Variations in Estimated Blood Loss During Longitudinal Vaginal Septum Excision: Monopolar Cautery versus Vessel...

Longitudinal vaginal septum (LVS) is a congenital anomaly; in symptomatic adolescents, the septum may be excised. We aimed to evaluate whether estimated blood loss (EBL) and postoperative complications differed between LVS excision with monopolar electrocautery versus with an advanced bipolar device. We hypothesized that EBL and complications would be low with both techniques.

This IRB-approved retrospective study included patients who underwent LVS excision by the gynecology division at a single pediatric tertiary care institution from 2012 to 2026. Demographic and clinical characteristics, surgical instrument(s) used, EBL, and postoperative complications occurring through the initial postoperative visit were abstracted from the chart.

During the study period, 47 patients underwent LVS excision with either cautery or a vessel sealing device; vaginal mucosa was oversewn in all cases. Thirty-three patients (70%) underwent cautery, 13 (28%) underwent vessel sealing, and 1 (2%) underwent both. Mean EBL was not significantly different between techniques (cautery 13 ml vs. vessel sealing 4 ml, P = .067). Complications were rare across methods. Eight (17%) patients presented to the emergency department at a mean of 13 days postoperatively. Of these, 4 presented for vaginal bleeding, 2 from each study group. Only 2 patients, one each from each study group, required revision for postoperative vaginal bleeding.

Use of monopolar cautery or a vessel sealing device both appear to be safe techniques for performing LVS excision. Surgeons may consider the utilization of several different techniques, including possible oversewing of the vaginal mucosa.