Vault haematoma and febrile morbidity after vaginal hysterectomy

Thomson, Ajm; Farquharson, R. G.

doi:10.12968/hosp.2000.61.8.1395

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…Vault hematoma following vaginal hysterectomy can be associated with febrile morbidity and increased hospital stay. 9 Once the uterosacral cardinal ligament complex is divided there will be significant uterine descent and hysterectomy becomes easier. In our technique, only the uterosacral cardinal ligament complex is cauterized and rest of all pedicles are ligated.…”

Section: Discussionmentioning

confidence: 99%

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Nambiar

Pai

Poojari

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONHysterectomy is a most commonly performed gynaecological operation. Abdominal and laparoscopic route of hysterectomy are associated with higher costs. 1 Most hysterectomies can be completed with vaginal route. However currently only 25-30 percent of them performed vaginally.2 It is a well-established fact that vaginal hysterectomy has less complications and a better post-operative out outcome.3-5 Purohit R has devised a technique where all stumps are secured by means of electrocautery.6 Sheth S has suggested that NDVH can be in done all situations like previous caesarean section and larger uteri. 7 We slightly modified this technique and used electrocautery only for cardinal uterosacral ligament complex. Use of electrocautery for all stumps may cause more charring and tissue destruction. There can be lateral spread of the electrocautery effect and may result in more tissue damage. 8 We selectively used electrocautery for securing cardinal uterosacral ligament complex. We feel division of cardinal uterosacral ligament complex is the most difficult step in vaginal hysterectomy. Once this is done NDVH becomes easier. We present a new technique where in only uterosacral ligaments are divided after electrocauterization. We have done 21 cases of NDVH using this technique with no complications. METHODSWe did a prospective observational study among patients undergoing NDVH using this new technique. Only cases where uterine size is less than 14 weeks of pregnant uterus entered the study. Before surgery a per speculum examination was done and if cervix was visualized easily they entered the study. Cases where cervix was not easily visualized were excluded from the study. The procedure for hysterectomy consisted of the following• After putting a vaginal speculum, Cervix pulled with a vulsellum. We did not infiltrate saline adrenaline around the cervix • Vaginal walls were incised both anteriorly and posteriorly with small transverse incision • Bladder dissected of the cervix ABSTRACT Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH. Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated. Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications. Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy.

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Section: Discussionmentioning

confidence: 99%

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Nambiar

Pai

Poojari

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…The incidence of febrile morbidity is highly dependent on the definition applied. Our sample size calculation was based on an incidence of 30% as described by Thomson and Farquharson 9 in a review article. This rate represents a combined incidence of febrile morbidity ranging from 39% (for women with haematoma) to 16% (for women with no haematoma).…”

Section: Discussionmentioning

confidence: 99%

“…This was a prospective randomised study comparing the use of vault ‘drain’ with ‘no drain’ at vaginal hysterectomy. Sample size calculation, was based on an incidence of febrile morbidity of 30% as described in a review article 9 and including data from six studies relating to morbidity following VH. To demonstrate a 50% reduction in the treatment group, 135 women were required in each arm of the study (α = 0.05, β = 0.80 1:1 randomisation ratio).…”

Section: Methodsmentioning

confidence: 99%

The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial

Dua

Galimberti

Subramaniam

et al. 2011

BJOG

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Please cite this paper as: Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03170.x. Objective To evaluate the efficacy of vault drainage in reducing the immediate postoperative morbidity associated with vaginal hysterectomy carried out for benign gynaecological conditions. Design Randomised controlled trial. Setting A tertiary referral gynaecology centre in UK. Population A total of 272 women who underwent vaginal hysterectomy for benign conditions between March 2005 and June 2010. Methods The 272 women were randomised to have a drain inserted or not inserted, ‘drain’ or ‘no drain’, respectively, before vault closure during vaginal hysterectomy, using a sealed envelope technique. The surgical procedures were performed using the surgeons’ standard technique and postoperative care was delivered according to the unit’s protocol. Main outcome measures The primary outcome measure was reduction in postoperative febrile morbidity. Secondary outcome measures were hospital readmission rate, blood transfusion, change in postoperative haemoglobin and length of stay. Results In all, 135 women were randomised to have a drain and 137 to ‘no drain’. There were no differences in the incidence of febrile morbidity, length of stay, change in haemoglobin or need for postoperative blood transfusion between the two groups. Conclusions The routine use of vault drain at vaginal hysterectomy for benign disorders has no significant effect on postoperative morbidity. The use of vault drain in this context is not recommended.

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“…[44][45][46] It has been suggested that vault haematoma is an inevitable consequence of vaginal hysterectomy 45 and laparoscopic studies have confirmed that a high proportion of women undergoing vaginal hysterectomy will have evidence of bleeding at the completion of the procedure. 47 In one study 48 that assessed the pelvis laparoscopically following vaginal hysterectomy, 48% of women had evidence of bleeding; previous studies indicated an incidence of 30-98%. In this series the most common site of bleeding was the vaginal vault.…”

Section: A Disadvantage Of the Vaginal Approach: Pelvic Haematomamentioning

confidence: 99%

“…The presence of a vault haematoma can cause increased morbidity, [46][47][48] with an increased incidence of febrile morbidity, vaginal discharge, continued vaginal bleeding and occasional pelvic abscess formation. Although good haemostasis is vital during vaginal surgery, the nature of vaginal hysterectomy means that there is an increased risk of bleeding from the vaginal vault following surgery.…”

Section: A Disadvantage Of the Vaginal Approach: Pelvic Haematomamentioning

confidence: 99%

Vaginal hysterectomy in the absence of prolapse

Olàh¹

2005

The Obstetrician &Amp; Gynaecologist

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The perceived advantages of subtotal hysterectomy have not been realised and the procedure can result in continued symptoms in 10% of women. Vaginal hysterectomy should be considered the operation of choice for the majority of women with dysfunctional uterine bleeding. Many of the traditional contraindications to vaginal hysterectomy are no longer valid and the incidence of operative injury is low. Most gynaecologists have the skills required to perform vaginal hysterectomy in the absence of prolapse and there are distinct advantages to this approach. An effort should be made to encourage the next generation of gynaecologists to acquire the appropriate skills.

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Vault haematoma and febrile morbidity after vaginal hysterectomy

Abstract: Vaginal hysterectomy is associated with significant risk of vaginal vault haematoma (40%) and febrile morbidity (30%). Numerous interventions have been used to try and avoid these complications but very few have been shown to be effective.

Cited by 11 publications

References 17 publications

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial

Vaginal hysterectomy in the absence of prolapse

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