The influence of suture material on vaginal vault granulations following abdominal hysterectomy

Abstract

Summary. A questionnaire was circulated to 1147 members (consultant status) and fellows of the Royal College of Obstetricians and Gynaecologists to survey the current management of the vaginal vault following abdominal hysterectomy. Of the 56% who responded, the majority (87%) routinely close the vault. An interrupted mattress suture is used by 60%, a continuous suture by 43% and the Lembert suture by 2%. Chromic catgut is favoured by 60%, a synthetic polymer by 33% and plain catgut by 6%. We then organized a prospective, randomized trial involving 114 women who underwent total abdominal hysterectomy for benign indications. No. 1 polygalactide (Vicryl) was used in 58 women, and No. 1 chromic catgut in 56. Overall, 37 (32%) had vault granulations 6 weeks post‐operatively. Chromic catgut had been used in 25 (68%) and polygalactide in the remaining 12 (32%) (P= 0·01). Only 2 (5%) of these women denied any symptoms, while the rest complained of vaginal discharge, bleeding or both. Neither the patients' age, weight or parity, nor the status of the surgeon influenced the occurrence of granulations. We conclude that the widespread use of chromic catgut revealed by our survey is unacceptable: polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut.

Vaginal Cuff Closure: A Comparison between the Vaginal Route and Laparoscopic Suture in Patients Undergoing Total Laparoscopic Hysterectomy

“…When chromic catgut was used for the vaginal vault, granulation occurred in 10.8% of patients. When polyglactin was used, the frequency was reduced to 2.7% [21]. This might be due to the characteristically low tissue reaction during absorption associated with polyglactin.…”

Bladder, bowel and sexual function after hysterectomy for benign conditions

“…found a lower morbidity rate with subtotal compared with total hysterectomy and reported that wound infections, haematomas and urinary tract infections may be less common. Vault granulations do not occur with subtotal hysterectomy while they complicate 21% of total hysterectomies 34 . However, in general, the British gynaecologist has a negative view to subtotal hysterectomy.…”

Preventable gynecological surgeries in hysterectomized women : a review of causes and measures of prevention

“…As early as 1990's it was found that polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut. 29 Staplers (absorbable) also has lower frequency of postoperative granulation tissue at the apex of the vaginal vault and vaginal discharge during 12 weeks of followup. 30 Siedhoff et al have observed a lower incidence of vaginal cuff dehiscence, postoperative bleeding, presence of granulation tissue and cuff cellulitis when bidirectional barbed suture was used in the laparoscopic vaginal suturing after hysterectomy and trachelectomy.…”