Surgical intervention for uterine fibromyoma in a country with limited resources: case of the gynaecology-obstetrics department of the Communal Medical Centre of Ratoma Conakry (Guinea)

Abstract

Objectives : The objectives of the study were to calculate the frequency of uterine fibromyomas, describe the socio-demographic characteristics of patients , identify the main clinical data and to describe the modalities of surgical management.

Patients and Method : It was a mixed descriptive study, cumulative over a period of 5 years (60 months) with data collection in two phases: a 4-year retrospective study and a 1-year prospective study.

Results : We collected 135 cases of uterine fibromyomas operated on out of a total of 260 cases of gynaecological pathologies, i.e. a frequency of 51.92%. Nulliparous women were the most concerned (45.18%), , and women who attended school (60%) and those who did not attend school (40%). Women at home and housewives accounted for 42.20% and 54.07% respectively. Clinically, the circumstances of discovery were dominated by menometrorrhagia and menorrhagia respectively 77.77% and 68.14%. The large uterus was the most frequent physical sign found in 96.29% of cases. Uterine fibromyomas were recorded in 86.6% of cases in women with genital activity. The operative indications were dominated by the large polymyomatous uterus (64.44%), followed by hemorrhagic fibroma (18.52%) The surgical treatment was conservative in 92.60% . The total hysterectomy was performed in 7.40.  Lethality was 1,4%.

Conclusion : The surgical management of fibroids contrasts conservative treatment (myomectomy) with radical treatment (hysterectomy) with multiple possible approaches (hysteroscopy, vaginal surgery, laparoscopy or laparotomy). In our context, only laparotomy was possible due to lack of equipment. Laparoscopy and hysteroscopy equipment is necessary for less invasive surgery.