Evaluating retrograde hysterectomy in the surgery of pelvic gynaecologic diseases in Nigeria.

A modified technique of total abdominal hysterectomy in the presence of gross distortion of pelvic anatomy with displacement of vital structures by chronic pelvic inflammatory disease with or without tubo-ovarian abscess formation and adherent giant myomas of the uterus is described. In the 16 cases personally operated upon by the author there were no major operative or post-operative complications. Experience with this procedure is reviewed and its wider use advocated. The removal of the uterus and adnexa by the abdominal route is one of the commonest procedures in gynaecological practice. The technique is fairly well standardized and is a relatively simple operation provided that the surgeon has a thorough knowledge of the anatomy of the pelvic organs. In our practice at Ibadan, it is fair to say that the uterus of normal size and mobility to which most textbook descriptions of technique apply forms a minority of the cases presenting for total abdominal hysterectomy. Experience has shown that there is a high incidence of chronic pelvic inflammatory disease with or without tubo-ovarian abscess formation, adherent giant myomas of the uterus, cervical and intra-ligamentous fibroids and cysts and enlarged adherent benign ovarian tumours in the community. These may cause distortion of pelvic anatomy with displacement of the ureters, bladder, colon and rectum from their normal position. Experience has shown that urinary tract and colonic injuries may occur at operation when the pelvic anatomy is grossly distorted making true anatomical dissection often impracticable. Operative treatment can be very difficult in these instances and success depends on correct surgical technique with suitable instruments and personal experience, the necessary versatality and skill developed with practice. Various techniques for abdominal hysterectomy have been developed and reported (Richardson, 1929; Farrar, 1935; Aldrige, and Meredith 1950; Gray, 1958; Murless, 1963; Cabaniss, and Gill, 1964). The technique to be described was originally developed by Bonny (Macleod and Howkins 1964) except for minor modifications and has been used exclusively by the author in the last three years in selected cases with gross pelvic anatomic distortion where the conventional method of abdominal hysterectomy is impracticable. This improved surgical technique has decreased the hazards of pelvic surgery tremendously in difficult hysterectomies in my practice.