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Vaginal cuff closure technique and the risk for infected pelvic hematoma after vaginal hysterectomy
Ido Feferkorn1, Meirav Schmidt1, Yakir Segev1
1Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
Insights
Leaving the vaginal cuff open after vaginal hysterectomy significantly reduced infected pelvic hematoma rates. This surgical technique allows drainage, decreasing postoperative complications and hospitalizations.
Area of Science:
- Gynecology
- Surgical Innovation
- Pelvic Health
Background:
- Infected pelvic hematoma is a frequent complication after vaginal hysterectomy.
- This complication often leads to postoperative pain, fever, and the need for surgical drainage.
Purpose of the Study:
- To evaluate how different vaginal cuff closure techniques impact the incidence of infected pelvic hematoma.
- To compare outcomes between complete closure and leaving a patent tract for drainage.
Main Methods:
- A retrospective review of medical records for women undergoing vaginal hysterectomy for pelvic organ prolapse between 2006 and 2015.
- Comparison of infected pelvic hematoma rates before (complete closure) and after (patent tract) March 31, 2010.
Main Results:
- 325 women in the complete closure group (Group I) and 243 in the patent tract group (Group II).
- Group II showed a significantly lower incidence of infected pelvic hematomas requiring hospitalization (3.8% vs. 13.5%, p<0.0001).
- Demographic and clinical data were comparable between groups.
Conclusions:
- Employing a surgical technique that maintains a patent vaginal cuff tract for drainage significantly reduces infected pelvic hematoma incidence.
- This approach offers a simpler method to decrease postoperative complications following vaginal hysterectomy.
Objectives:
Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication.
Study Design:
Until March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010.
Results:
We identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001).
Conclusions:
A significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.
