· Frequency

During our study period, we recorded 10,575 gynaecological outpatient consultations. Of these consultations, 256 cases were related to uterine fibroids and 109 or 42.6% were received surgical management.

· Socio-demographic characteristics

Age

The age distribution of the patients is shown in Figure 1.

The average age was 38.9 ± 7.8 years with extremes of 25 and 59 years. Patients between 30 and 40 years of age constituted 47.7%.

Number of pregnancies, deliveries, and marital status

The average number of pregnancies was 2.1. Patients with at least two pregnancies represented 59.6% of the population and those with at least two deliveries 51.4%. Women with a marital life represented 77.1%.

Occupancy

Patients with a paid activity (Employee + worker in the informal sector) accounted for 79.8%.

The distribution of patients according to the reasons for consultation is presented in Figure 2.

The reasons for consultation were isolated or associated. Pelvic pain associated with metrorrhagia accounted for 46.8% and hypofertlity 31.2%.

Ultrasound

Ultrasound was performed in all patients. It showed 247 fibroids, 115 of which were located in the interstitial lining of the uterus. The corporal segment contained 226 fibroids. Concerning the size, 140 fibroids were smaller than 5 cm. The distribution of the number of fibroids according to topography and size in the uterus is shown in Table 1.

· Surgical indication

Haemorrhagic myoma and hypofertility accounted for 43.12% and 32.11% of

the indications for surgery respectively. The distribution of patients according to the indication for surgery is shown in Table 2.

· Approach

Laparotomy was performed in 105 patients, i.e. 96.3%, all with a Pfannenstiel-type incision, and the vaginal route in four patients.

· Type of intervention

The interventions performed were myomectomy in 58.7%, hysterectomy in 27.4% and bistournage in 13.9% of cases.

· Anatomopathological results

Anatomopathological results were available for 30 patients. Uterine leiomyoma was found in 100% of cases.

We observed 25 cases of complications, i.e. 22.9% of patients operated on. These were intraoperative complications (13.8%) and postoperative complications (9.1%).

· Intraoperative complications (n = 15)

They were mainly represented by haemorrhage in 7 cases and uterine effraction in 6 cases (Table 3).

· Postoperative complications (n = 10)

These were haemorrhages in 6 cases or 5.5%, urinary tract infections and thrombophlebitis of the lower limbs with 2 cases each or 1.8%.

The average length of hospitalization was 04 days ± 1.4 with extremes of 02 and 10 days.

The hospital frequency of uterine fibroids treated surgically was 42.6%. This frequency seems high because in the majority of cases the uterine fibroid is asymptomatic [8] [9] . In our African context, because of the delay in consultation, fibroids are discovered during complications such as metrorrhagia, compression of neighboring organs with its multiple consequences requiring surgery as a therapeutic alternative. Our results are similar to those obtained in most African studies such as Baldé et al. [6] in 2015 in Guinea, Coulibaly et al. [7] in 2015 in Mali which also found high frequencies of 42.4% and 48.88% respectively.

The mean age of patients was 38.9 years. It is a pathology whose incidence

increases with age in women during genital activity [10] . On the other hand, the lack of financial means, the fear of surgery are other factors that could explain the delay in surgical management. Our results are similar to those found by Tiemtoré et al. at the CHU of Bogodogo in Burkina [11] and Koffi et al. [12] in Côte d’Ivoire which found respectively an average age of 37 years and 37.5 years.

The reasons for consultation were dominated by uterine haemorrhage (53.1%), pelvic pain (40.4%) and subfertility (31.2%). This high frequency of genital bleeding could be explained by the fact that glandular hyperplasia created by estrogen-progestin imbalance, and the mechanical pressure exerted by myomas lead to favorable bleeding conditions [8] . The role of uterine myomas as a causative factor for infertility seems logical. Several mechanisms can explain infertility, including obstruction of tubal orifices and modification of the uterine cavity by submucosal fibroids [13] . The rate of infertility related to uterine fibroids cited in the literature ranges from 5% to 10% [13] . In our series, the high proportion of subfertility could be explained by the delay in management allowing time for obstruction of the tubal orifices and modification of the uterine cavity. Our results are similar to those of Baldé et al. [6] in Guinea which also reported genital bleeding as the main reason for consultation in 85.8% of cases. Our results support the literature evidence that genital bleeding is the essential telltale functional manifestation of uterine fibroids [14] .

· Indications for surgical treatment

Haemorrhagic myoma was the main operative indication (50.4%). According to Foulot et al. [15] , myomectomies are mainly intended for women of childbearing age whose myomas are symptomatic (menorrhagia or menometrorrhagia, pelvic pain and signs of compression of neighboring organs...). Myomectomy is rarely performed after menopause except for a single fibroid that is interstitial and hemorrhagic or subserous pedunculated and painful [10] . Hysterectomy is indicated in case of polymyomatous uterus in a multiparous, in case of associated pathologies such as adenomyosis or adnexal pathology or in case of menorrhagia rebellious to conservative treatment.

· Types of surgical treatment

The treatment of uterine fibroids has evolved in recent years. The sole purpose of medical treatments is to treat myoma-related symptoms [16] . Surgical treatment is still a very important component, and in recent years it has benefited from the contribution of new endoscopic techniques. A technique using high-intensity focused ultrasound under ultrasound guidance could revolutionize the management of fibroids. Called HIFU (High Intensity Focused Ultrasound), it has the advantage of being non-invasive, to be able to be performed on an outpatient basis under simple sedation and to cause few complications. Myomectomy and hysterectomy were the types of procedures performed in our study due to insufficient technical platform. This could explain the long hospitalization of our patients (4 days on average). Myomectomy in general was performed in 76.1% and hysterectomy in 23.9% of cases. Indeed, while hysterectomy eliminates the possibility of recurrence, it is still not chosen by patients who, even in the absence of desire for pregnancy, the idea of wanting to keep one’s uterus makes prefer the choice of a myomectomy. This high frequency of myomectomy practice in our series is comparable to those obtained by Baldé et al. [6] in Guinea and Hamad et al. in Mauritania [17] which also found a higher frequency for the practice of myomectomy with respectively 70% and 75% of cases. Laparotomy was the most commonly used route in our study (95.4%). This result is comparable to that obtained by Hamad et al. in Mauritania [17] who reported a laparotomy in 100% of cases. Hysteroscopic and laparoscopic pathways are methods that were not used in our series due to the insufficiency of the technical platform.

Intraoperative complications were observed in 13.8% of cases, mainly represented by haemorrhages and uterine intrusion, and postoperative complications in 9.1% of cases, also dominated by hemorrhages.

These data seem high and require special attention in the management of myomas. Thus, Davitian et al. stipulate that the use of agonists of Gonadotropin releasing hormone (Gn-RH) in preoperative seems to allow, via a reduction of uterine volume by vascular rearrangements of the myometrium, a decrease in intraoperative haemorrhage [18] .

Our study had some limits related to the incompleteness of the data and the low availability of histopathological test results.

Despite these limitations, we arrived at results that allowed us to conduct a discussion in comparison with those presented by other authors.