Different routes of hysterectomy

• Abdominal hysterectomy (AH)
• Vaginal hysterectomy
• Laparoscopic hysterectomy that include total laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy
• Subtotal hysterectomy

Aims and objectives

Comparison of national hysterectomy rate to hysterectomy in UHB trust

• Identify indications of hysterectomy.
• Histology
• Compliance for conservative management prior to hysterectomy as per NICE guidelines.

Methodology

• Retrospective data collection from concerto and clinical portal from  January 2019 to December 2022.
• Hysterectomies done for  women aged 40 yrs and less at UHB for benign conditions.
• Women with abnormal endometrial and cervical biopsy excluded.

Figure 1; Age Group

Ages :26 to 40 yrs, Mean Age :35 yrs

Figure 2: Ethnicity

Figure 3: Parity

Figure 4:  Symptoms at presentation

Figure 5: Treatment offered before hysterectomy

Figure 6:  Indications at surgery

Figure 7: Histology

Conclusion

• The hysterectomy rate for  benign disease of women aged less than equal  to  40 at UHB is slightly lower  than national rate 12.76% of 10.5%.

• The most common symptoms with which women presented is heavy menstrual bleeding and pain or both together.

• Its worth noting that most women were parous , and first line of management for HMB was done.

• All women have tried alternate treatment either conservative like medications, hormonal before hysterectomy was offered.

• Abnormal uterine bleeding and Endometriosis were the most common diagnosis.

• Histology report showed 98% women had hysterectomy for benign condition and it was unremarkable, 2% had CIN II.

Action plan

• 100 % compliance is seen in women according to NICE  guideline first line of management .

• Reaudit in 2024 to see for incidence of hysterectomy