Impact of vertical versus horizontal vaginal cuff closure on vaginal length following hysterectomy: a meta-analysis of randomized trials

  • Vasilios PergialiotisEmail author
  • Georgios Daskalakis
  • Nikolaos Thomakos
  • Dimitrios Haidopoulos
  • Dimitrios Loutradis
  • Alexandros Rodolakis
Review Article


Introduction and hypothesis

Posthysterectomy vaginal length has been previously associated with postoperative sexual dysfunction, but evidence for this in the literature is controversial. The purpose of this meta-analysis was to investigate whether vertical or horizontal closure of the vaginal cuff has a direct effect on posthysterectomy vaginal length and on postoperative sexual dysfunction.


The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Medline, Scopus,, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar databases.


Overall, five randomized trials were included in this meta-analysis with 223 patients. The results suggest that horizontal closure of the vaginal cuff results in a shorter vaginal length compared with vertical closure [mean difference (MD) −0.77 cm, 95% confidence interval (CI) −1.12 to −0.43]. Mean vaginal length significantly decreased when the horizontal method was used (MD −0.61 cm, 95% CI −0.97 to −0.24). The subgroup analysis revealed that vertical closure was associated with longer vaginal length only in cases treated with vaginal hysterectomy. Trial sequential analysis revealed that our meta-analysis had adequate power to support these results. Postoperative sexual function was evaluated in only one study; no differences were observed.


Findings of our meta-analysis suggest that horizontal closure of the vaginal vault results in shorter vaginal length in vaginal hysterectomies; thus, we suggest that this technique be avoided. Data concerning quality of life of patients and specifically sexual dysfunction remain extremely limited and should be studied in future trials.


Horizontal Vertical Vaginal cuff Hysterectomy Dyspareunia Meta-analysis 


Compliance with ethical standards

Conflicts of interest


Research involving human participants and/or animals

This systematic review and meta-analysis are based on previously published aggregated data.

Institutional review board approval

An IRB approval was not needed because this study used previously published aggregated data.

Informed consent

Formal consent is not required for this type of study.

Supplementary material

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ESM 1 (JPG 616 kb)
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ESM 2 (JPG 734 kb)


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Laboratory of Experimental Surgery and Surgical Research N.S ChristeasNational and Kapodistrian University of AthensHalandriGreece
  2. 2.1st Department of Obstetrics and Gynecology, Alexandra HospitalNational and Kapodistrian University of AthensAthensGreece

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