Comparison of copolymer staple versus chromic suture during hysterectomy: gross, histologic, and microbiologic findings.
Mechanical stapling of the vaginal cuff during hysterectomy has been proposed as a way to minimize bacterial contamination, thereby reducing infectious morbidity and hospital stay. Twenty-four pathogen-free New Zealand white rabbits underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy using either chromic suture or copolymer staple to close the vaginal cuff. Aerobic and anaerobic cultures were obtained from the peritoneal cavity upon entering, and from the vaginal cuff during the initial operation and on postoperative day 3 or 8. When compared with chromic suture, stapling of the vaginal cuff during hysterectomy did not result in significant reduction of postoperative bacteria isolated from the vaginal cuff or peritoneal cavity. In addition, copolymer staples were associated with histologic evidence of more extensive necrosis and cellular exudate while significantly increasing adhesion formation between the vaginal apex and surrounding viscera. Stapling the vaginal cuff does not significantly reduce bacterial count after hysterectomy, significantly increases adhesion formation, and may interfere with normal wound healing in an animal model.
McNeeley
S G
SG
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Elkins
T E
TE
Portz
D M
DM
Warren
J
J
DeLancey
J O
JO
D000818:Animals; D001419:Bacteria / Q000302:isolation & purification; D005260:Female; D007044:Hysterectomy; D010529:Peritoneal Cavity / Q000382:microbiology / Q000473:pathology; D011817:Rabbits; D013528:Surgical Staplers / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects; D000267:Tissue Adhesions; D014621:Vagina / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D014945:Wound Healing