[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.

[Emergency obstetrical hysterectomy: about 58 cases at Libreville Hospital Centre]. / L'hystérectomie obstétricale d'urgence. A propos de 58 cas au Centre hospitalier de Libreville.

OBJECTIVE: To evaluate the incidence, indications and prognosis of this surgery in our daily practice in order to suggest preventive action. PATIENTS AND METHOD: This is a retrospective study over a period of 10 years, from January 1, 1992 to December 31, 2001. Using patient's documents, parameters have been analysed as followed: age, parity, antecedent of uterine surgery, indications, surgery technique, foeto-maternal prognosis. RESULTS: The frequency of this intervention is 0.07%. The average age of patients was 31 years and the average parity was 6. The indications were: 44 cases of haemorrage (76%) and 14 cases of post-abortum infection (24%). Sub-total hysterectomy was performed on all the patients. We have observed 14 cases of maternal death (24%) and 24 cases of foetal death (57%). CONCLUSION: The frequency of this surgery is weak in our daily practice, compared with other Black African countries. But foeto-maternal prognosis is severe. A better sensibilisation of the population on prenatal consultations benefits and the setting up of a real national strategy of obstetrical emergency care constitute a means to prevent this type of surgery.