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. 2014 Apr;5(2):55-61.
doi: 10.4103/0976-7800.133988.

Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery

Chanderdeep Sharma  1 , Manupriya Sharma  2 , Rashmi Raina  2 , Anjali Soni  1 , Bal Chander  2 , Suresh Verma  1
Affiliations

Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery

Chanderdeep Sharma et al. J Midlife Health. 2014 Apr.

Abstract

Objective: The aim of the study was to generate baseline data for indications of gynecological surgeries, and to assess route of surgery and histopathology correlation in women undergoing major gynecological surgery in a rural tertiary level teaching hospital in India.

Materials and methods: Surgical indications, route of surgery and histopathology findings were reviewed and analyzed retrospectively, in 922 patients (≥35 years age) who underwent gynecological surgery at Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India from January 1, 2011 to May 31, 2013.

Results: Of 922 surgeries, 65 had malignancy (7%). Pelvic organ prolapse (POP) (32.3%) and leiomyoma uterus (29%) were two most common benign indications for hysterectomy. Ovarian tumors were present in 13% (25% of these were malignant). Postmenopausal bleeding (PMB) was seen in 5.5% (55% of these were malignant).

Conclusions: All except 10% surgeries were done in the absence of definite histopathology diagnosis that is dysfunctional uterine bleeding (n = 42 [45%]), chronic pelvic pain/severe dysmenorrhea (n = 34 [36%]) and recurrent PMB (n = 17 [19%]). Majority of surgeries had histopathological correlation except for six cases (0.6%) of malignancy, which were missed on initial work-up. Majority of the surgeries were done abdominally. In rural areas of developing countries poverty, lack of regular follow-up, resource constraints and lack of technical skills (with respect to laparoscopic/robotic surgeries) pose major challenge in providing quality health care.

Keywords: Developing countries; histopathological correlation; hysterectomy; rural.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Total surgeries in the study period (TAH BSO: Total abdominal hysterectomy with bilateral slpingo-oopherectomy, TAH: Total abdominal hysterectomy, TAH USO: Total abdominal hysterectomy with unilateral salpingo-oopherectomy)
Figure 2
Figure 2
Indications for surgeries (*or severe dysmennorhoea)
Figure 3
Figure 3
Age wise distribution of common gynecological malignancies
See this image and copyright information in PMC

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