Case records and commentaries in obstetrics and gynaecology

Abstract

Introduction Gynaecologic surgery contributes to 16% of all surgical workload in rural Kenya (3). Most of this surgery is performed by Gynaecologist trained at Kenyatta National Hospital. The study provided a form of audit of gynaecological surgery done in the Kenyatta National Hospital, which will be useful in management of the department in terms of staff; theatre allocation and other resources, and review of competence of staff conducting training and being trained. Objective To describe the gynaecological surgeries, clinical outcome and complications over one year period at KNH from 15t January 2003 to 315t December 2003. Study design This was a retrospective descriptive study Study population Retrospectively women who had undergone gynaecological surgery in both elective and Emergency gynaecology wards between 1st January 2003 and 315t December 2003 both days inclusive. Data source Theatre registration book and patients' files from the records department. Results: The population studied was 605 and had a mean age of 32.5 years with a median of 30.0 years and a range of 6-99 years; 71.3% were married, 43% had a primary education, 46.4% were housewives and 21.8% self-employed. There were 286 (47.4%) elective surgeries and 319 (52.6%) emergency surgeries done. Majority of Emergencies (69.5%) were salpingectomies and majority (33.2%) of the electives were hysterectomies. Ectopic pregnancy was a 'cause of majority (97.8%) of the salpingectomies done and 77.5% of the hysterectomies were due to symptomatic uterine fibroids. Most of the salpingectomies were done by Registrars (92.9%) and most of the hysterectomies were done by the Senior Registrars (61.8%). Registrars did not do hysterectomy. Most of the surgeries (95.7%) were uneventful. Anesthetic complications were more common in 296 emergency surgery (0.6%) whereas wound infection (3.1%) was more common III elective surgery but the differences were not statistically significant (p>0.05). Conclusion: The majority of gynaecological operations done at KNH were emergencies. Majority of emergencies were done salpingectomy and were mainly due to ectopic pregnancy; the main surgeon doing this operation being the registrar. Majority of electives were hysterectomies due to mainly uterine fibroids and were done by senior registrars. The registrars did not do hysterectomies. Recommendations: There is a need for auditing the output of gynaecological surgery regularly. Registrars did no hysterectomies. The Registrars should be given opportunities to perform hysterectomies in anticipation of the tasks a head of their future practices at the provincial and district Hospital.