Clinicopathological correlation of abdominal hysterectomy

Tara Manandhar, Sarita Sitaula, Baburam Thapa Dixit, Ajay Agrawal


Background: Hysterectomy is the most common gynaecological procedure performed worldwide. Abdominal hysterectomy remains the most common approach though recently there has been preference towards laparoscopic hysterectomy. Fibroid uterus is the most common indication for hysterectomy followed by pelvic organ prolapse, benign ovarian tumour and abnormal uterine bleeding. The objective of this study was to analyse the indication, outcome and correlate the clinical indication with the histopathological diagnosis.

Methods: This study was conducted in the Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, from January 2017 to December 2019. This is a descriptive analysis of the patients who had undergone abdominal hysterectomy during the study period.

Results: A total of 801 patients underwent abdominal hysterectomy and the most common indication was fibroid uterus (n=391, 48.81%), followed by abnormal uterine bleeding. The total complication rate was 3.24% (n=26) and we had one (0.1%) mortality. Histopathological analysis of the specimen revealed leiomyoma (54.43%) as the most common finding. The clinical indication and histopathological diagnosis matched in 373 (86.94%) patients.

Conclusions: Abdominal hysterectomy is the most common approach and it is associated with risk of complications, so the indication for hysterectomy should be adequately evaluated. With the improvement in the different organ-preserving options, hysterectomy in benign disease should only be opted when all the other conservative options fails.


Abdominal hysterectomy, Gynaecology, Leiomyoma

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Liu F, Pan Y, Liang Y, Zhang C, Deng Q, Li X, et al. The epidemiological profile of hysterectomy in rural Chinese women: A population-based study. BMJ Open. 2017;7(6):1-9.

Wiser A, Holcroft CA, Tulandi T, Abenhaim HA. Abdominal versus laparoscopic hysterectomies for benign diseases: Evaluation of morbidity and mortality among 465,798 cases. Gynecol Surg. 2013;10(2):117-22.

Morgan DM, Kamdar NS, Swenson CW, Kobernik EK, Sammarco AG, Nallamothu B. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. Am J Obstet Gynecol. 2018;218(4):425:1-425.

Committee on Gynecologic Practice. Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):155-9.

Neis KJ, Zubke W, Fehr M, Römer T, Tamussino K, Nothacker M. Hysterectomy for Benign Uterine Disease. Dtsch Arztebl Int. 2016;113(14):242-9.

Lykke R, Blaakær J, Ottesen B, Gimbel H. The indication for hysterectomy as a risk factor for subsequent pelvic organ prolapse repair. Int Urogynecol J. 2015;26(11):1661-5.

Shekhar C, Paswan B, Singh A. Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India. Reprod Health. 2019;16(1):1-16.

Toma A, Hopman WM, Gorwill RH. Hysterectomy at a Canadian tertiary care facility: Results of a one year retrospective review. BMC Womens Health. 2004;4:2-8.

Kovac SR. 28 Years of Using Hysterectomy Guidelines to Determine the Feasibility of Vaginal Hysterectomy. Gynecol Obstet. 2015;6(4).

Driessen SRC, Baden NLM, van Zwet EW, Twijnstra ARH, Jansen FW. Trends in the Implementation of Advanced Minimally Invasive Gynecologic Surgical Procedures in The Netherlands. J Minim Invasive Gynecol. 2015;22(4):642-7.

Mäkinen J, Brummer T, Jalkanen J, Heikkinen A-M, Fraser J, Tomás E, et al. Ten years of progress—improved hysterectomy outcomes in Finland 1996–2006: a longitudinal observation study. BMJ Open. 2013;3(10):003169.

Leung PL, Tsang SW, Yuen PM, Quality Assurance Subcommittee in Obstetrics and Gynaecology, Hospital Authority HK. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. Hong Kong Med J - Xianggang yi xue za zhi. 2007;13(3):187-93.

Makinen J. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod. 2001;16(7):1473-8.

Wright JD, Herzog TJ, Tsui J, Ananth C V., Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233-41.

Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstet Gynecol. 2000;95(2):199-205.

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;1-6.

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891-6.

Yadav DP, Yadav R, Bhati I. Abdominal hysterectomy: analysis of clinico-histopathological correlation in Western Rajasthan, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1012.

Titloye NA, Duduyemi BM, Asiamah EA, Okai I, Ossei PPS, Konney TO, et al. Total abdominal hysterectomy in a Tertiary Hospital in Kumasi. J Med Biomed Sci. 2018;7:22-8.

Vaidya S, Vaidya SA. Patterns of lesions in hysterectomy specimens in a tertiary care hospital. J Nepal Med Assoc. 2015;53(197):18-23.

Sandberg EM, Hehenkamp WJK, Geomini PM, Janssen PF, Jansen FW, Twijnstra ARH. Laparoscopic hysterectomy for benign indications: clinical practice guideline. Arch Gynecol Obstet. 2017;296(3):597-606.

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):55-61.

Shergill SK, Shergill HK, Gupta M, Kaur S. Clinicopathological study of hysterectomies. J Indian Med Assoc. 2002;100(4):238-9.

Rai R, Bhutia PC, Tshomo U. Clinicopathological profile of adnexal masses presenting to a tertiary-care hospital in Bhutan. South Asian J cancer. 2019;8(3):168-72.

Sawke NG, Sawke GK, Jain H. Histopathology findings in patients presenting with menorrhagia: A study of 100 hysterectomy specimen. J Midlife Health. 2015;6(4):160-3.