Interventions to reduce morbidity from vault hematoma following vaginal hysterectomy: a systematic review and meta-analysis

  • Suneetha RachaneniEmail author
  • Anupreet Dua
Review Article


Introduction and hypothesis

A frequent complication following vaginal hysterectomy is the formation of vaginal vault hematoma. The objective of our systematic review was to assess the impact of various interventions in reducing the incidence of vault hematoma or postoperative febrile morbidity following vaginal hysterectomy.


We carried out a systematic search of Cochrane, MEDLINE, Embase, CINAHL, HTA database, PROSPERO, meta-Register of Controlled Trials (mRCT), PubMed, CENTRAL, Google Scholar, conference abstracts, and a hand search of journals from inception until September 2018. Our search strategy included interventions in women undergoing vaginal hysterectomy with modified vault closure with inclusion of peritoneal edges, vaginal vault drainage, or vaginal packing to reduce the incidence of clinically significant vault hematomas. Two independent reviewers (SR and AD) extracted data using a structured proforma. Meta-analysis was carried out using RevMan 5.3 software.


We identified two studies on modified vaginal vault closure incorporating peritoneal edges that reported a significant reduction in vault hematoma incidence. Meta-analysis of two randomized trials on vaginal drains showed no difference in postoperative febrile morbidity secondary to vault hematoma [risk ratio (RR) 0.8, 95% confidence intervals (CI) 0.43–1.50]. Similar results were seen on meta-analysis of four randomized trials on the use of vaginal packing (RR 0.8, 95% CI 0.43–1.50).


Inclusion of peritoneal edges in vaginal vault closure may reduce the incidence of vault hematoma. The routine use of vaginal vault drainage and/or packing has not shown to reduce vault hematoma incidence or postoperative febrile morbidity. We recommend a change of practice to include peritoneal edges in vault closure based on the evidence available in our systematic review.


Vaginal hysterectomy Packing Drain Systematic review Vaginal cuff closure Vault hematoma 



We thank Professor Bob Freeman for his input into the preparation of the manuscript.

Compliance with ethical standards

Conflicts of interest


Details of ethical approval

Ethical approval was not required as this is a systematic review of published manuscripts.


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of UrogynaecologyUniversity Hospitals Plymouth NHS TrustPlymouthUK

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