[Surgical approaches to hysterectomy]. / Les voies d'abord de l'hystérectomie.

OBJECTIVES: this study aims to assess the frequency, complications and advantages of each of the three principal approaches to hysterectomies: abdominal, vaginal, and laparoscopic. PATIENTS AND METHOD: this prospective study analyses a consecutive series of 78 hysterectomies for benign disease (myomas and precancerous lesions of the cervix) in the gynaecological surgery department of Libreville Hospital Centre from March 1, 2006, to November, 2010. We excluded cases of genital prolapsus, invasive uterine cancer, and hysterectomy during pregnancy or delivery. Data were collected from the surgical registers and reports and from patients' files. RESULTS: the frequency of abdominal hysterectomy was about 39% (31 cases), and that of vaginal hysterectomy 61% (31 cases); laparoscopic assistance was involved in 20.58% (14 cases). The women's mean age was 46  years (range: 45 to 60  years). Mean parity was 5.5 (range: 0 to 9). Overall, 30% of the patients had previously undergone pelvic surgery by the abdominal route. Two wounds, one of the bladder and the other of the uterus, comprised the surgical morbidity. No deaths occurred. CONCLUSION: the surgeon's experience with the vaginal route, sometimes with laparoscopic assistance, resulted in limited use of the abdominal route.