Surgical treatment of benign gynecological disorders

BACKGROUND: All of Norway's inhabitants are entitled to health services of a good and equal quality. The aim of this study was to evaluate whether women with benign gynaecological disorder are treated according to this principle. Guidelines recommend that the laparoscopic technique should be used to operate ectopic pregnancies and ovarian cysts. Vaginal or laparoscopic technique should be used for hysterectomies. MATERIAL AND METHODS: Recording of surgical modality used in gynaecological departments in Norway to treat ectopic pregnancies, ovarian cysts and hysterectomies on the indication bleeding disorders and/or fibroids. Data were retrieved from the National Patient Register for the years 2003 - 06. RESULTS: The proportion of operations performed with laparotomy was gradually reduced for the conditions assessed during the period of observation. 24 % of women with ectopic pregnancies were operated with laparotomy in 2003 and 14 % in 2006; 50 % of women with ovarian cysts were operated with the technique in 2003 and 41 % in 2006. For hysterectomies due to bleeding disorders and/or fibroids, the frequency of laparotomies decreased from 75 % in 2003 to 62 % in 2006. Adherence to guidelines is best in departments that perform many operations. INTERPRETATION: Different surgical approaches are used to treat the same benign gynecological disorders in Norway. The reason for this difference has not been evaluated, but it may be explained by tradition, lack of competence and inadequate training of gynecologists.