[Hysterectomy for benign lesions in the north of France: epidemiology and postoperative events].
OBJECTIVE
We conducted an inquiry on hysterectomy practices in gynecology and obstetric units of general hospitals in the north of France (North and Picardy regions) focusing on procedures made for benign lesions of non-prolapsed uteri.


METHODS
and methods: Two studies supported this inquiry. The first was a retrospective study in 1997 concerning 21 gynecology and obstetric units in general hospitals among the 24 units belonging to the general hospital network in the North and Picardy regions. The series included 1293 hysterectomies for benign lesions on non-prolapsed uteri, accounting for 68.6% of all hysterectomies performed during the study period. Surgical route, indications and duration of hospital stay were recorded. The second study was a prospective study conducted in 1998 in 9 voluntary units among the 24 units in the hospital network. This study included 423 hysterectomies and recorded techniques, indications, and complications as well as late complications and social and psycho-sexual impact assessed during a telephone interview at 3 months. The 5 University Hospitals in the North, Picardy and Champagne regions also participated in the inquiry and provided data on 191 hysterectomies performed during a three-month period.


RESULTS
Twenty-seven hysterectomies were performed per year and per operator. The main indications for hysterectomy were, for the two studies respectively: fibroid uterus 66.7% and 60%, menstrual disorders 13.8% and 27.2%, endometriosis 10.6% and 5%, and hyperplasia of the endometrium 3.9% and 5%. Surgical routes recorded in the second study were: vaginal 64.8%, abdominal 30.5%, vaginal laparoscopy 4.7%. Reductions were performed to facilitate vaginal hysterectomy in 25% of the cases. The vaginal route was used for adnexectomy in 30% of the cases. The rate of peroperative complications were observed in 3 - 4.8% of the vaginal, 4.8 - 10.7% of the abdominal and 15% of the laparoscopic vaginal hysterectomies. Bleeding was reported in 0.4% and 9.3% of the vaginal and abdominal hysterectomies respectively (p<0.001). The rate of postoperative complications was 0.8 - 4.9%, 1.6 - 19.4%, and 5% for vaginal, abdominal and vaginal laparoscopic hysterectomies respectively. Duration of convalescence was 4.4 weeks for vaginal and 6.1 weeks for abdominal (p<0.00001) and 5.3 weeks for vaginal laparoscopic procedures. The quality of sexual intercourse was improved in 30% of the patients irrespective of the surgical rout but was found to be deteriorated in 20% of those who had laparoscopic vaginal hysterectomy.


CONCLUSIONS
It is difficult to ascertain the exact number of hysterectomies performed in France. The computerized information system currently in use in France (PMSI) should provide interesting data. Reports from North America, Great Britain and the Scandinavian countries have found comparable data. Complication rate, duration of hospitalization and social impact are in favor of vaginal hysterectomy.
Debodinance
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Service de Gynécologie Obstétrique, CH Dunkerque, rue des pinsons, 59430 Saint-Pol-sur-Mer.
D004714:Endometrial Hyperplasia / Q000601:surgery; D004715:Endometriosis / Q000601:surgery; D005260:Female; D005602:France; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000601:surgery; D008599:Menstruation Disturbances / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014591:Uterine Diseases / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery