Conservative treatment of vaginal vault granulation tissue following total abdominal hysterectomy

To study the incidence, symptoms and spontaneous regression rate of vault granulation tissue in relation to their sizes following total abdominal hysterectomy for benign conditions.

Prospective descriptive study; 352 patients who underwent total abdominal hysterectomy for benign conditions between September 1995 and April 1996 were included. All patients with vault granulation tissue were followed up until the 20th week after the operation. The main outcome measures were incidence of vault granulation tissue, symptoms, sizes of lesions, spontaneous regression rate and relationship between size and regression rate.

The incidence of vault granulation tissue was 34%. Nearly 60% of the lesions were < or = 5 mm. Spontaneous regression occurred in 52% of the cases. If the lesion was < or = 5 mm the chance of it to completely disappear was 72% whereas the same would happen in only 33% if the lesion was > 5 mm (P < 0.01, significant). Although only 7% of the patients with lesions < or = 5 mm had symptoms as compared to 18% of those with lesions > 5 mm; the difference was not statistically significant.

Vault granulation tissue is a common complication, occurring in approximately one-third of patients who had total abdominal hysterectomy. The results of our study suggests that if the lesions are small (< or = 5 mm) it would be reasonable to leave them alone as few give symptoms and most regressed spontaneously; saving the patients' time, inconvenience, expenses and discomfort.