Vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy

Abstract

Study objective:To evaluate the feasibility and safety of vaginal vault drainage after complicated singleport access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH).Design:Retrospective cohort study.Setting:Ulsan University Hospital (tertiary teaching hospital), South Korea.Patients:A total of 359 women underwent SPA-LAVH for the following conditions: benign uterine tumor, preinvasive uterine lesion, and microinvasive cervical cancer.Interventions:The participants included 124 women with vault drains and 235 women without drains.Measurements:Surgical outcomes, perioperative complications and morbidity, postoperative febrile morbidity.Results:There were no differences in background features between drain and no-drain groups. In surgical outcomes, mean uterine weight (364.2 ± 184.9 g vs. 263.7 ± 138.6 g; p < 0.001), operation time (87.4 ± 21.5 min vs. 73.0 ± 17.6 min; p < 0.001), blood loss (225.3 ± 122.2 mL vs. 150.4 ± 95.2 mL; p < 0.001), and hemoglobin decline (1.97 ± 0.96 g/dL vs. 1.42 ± 0.89 g/dL; p < 0.001) were significantly larger for the drain group compared with the no-drain group. However, with regard to postoperative morbidity and complications, there were no group differences in the transfusion rates (6.5% vs. 3.8%; p = 0.300), intraoperative complications (2.4% vs. 1.3%; p = 0.420), perioperative complications (2.4% vs. 0.9%; p = 0.345), and febrile morbidity ≥ 37.5°C (8.9% vs. 11.5%; p = 0.477), although the drain group was more prone to the development of pelvic fluid collection and febrile morbidity than the no-drain group.Conclusion:Vaginal vault drainage could be a safe alternative that allows for the management of postoperative morbidity and retains the advantages of minimally invasive surgery after complicated SPA-LAVH.

Vaginal vault drainage as an effective and feasible alternative in laparoscopic hysterectomy

“…Another retrospective study evaluated the efficacy and safety of vaginal vault drainage after a complicated single-port access laparoscopic-assisted vaginal hysterectomy. Although there was a tendency for patients with vaginal drainage to develop pelvic fluid collection and febrile morbidity occurred more frequently than that in patients without drainage, the differences were minimal regarding transfusion rates, intraoperative and perioperative complications, and febrile morbidity [ 10 ]. In contrast, a retrospective study found that leaving a patent tract in the vaginal vault instead of a complete closure significantly reduced the possibility of pelvic hematoma infection after a vaginal hysterectomy.…”