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

  • Suneetha RachaneniEmail author
  • Anupreet Dua
Review Article
  • 38 Downloads

Abstract

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Vaginal hysterectomy Packing Drain Systematic review Vaginal cuff closure Vault hematoma 

Notes

Acknowledgements

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

Compliance with ethical standards

Conflicts of interest

None.

Details of ethical approval

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

References

  1. 1.
    Gupta J. Vaginal hysterectomy is the best minimal access method for hysterectomy. Evid Based Med. 2015;20(6):210.CrossRefGoogle Scholar
  2. 2.
    Gitsch G, Berger E, Tatra G. Trends in thirty years of vaginal hysterectomy. Surg Gynecol Obstet. 1991;172(3):207–10.PubMedGoogle Scholar
  3. 3.
    Thomson AJ, Farquharson RG. Vault haematoma and febrile morbidity after vaginal hysterectomy. Hosp Med. 2000;61(8):535–8.CrossRefGoogle Scholar
  4. 4.
    Kuhn RJ, de Crespigny LC. Vault haematoma after vaginal hysterectomy: an invariable sequel? Aust N Z J Obstet Gynaecol. 1985;25(1):59–62.CrossRefGoogle Scholar
  5. 5.
    Dane C, Dane B, Cetin A, Yayla M. Sonographically diagnosed vault hematomas following vaginal hysterectomy and its correlation with postoperative morbidity. Infect Dis Obstet Gynecol. 2009;2009:91708.PubMedGoogle Scholar
  6. 6.
    Thomson AJ, Sproston AR, Farquharson RG. Ultrasound detection of vault haematoma following vaginal hysterectomy. Br J Obstet Gynaecol. 1998;105(2):211–5.CrossRefGoogle Scholar
  7. 7.
    Ayeleke RO, Mourad S, Marjoribanks J, Calis KA, Jordan V. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev. 2017;6:CD004637.PubMedGoogle Scholar
  8. 8.
    Pergialiotis V, Vlachos D, Rodolakis A, Haidopoulos D, Christakis D, Vlachos G. Electrosurgical bipolar vessel sealing for vaginal hysterectomies. Arch Gynecol Obstet. 2014;290(2):215–22.CrossRefGoogle Scholar
  9. 9.
    Gupta JK, Sengupta-Giridharan R, Clark TJ. A randomized, controlled trial of open versus closed vaginal vault at vaginal hysterectomy. Acta Obstet Gynecol Scand. 2005;84(1):90–1.CrossRefGoogle Scholar
  10. 10.
    Jeppson PC, Balgobin S, Rahn DD, Matteson KA, Dieter AA, Ellington DR, et al. Comparison of vaginal hysterectomy techniques and interventions for benign indications: a systematic review. Obstet Gynecol. 2017;129(5):877–86.CrossRefGoogle Scholar
  11. 11.
    Lee SJ, Roh HJ, Cho HJ, Lee SH, Ahn JW, Kwon YS. Vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy. Gynecol Minim Invasive Ther. 2017;6(2):58–62.CrossRefGoogle Scholar
  12. 12.
    Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefGoogle Scholar
  13. 13.
    Wells G, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011.Google Scholar
  14. 14.
    Page MJ, McKenzie JE, Kirkham J, Dwan K, Kramer S, Green S, et al. Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions. Cochrane Database Syst Rev. 2014;10:MR000035.Google Scholar
  15. 15.
    Morris EP, El-Toukhy T, Toozs-Hobson P, Hefni MA. Refining surgical technique to prevent occurrence of vault haematoma after vaginal hysterectomy. J Obstet Gynaecol. 2001;21(4):379–82.CrossRefGoogle Scholar
  16. 16.
    Miskry T, Magos A. Mass closure: a new technique for closure of the vaginal vault at vaginal hysterectomy. BJOG. 2001;108(12):1295–7.PubMedGoogle Scholar
  17. 17.
    Baumgarten M, Vos C, Vervest H. Short term postoperative complications after vaginal packing, a randomised controlled study. In: ICS, Toronto, Canada. 2010.Google Scholar
  18. 18.
    Swartz WH, Tanaree P. T-tube suction drainage and/or prophylactic antibiotics. A randomized study of 451 hysterectomies. Obstet Gynecol. 1976;47(6):665–70.PubMedGoogle Scholar
  19. 19.
    Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG. 2012;119(3):348–53.CrossRefGoogle Scholar
  20. 20.
    Krishnaswamy PH, Jha MS. Efficiency of using a Foley catheter as a pelvic drain in vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2018;226:21–4.CrossRefGoogle Scholar
  21. 21.
    Urzua M, Astorquiza MRC, Braun H. Post vaginal hysterectomy packing, is it worth? Prospective randomised study. In: IUGA Annual Meeting, Dublin, Ireland. 2013.Google Scholar
  22. 22.
    Thiagamoorthy G, Khalil A, Cardozo L, Srikrishna S, Leslie G, Robinson D. Te value of vaginal packing in pelvic floor surgery: a randomised double-blind study. Int Urogynecol J. 2014;25(5):585–91.CrossRefGoogle Scholar
  23. 23.
    Westermann LB, Crisp CC, Oakley SH, Mazloomdoost D, Kleeman SD, Benbouajili JM, et al. To pack or not to pack? A randomized trial of vaginal packing after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2016;22(2):111–7.CrossRefGoogle Scholar
  24. 24.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefGoogle Scholar
  25. 25.
    Zhang Y, Alonso-Coello P, Guyatt GH, Yepes-Nuñez JJ, Akl EA, Hazlewood G, et al. GRADE guidelines: 19. Assessing the certainty of evidence in the importance of outcomes or values and preferences-risk of bias and indirectness. J Clin Epidemiol. 2018.  https://doi.org/10.1016/j.jclinepi.2018.01.013.
  26. 26.
    Zhang Y, Coello PA, Guyatt GH, Yepes-Nuñez JJ, Akl EA, Hazlewood G, et al. GRADE guidelines: 20. Assessing the certainty of evidence in the importance of outcomes or values and preferences-inconsistency, imprecision, and other domains. J Clin Epidemiol. 2018.  https://doi.org/10.1016/j.jclinepi.2018.05.011.

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of UrogynaecologyUniversity Hospitals Plymouth NHS TrustPlymouthUK

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