Vaginal hysterectomy is the removal of the uterus and cervix through the vagina. It is associated with less duration of hospital stay, morbidity and mortality. However, the procedure of vaginal hysterectomy is a fast disappearing art in most settings in Nigeria. 

The objective of the study was to determine the trend, prevalence, indications and outcome of vaginal hysterectomies in Federal Teaching Hospital Owerri over a 6-year period.

A-6year retrospective study of all the vaginal hysterectomies performed in the hospital between January 1, 2019 and December 31st, 2024. During the period of  review, there were 1229 major gynecological surgeries, of which vaginal hysterectomy accounted for 76, giving an incidence of 6.2%. The trend of vaginal hysterectomy over a 6-year period revealed almost a sinusoidal pattern, with the highest peak in 2022 at the rate of 22.4% and a sharp decline in the year 2023 (5.3%), and back again in 2024(19.7%). However, 2019, 2021 and 2024 showed a similar number of patients 15(19.7%). The lowest number of patients were recorded in 2020 and 2023 with 10(13.2%) and 4(5.3%) respectively. Vaginal hysterectomy was highest among women aged 60 -69 years, accounting for 46.1% of cases. About 78.9% of the studied population were grand multipara. Most of our patients were farmers (39.6%). The most common indication for vaginal hysterectomy was uterovaginal prolapse constituting 94.7% of the studied women. There was a relative absence of complications as 89.5% of the patients did not present with any identifiable complication. The complication rate was 10.5%, of which 2.6% was bladder injury and 7.9% was post operative anaemia, probably from intraoperative haemorrhage. It was shown that 92.1% of the surgeries were done by the consultant and about 7.9% done by the senior registrar, However 59.2% of the surgeries were assisted by the senior registrar and 23.7% were assisted by the consultant and 17.5% assisted by the junior registrar. There was no recorded mortality among the study population. The prevalence of vaginal hysterectomy over the said period was 6.2% with Uterovaginal prolapse being the most common indication and postoperative anaemia was the most common complication found. Most of the surgeries were done by the consultants

An abdominal, vaginal, or laparoscopic hysterectomy is a surgical surgery in which the uterus is removed.[1-3] The disease, the patient's characteristics, such as obesity and other co-morbidities, and the surgeon's expertise and preferences all influence the hysterectomy technique. [1–5] 

A vaginal hysterectomy involves removing the uterus through the vaginal method and then using a shelf of tissue from the uterus's lateral attachments to approximate the space that the uterus once filled.[6–12] 

In benign gynaecological disorders, it is linked to decreased overall morbidity and mortality, shorter hospital stays, shorter operating times, and lower patient costs.[13, 14]. For obese ladies, it is also the best option.[15, 16] The adage that the vaginal.

This was a retrospective study of vaginal hysterectomies performed at Federal Teaching Hospital Owerri, Imo State in a six-year period between January 1st 2019 to Dec 31st, 2024. The total number of major gynaecological operations, vaginal and abdominal hysterectomies was obtained from the theatre register. The patient’s identification numbers for vaginal hysterectomies were obtained and their case files were retrieved from the medical record department.

The sociodemographic characteristics of the patients, the indications for surgery, cadre of surgeon, postoperative morbidity and mortality; and the nature of complications were extracted from the patients’ case files. The data obtained were analyzed using Statistical Product and Service Solution (SPSS) version 25.

During the period of review, there were 1229 major gynecological surgeries, of which vaginal hysterectomy accounted for 76, giving an incidence of 6.2%. The trend of vaginal hysterectomy over a 6-year period revealed almost a sinusoidal pattern, with the highest peak in 2022 at the rate of 22.4%  and a sharp decline in the year 2023 (5.3%), and back again in 2024(19.7%). However, 2019, 2021 and 2024 showed a similar number of patients 15(19.7%). The lowest number of patients were recorded in 2020 and 2023 with 10(13.2%) and 4(5.3%) respectively. See tables 1, 2 and Figure 1. 

Table 1: Trend of Gynaecological surgeries and vaginal hysterectomy

Average vaginal hysterectomy rate from 2019 to 2024 in FTH Owerri is 6.2%. 

Table 2: distribution of hysterectomies in years

Figure 1: Distribution of hysterectomies done from 2019 to 2024

Vaginal hysterectomy was highest among women aged 60 -69 years, accounting for 46.1% of cases. The age range of the studied population was 29-73years with the median age of 65years (table 4 and figure 2). The most common indication for vaginal hysterectomy was uterovaginal prolapse constituting 94.7% of the studied women. (Table 3). 

Table 3: Indication for hysterectomy

Table 4: Age distribution of patients

Age range: 29-73 years

Median age:  65years.

Figure 2: Age distribution of patients.

About 78.9% of the studied population were grand multipara. Majority of our patients were farmers (39.6%), followed by traders. (25%) as noted in table 5, figure 3, and table 6, Figure 4.

Table 5: Occupation of patients

Figure 3: Occupation of patients

Table 6: Distribution of parity of patients

Figure 4: Distribution of the parity of patients

 There was a relative absence of complications as 89.5% of the patients did not present with any identifiable complication.  The complication rate was 10.5%, of which 2.6% was bladder injury and 7.9% was post operative anaemia, probably from intraoperative haemorrhage. 

Table 7: Complications of Hysterectomy

Figure 5: Complications Of Hysterectomy

It was shown that 92.1% of the surgeries were done by the consultant and about 7.9% were done by the senior registrar. However 59.2% of the surgeries were assisted by the senior registrar and 23.7% were assisted by the consultant and 17.5% assisted by the junior registrar. There was no recorded mortality among the study population. See tables 8, 9 and 10, and figures 6 and 7.

Table 8: Cadre of the Surgeon

Figure 6: The cadre of surgeon

The outcome of the surgery was excellent with no mortality recorded.

Table 9: Outcome of surgery

Table 10: Cadre of the Assistant surgeon

Figure 7: Cadre of the Assistant Surgeon

Vaginal hysterectomies accounted for 76 (6.2%) of the 1229 major gynaecological procedures carried out during the assessment period. 6.2% of all major gynaecological surgeries were vaginal hysterectomy procedures. This study's vaginal hysterectomy prevalence is significantly greater than that of Gombe (2.2%), Kano (1.1%), and Lagos (1%), as well as higher than that of Nnewi (3.7%), Ile-Ife (3.3%), and Jos (3%), [10], [8], and [21].[26], [22], and [24] Nonetheless, it was quite similar to the 8% figure cited from the United States.[23] This discrepancy most likely results from the surgeon's competence, experience, and preference as well as the lack of defined standards for choosing a surgical method. The fact that FTH Owerri is the primary referral centre in IMO State and the surrounding areas may further contribute to the high frequency.

According to the distribution in Table 2, the trend of vaginal hysterectomy over a 6-year period showed nearly a sinusoidal pattern, peaking in 2022 at a rate of 22.4%, sharply declining in 2023 at 5.3%, and then rising again in 2024 at 19.7%, as shown in Figure 1. However, a comparable number of patients (15, or 19.7%) were seen in 2019, 2021, and 2024. 2020 and 2023 saw the fewest cases, with 10 (13.2%) and 4 (5.3%), respectively. 

Table 4 and Figure 2 show that the age group of 60-69 years had the highest number of vaginal hysterectomy cases (46.1%). This study was comparable to others.[8, 10, 21], and least among the 20–29 age group (1.3%)

The rate of vaginal hysterectomy among grand multipara was 78.9%. This is to be expected as uterovaginal prolapse, the most frequent reason for vaginal hysterectomy in both our study and other studies, is more likely to occur in this group of women.[8, 10, 21, 26] They are easily at risk for uterovaginal prolapse due to oestrogen shortage and damage to the pelvic support tissues from several vaginal deliveries.[6]. The majority of our patients (39.6%) were farmers, as indicated by Table 5 and Figure 3, which may have required carrying a high load, one of the risk factors for pelvic organ prolapse.

Table 7 and Figure 5 show a relative lack of problems, with 89.5% of patients showing no discernible issues. However, the study's complications rate was roughly 10.5%, which was comparable to Ife's rate of 10.9%. [8]. Bladder damage accounted for 2.6% of the complications in our study, while postoperative anaemia accounted for 7.9%.

Table 8 and Figure 6 display the carder of surgeons that perform vaginal hysterectomy in our study. According to the data, the consultant performed 92.1% of the surgeries and the senior registrar performed roughly 7.9%. This is comparable to the findings from Jos, where the consultants performed 87% of vaginal hysterectomies and the residents performed 13%.[21] In contrast to Nnewi, where consultants performed all vaginal hysterectomies.[10] These results demonstrate that residents receive insufficient training in the technique of vaginal hysterectomy.

However, table 10 figure 7 revealed that the senior registrar assisted with 59.2% of the procedures, the consultant assisted with 23.7%, and the junior registrar assisted with 17.5%. Consequently, more resident physicians are exposed to the talent. Nonetheless, enabling more senior resident physicians to operate under the guidance of experts will aid in reversing the trend of vaginal hysterectomy in Nigeria. 

The study population did not have any mortality. Table 9, which was comparable to the Owolabi research.[8] This study's lack of mortality is consistent with prior research that found rates of less than 0.1% [12], supporting the relative safety of vaginal hysterectomy[6].