Comparison between Per-Operative Findings and Histopathological Diagnosis in Cases of Total Abdominal Hysterectomy

Résumé

Introduction: Hysterectomy is the most commonly performed gynecological surgery throughout the world as well as in our country. Many a time, the clinical and per operative diagnosis does not correlate with histopathological diagnosis. Aim of the study: The aim of the study was to correlate the indication of abdominal hysterectomy with the histopathological findings, in order to determine the percentage of pre-operative diagnosis that was confirmed on histopathology and to determine the frequency of unexpected pathologies. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Medical College and Hospital, Sher-e-Bangla Nagar, Dhaka, from July 2011 to December 2011. One hundred sixteen patients undergoing total abdominal hysterectomy for the gynecological disease were studied. Data was recorded on proformas, including clinical features. Indication for the procedure was documented. Surgical specimens were sent for histopathology and reports were analyzed and compared with the indications of surgery. Result: Commonest indication for hysterectomy was fibroid in 44.08%% followed by dysfunctional uterine bleeding (DUB) in 19.0% cases. During operation, 92.03% of fibroid uterus was found to have fibroid and the rest were found to have different pathology. Histopathological confirmation of per-operative diagnosis was 88.02% for fibroids, 94.07% for adenomyosis, 66.07% for pelvic inflammatory disease, and 54.05% for DUB. An important portion of cases (18.02%) pre-operatively diagnosed as DUB was found to have adenomyosis. Conclusion: Histopathological analysis correlates well with the pre-operative diagnosis and also with the per-operative findings during abdominal hysterectomy. Histopathology is thus mandatory for ensuring diagnosis and thus management.