Hysteroscopic surgery at the Aga Khan Hospital, Nairobi.

OBJECTIVES To determine the experience, acceptability and outcome of hysteroscopic surgery at the Aga Khan Hospital, Nairobi. DESIGN A retrospective study. SETTING Aga Khan Hospital, Nairobi. PATIENTS Between May 2000 and April, 2003, 463 cases of hysteroscopy were undertaken at the Aga Khan Hospital, Nairobi, of these 54 patients (11.7%) underwent various hysteroscopic surgical procedures. A review of these cases and their outcomes are analysed and presented. RESULTS In a thirty six month period 463 cases of Hysteroscopy were done at the Aga Khan Hospital, Nairobi. Of these 54 cases had operative intervention (11.7%). The case load of diagnostic hysteroscopy increased from 50 in the year 2000, to 206 and 159 respectively in the years 2001 and 2002. By this time, some consultants were performing diagnostic hysteroscopies on their own. The surgical procedures performed included hysterscopic retrieval of "lost" IUCD's, and intrauterine bone spicules and hysteroscopic resection of submucous fibroids (25.9% of the cases), resection of endometrial polyps (25.9%) hysteroscopic synechiolysis, (16.6%) and endometrial resection or ablation (cauterisation) (7.4%). All the patients were reviewed by the consultant pool after one week. Three cases of complications were encountered, two cases of uterine perforation and one case of fluid overload (TURP syndrome) following a resection of a submucous fibroid. CONCLUSION Hysteroscopy and hysteroscopic surgery are the established gold standards for the management of intrauterine pathology. The procedures were well accepted amongst patients who had undergone these procedures. RECOMMENDATIONS In Kenya, gynaecologists still have to embrace change and undergo adequate and sustained training in the various aspects of hysteroscopy, so as to make the proecdures acceptable and accessable to more patients.