Razia Iftikhar.
Outcome after total versus subtotal abdominal hysterectomy in benign uterine diseases.
J Surg Pak Jan ;12(3):102-5.

Objective: To determine the outcome of total abdominal hysterectomy (TAH) versus subtotal abdominal hysterectomy(STAH) in terms of intraoperative and post operative complications in women with benign uterine conditions. Study Design: A comparative study. Place & Duration of Study: The Jinnah Medical and Dental College and hospital Karachi, from January 2003 to January 2006. Patients & Methods: The study included 50 women who underwent total abdominal hysterectomy and 50 women had subtotal abdominal hysterectomy for benign uterine diseases. Inclusion criteria were menorrhagia and pelvic pain, dysfunctional uterine bleeding, fibroid uterus, adenomyosis of uterus. Patients over 60 years of age, uterine prolapse and suspected cancer of cervix were excluded from the study. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out and hysterectomy was performed by clamp-cut and ligate method. Results: The mean age of patients was 47 years and parity between 4-10.The most common complaint was excessive menstrual loss. Fibroid was found in 20(20%), dysfunctional uterine bleeding in 30 (30%), adenomyosis of uterus in 26 (26%) and repeated pelvic infection refractory to medical treatment in 24 (24%).There was no injury to adjacent viscera during the procedure. Early post operative complications like pyrexia 5 (10%), wound infection 1(2%)and urine infection1(2%) occurred in STAH, while in TAH pyrexia occurred in15 (30%), wound haematoma 1 (2%) and paralytic ileus 4 (8%). Late complications like vaginal bleeding was noted in 1 (2%) of STAH while persistent pelvic pain in 4 (8%), urge incontinence in 5 (10%) and constipation in 4 (8%) of TAH cases. Conclusions: Subtotal abdominal hysterectomy took less operation time, rapid recovery, short term complications, but frequently resulted in cyclical bleeding and vaginal discharge while total abdominal hysterectomy was associated with a significantly longer duration of surgery, greater blood loss and longer hospital stay. The STAH resulted in complications despite having advance pathology and technical difficulty, the only problem was vaginal bleeding which can be prevented by regular conisation of cervix.

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