Abdominal versus Vaginal Hysterectomy: A Comparative Study at a Sub-Saharan Referral Hospital

Abstract

Background: Hysterectomy is a common gynecological procedure, with the vaginal route and minimally invasive techniques preferred in high-income countries due to better outcomes. In contrast, low- and middle-income countries (LMICs), including Cameroon, still predominantly use the abdominal approach, often due to limited surgical training, late-stage presentations, and infrastructural constraints. Given the lack of recent comparative data in this setting, this study evaluates perioperative and postoperative outcomes of both approaches at a major referral hospital in Sub-Saharan Africa. Objective: To compare perioperative and postoperative outcomes between abdominal and vaginal hysterectomy at the Douala General Hospital. Methods: This cross-sectional study included 215 patients who underwent hysterectomy (abdominal or vaginal) between January 1, 2019, and December 31, 2023. Data were extracted from patient files and analyzed using means (±SD) for quantitative variables and percentages for qualitative variables. Chi-square and Fisher’s exact tests were used for comparisons (significance at p ≤ 0.05). Results: The mean age was (49.65 ± 8.63) years, with an average parity of 3.69. Abdominal hysterectomy accounted for 88.8% of cases, while vaginal hysterectomy represented 11.2%. Primary indications were uterine fibroids (55.5%, abdominal) and cervical dysplasia (41.7%, vaginal). Compared to vaginal hysterectomy, abdominal hysterectomy had: 1) Longer operative time (184 vs. 136 minutes, p Conclusion: Despite the predominance of abdominal hysterectomy in our setting, vaginal hysterectomy demonstrates superior outcomes, including shorter surgery duration, reduced costs, faster recovery, and fewer complications. These findings underscore the need to prioritize vaginal hysterectomy training and adoption in LMICs where feasible.