively low in this study. In Tikur Anbessa Teaching hospital elective
hysterectomy accounts 78.3% of elective gynecologic surgeries while in this study it accounted
51.00% of the cases.

TAH was the commonest elective gynecologic operation performed in Jimma University
Medical Center followed by VH and myomectomy. In this study there were 94(71.80%),
abdominal and 37(28.00%) vaginal hysterectomies.

In university of Ilorin Teaching hospital, Ilorin, Nigeria, an analysis of 128 cases revealed that
100(78%) of patients had TAH while remaining 28(22%) have vaginal hysterectomy.

The major indications for elective hysterectomies in this unit were pelvic organ prolapse (43%),
myoma (20.00%), and ovarian tumors (12.50%). In Tikur Anbessa Teaching hospital, Addis
Ababa, the three major indications for elective hysterectomies were leiomyoma (41.1%), UVP
(23%), and ovarian tumors (19.5%). In this study pelvic organ prolapse, ovarian tumors, and

18
myoma were the leading indications for TAH while all the vaginal hysterectomies were for
pelvic organ prolapse.

In 51 (20.00%) patients myoma was the indication for myomectomy. Total of 16 (6.25%)
patients developed Intraoperative complications. Major complication encountered was
hemorrhage 10(62.50%). Bowel injury, bladder injury and nerve injury accounted for 5(37.50%)
of complications occurred.

Concerning post-operative complications 32(12.50%) patients developed post-operative

complications.

The major complications encountered were UTI (46.8%), sepsis (37.5%), and surgical site
infection(15.7%). Study done in Sweden in 2004, shows that 10.4% of patients were considered
to post-operative infections. The relatively high post-operative complication s in this unit can be
due to poor preoperative antibiotics prophylaxis.

Of all cases 37 patients were transfused. The common gynecologic procedures those associated
with most of the transfusion were TAH, VH and myoma.

Concerning duration of hospital after the operation 117 (45.70%) of patients were discharged
after a week and 111(43.30%) of patients were discharged within 4-7 days while only 28(11%)
patients were discharged within less than 4 days duration.

19
 CHAPTER SEVEN

CONCLUSION AND RECOMMENDATION

7.1 Conclusion
This study displayed that

 Majority of the patients are in their third and fourth decades of life.
 Hysterectomy was the most common elective gynecologic surgery done in this hospital
 Pelvic organ prolapse, myoma, ovarian tumor, cervical cancer and endometrial
hyperplasia were the major indications for elective gynecologic surgeries in this study.
 Pelvic organ prolapse was the most common indication for elective hysterectomy in this
study.
 Pelvic organ prolapse and ovarian tumor were the most common indications for TAH.
 There was no intra operative complication occurred in most of the cases while UTI and
sepsis were the most common postoperative complications occurred.
 Majority of the patients were discharged after a week stay in the hospital.

7.2 Recommendations
 Further study is needed on this area to provide a base line data and references.
 Patients record keeping needs adjustment and improvement.
 Necessary information concerning patient’s condition should be recorded on patient’s
card and operating log book properly.

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  The operation log book should be kept safely so as to keep the patients information
recorded.
 Careful attention should be given to reduce postoperative complications related to those
operations.
 Surgeons should decrease intra operative blood loss to minimize intraoperative and
postoperative blood transfusion.

REFERENCES

1. Michael E. TOAFF,MD,MSc alternative to hysterectomy , myometomy for uterine

fibroids ,USA,2003

2. Hawkins and Bourne shaw’s text book of gynecology 14th ed. Page 461.
3. Karen J. Carlson, David H. Nichols Isaac Schiff: indication for hysterectomy. The new
England Journal of Medicine 1993,328(12): 856-860
4. Davies A,magos Al, indication and alternatives to hysterectomy, Royal Hospital , London
UK,2004.
5.Alan H.Decherney, laurenNathan , T. Murphy goodvoin
6. Afican Journal of pediatric surger 2010 sep-Dec; 7(3): 78-80.

7. Journal of minimal Access surgery 2011 Jan-March; 7(1): 71-77.

8. Aris A, endometriosis associated ovarian cancer: A ten year cohort study of women living in
the estrie region of Quebec Canada, Jovarianros 2010, 3:2
9. . Wuk zhanh WH zhangR,Li H, Bai P, li XG: analysis of post operative complications of
radical hysterectomy Chinese Acadamy of Medical sciences and Peking union Medical college
Beijing , china , zhonguazhongliuza , zhi 20;28(4):316-9.

10. .GaoJs, lengJH,Liu ZF, shen K, sun DW,Zhu L, urethral injury in

gyneocologiclaparascopieszhonghua FU chunKeZaZhi, 2004:39(5):311-4

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11. .J.SeffanR.Kwame, AryeeR,Adamu, K. Munumi.EAwotwi: indications for gynecologic
surgery and their implication for sexual function in menopausal women Ghana Accra,
international Journal of obstetrics and gynecology 2008:103(3): 203-206

12. Gaym,A elective hysterectomy at Tikuranbbessa teaching hospital , Addis Ababa, Ethiopia
medical Journal 2002: 40(3) 217-226.
13. Fekadu Jiru ,Jimma University Specialized Hospital,www.ju.edu.et/jush [internet]
14. Cancer information services (JP). Cancer statics in japan [internet]. Tokyo: National cancer
center japan; 2017
15. RosenblattKA, Thomas DB. Reduced risk of ovarian cancer in women with a tubal ligation
or hysterectomy. The world health organization collaborative study of neoplasia and steroid
contraceptives. Cancer epidemiol biomarker prev 1996;5:933-935
16. Aoki Y. the patient annual report in 2010. Acta obstet Gynaecol jpn 2012;64:1029-1077.
17. Schiotz HA, Tanbo TG. Postoperative voiding, bacteriuria and urinary tract infection with
Foley catheterization after gynecological surgery. Acta Obstet Gynecol Scand.2006;85:476-81.
18. McAlpine JN, Hanley GE,Woo MM, ToneAA, Rozenberg N, Swenerton KD, et
al.Opportunistic salpingectomy:uptake,risks and complications of regional initiative for ovarian
cancer prevention. Am J Obstet Gynecol 2014;210:471.e1-471.e11.

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 QUESTIONNAIRE

Jimma University College of medical sciences department of Anesthesia a format for

retrospective review of elective gyneocologic surgeries done at JUMC from Yekatit 1, 2011- Tir
30,2012 E.C

1. Identification
1.1 Card no ----------------------
1.2 Age --------------------------
1.3 Address --------------------------- Jimma town Out of Jimma
2. What type of elective gynecologic surgery was done?
a. Hysterectomy ---------------------
I.TAH ------------------------
II. Vaginal hysterectomy-----------------
III. Radical hysterectomy --------------------
IV. Other (specify) ---------------------------
b. Myomectomy ------------------
c. Oophorectomy ------------------
d. Tubal ligation -----------------
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 e. Others (specify) ---------------
3. What was the indication for surgery?
a. Myoma -------------------------
b. UVP-------------------------------
c. Ovation cancer ------------------------
d. Endometriosis -------------------------
e. Others (specify) ----------------------
4. Was there any complication? A, yes --------------------- B, No -------------------------

If yes for question No 4 what was the complication?

A. Intra operative complications
I. hemorrhage -----------------------------------
II. Ureteric injury ------------------------
III.Bladderinjury---------------------------
IV. Bowel injury ----------------------------
V. Nerve injury -----------------------------
VI. Other (specify) ---------------------------
B. Post-operative complications
I. Urinary tract infection -------------------------
II. Surgical site infection ------------------------------
III. Pneumonia --------------------------------------
IV.Wound Dehiscence --------------------------------------
V.Vault cellulites ----------------------------------
VI. Pelvic thrombophlebitis --------------------------
VII.Others (specify) ---------------------------------------------
5. Was the patient transfused?
a. Yes -----------------------------
b.No ------------------------------
6. Hospital stays in days ------------------------------------
7. Surgical outcome for those with any of the complications

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a. Good----------------
b. Bad------------------

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