title: A randomized trial of open versus closed vaginal vault in the prevention of postoperative morbidity after abdominal hysterectomy.
abstract: OBJECTIVE
  Our purpose was to evaluate the effects of two surgical techniques, closed vaginal vault with two layers of continous 3-0 polyglactin suture versus open vaginal vault with a locking 3-0 polyglactin suture, after abdominal hysterectomy.
  
  
  METHODS
  A prospective, randomized trial was performed. During the hospital stay and 4 to 8 weeks after the operation patients were observed for evidence of morbidity.
  
  
  RESULTS
  Of the 273 evaluable subjects, 141 had the vaginal vault left open whereas 132 were closed. Ten (7.1%) and eight patients (6.1%) had infections at the operative site (pelvis or abdominal wound) (p = 0.92). A urinary tract infection was diagnosed in three (2.1%) and in four subjects (3.0%) (p = 0.46). A pelvic hematoma developed in two patients of each group (p = 0.66). Vault granulations were recorded in 11% and 12% of subjects (p = 0.97).
  
  
  CONCLUSIONS
  This study failed to show some benefit in favor of either of the two surgical policies. A careful surgical technique and antibiotic prophylaxis seem to remain the most important factors in the prevention of postoperative morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, University of Milan, San Gerardo Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Colombo
authors.forename: A
authors.initials: A
authors.lastname: Maggioni
authors.forename: A
authors.initials: A
authors.lastname: Zanini
authors.forename: G
authors.initials: G
authors.lastname: Rangoni
authors.forename: S
authors.initials: S
authors.lastname: Scalambrino
authors.forename: C
authors.initials: C
authors.lastname: Mangioni
mesh_terms: D000328:Adult; D005260:Female; D006406:Hematoma / Q000517:prevention & control; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*