An Analysis of Complications and Indications of Hysterectomy between Scarred and Non Scarred Uterus

Objective: To compare operative and post operative complications of Hysterectomy between scarred and non scarred uterus, with an aim to improve management at our unit. Study Design: Place and Duration of the Study: This study was conducted in the department of Gynaecology PAEC. G. Hospital Islamabad from June 2006 to June 2009. Materials and Methods: This study was conducted in the department of Gynaecology PAEC. G. Hospital Islamabad from June 2006 to June 2009. This study was carried out in patients undergoing Hysterectomy who were followed from the time of admission to the time of discharge, two and six weeks post operatively. Indications, routes of Hysterectomy, number of previous surgeries, intra post operative morbidities during hospital stay, two and six weeks after discharge were assessed. Results: Total number of Hysterectomies performed in 3 years at our hospital were 167. 138 were total abdominal hysterectomies; 29 were vaginal hysterectomies. Out of these 167 patients, 70 were with previous scars. Indications of total abdominal hysterectomies were fibroid uterus (31.1), DUB (35.5%), Endometriosis/adenomyosis (8.6%), complex adenexal mass (8.6%), post menopausal bleeding (5.7%), CA Cervix (.7%), atypical hyperplasia (4.3%). All cases of vaginal hysterectomies were performed for 2nd degree uv prolapse. Intraoperative complications during surgery were 3 cases of haemorrhage, 1 patient had delayed recovery from general anaesthesia. There were 5 cases of injury to bladder in scarred uterus. Post operative complications noted were febrile morbidity in 8 cases. Urinary tract infections remained the most common febrile morbidity. There were 4(2.3%) cases of secondary haemorrhage, 2 patients developed paralytic ileus. There were 10 (5.9%) cases of wound infection in abdominal hysterectomy. Conclusion: It was found that frequency of complications in scarred uterus was higher especially bladder injuries than that for non scarred uterus because of adhesions due to previous surgeries.