[Abdominal hysterectomy without internal peritonealization: primary vaginal closure with stapler or open and drained...

The purpose of this study was to compare the postoperative course in 127 patients undergoing abdominal hysterectomy without closure of the visceral peritoneum, who were assigned to either staple closure of the vaginal cuff or drain use. In 31 patients, the vaginal cuff was closed with absorbable staples, and in the 96 patients of the control group, vaginal drain was used. Both, the rate of postoperative complications requiring antibiotic treatment and febrile morbidity were significantly lower in the staple group. This may be attributable to the fact that primary closure of the vaginal cuff prevents bacterial contamination of the peritoneal cavity. In the drain group, two patients had to undergo laparotomy immediately postoperatively due to ileus. Because of pelvic discomfort as a late complication, one patient had to undergo pelvic reexploration, and the other patient laparoscopy-assisted adhesiolysis. It is interesting to note, that, at the time of second-look intervention, adhesion in the region of the peritoneal defect was seen in only one of these 4 patients. In the staple group, both, the surgical procedure and anaesthesia time were shorter than in the drain group; the postoperative course was comparatively uneventful, and the period of hospitalisation was reduced. Thus, we conclude, that there is a clear advantage of the use of staples over drainage for vaginal cuff treatment in abdominal hysterectomy without closure of the visceral peritoneum.