Preventive effect of metronidazole vaginal tablets on vaginal bacteria-related postoperative complications with total laparoscopic hysterectomy

Abstract

Background The use of total laparoscopic hysterectomy is increasing. However, as with conventional abdominal hysterectomy, vaginal bacteria-related postoperative complications need to be managed in total laparoscopic hysterectomy. Therefore, we started to combine metronidazole vaginal tablets with intravenous administration of cephem antibiotics immediately before starting surgery to reduce complications. To evaluate the effect of this combination, and to determine the risk factors for these complications, we retrospectively collected medical records from our hospital and performed a multivariate analysis. Methods We reviewed the medical records of 520 patients who underwent total laparoscopic hysterectomy from 1 January 2015 to 31 December 2021. Among these cases, we identified 16 cases as having vaginal bacteria-related postoperative complications, defined as needing more than one additional day for treatment of postoperative complications, namely postoperative infection (10 cases) and vaginal dehiscence (6 cases). First, we evaluate the effect of metronidazole vaginal tablets by dividing the patients into two groups according to whether metronidazole vaginal tablets were used, and comparing the vaginal bacteria-related postoperative complication rates and other indices. Second, we performed a multivariate logistic regression analysis to assess the influence of each of 17 representative factors, including patient characteristics and symptoms, uterus and leiomyoma sizes, concomitant procedures such as laparoscopic cystectomy and pelvic lymphadenectomy, and others. Results In the multivariate analysis of the 520 cases, we confirmed that the use of metronidazole vaginal tablets could reduce the vaginal bacteria-related postoperative complications rate by more than half (odds ratio, 0.36). In addition to metronidazole vaginal tablets use, concomitant laparoscopic cystectomy and blood transfusion were associated with significant increases in the vaginal bacteria-related postoperative complication rate. Conclusions The effect of the addition of metronidazole vaginal tablets to pre- and postsurgical treatment on the reduction of vaginal bacteria-related postoperative complications was confirmed. This easy, safe, and low-cost method may improve the management of total laparoscopic hysterectomy.

Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study

“…The representative characteristics of the procedures are as follows. 1) In our hospital, as described in the previous report [20] , in addition to intravenous 1 g cefazolin administered immediately before starting the operation, we added metronidazole vaginal tablets before and after the operation. As bowel preparation, all patients received two tablets of sennoside (24 mg) one day before operation, though vaginal culture examination were not performed before operation.…”

PROJECT PREVENT: a randomized controlled trial of preoperative vaginal metronidazole to decrease patient issues and infections after hysterectomy

“…In a recent non-randomized retrospective study, Okamura et al reported that vaginal metronidazole 250 mg tablets before and immediately after total laparoscopic hysterectomy resulted in a greater than 50% reduction in complications related to vaginal bacteria. 5 In another retrospective study of a gynecologic oncology population, Avila et al found that a single dose of preoperative vaginal metronidazole reduced the risk of pelvic (13%, 0%) and urinary infection (20%, 2.2%) after robotic radical hysterectomy. 4 In our analysis, we included urinary tract infections and then did a post hoc analysis removing these infections and still, there was no difference between groups.…”

“…3 To our knowledge, current data evaluating the efficacy of metronidazole as an adjunct to hysterectomy antibiotic prophylaxis stems mainly from non-randomized studies. [4][5][6] Infection or patient-reported issues of infection with a subsequent use of healthcare resources can become an economic burden to our healthcare system and negatively affects patient satisfaction. Therefore, the primary aim of this study was to evaluate if vaginal metronidazole use for 5 days prior to scheduled hysterectomy, decreased postoperative issues and/or infections.…”