Indications and results of total hysterectomy

During a 16 year period, 3,410 total hysterectomies were performed. The abdominal approach was preferred in 2,910 cases (85.33%) and the vaginal in 500 (14.67%). About 3/4 (74.77%) of the patients subjected to abdominal hysterectomy (AH) were aged 36 to 55, and 70.6% of the women subjected to vaginal hysterectomy (VH) were aged 56 to 75. The indications were 85.75% for benign and 14.25% for malignant diseases. Among benign diseases, the main indications were 54.6% for uterine myomas, 13.51% for uterine prolapse and 5.46% for benign ovarian tumors. Indications due to malignant diseases rated 5.01% for malignant ovarian tumors, 4.94%, for Ca of corpus uteri and 3.02% for in situ cervical Ca. In almost one out of every three patients the condition was aggravated by a chronic disease or pathological situation. More than 1 in 4 patients had one postoperative complication. In hysterectomies due to benign diseases the complication rate was 24.21%, while those with malignant disease presented a two-fold complication rate. The complication rate for both routes of operation was similar, with fever complications in middle aged patients (25.98%), while patients of young or advanced age presented higher complication rates (29.71% and 31.28% respectively). The overall mortality rate up to the fourth postoperative day was 0.652%, 0.645% for AH and 0.60% for VH. Operations due to benign disease had a 0.20% mortality rate while those with malignant etiology rated 2.966%.