title: Comparison of one- and two-layer vaginal cuff closure and open vaginal cuff during laparoscopic-assisted vaginal hysterectomy.
abstract: OBJECTIVE
  To evaluate clinical outcomes of three surgical techniques during laparoscopic-assisted vaginal hysterectomy.
  
  
  METHODS
  Prospective, randomized study (Canadian Task Force classification I).
  
  
  METHODS
  Medical school-affiliated hospital.
  
  
  METHODS
  Four-hundred twenty-seven women.
  
  
  METHODS
  By means of a computer-generated randomization code, patients were assigned immediately before operation to one of three groups according to type of surgical procedure: group 1, 147 women having one-layer closure of the vaginal cuff; group 2, 138 having two-layer closure of the vaginal cuff; and group 3, 142 having open vaginal cuff.
  
  
  RESULTS
  Patients were observed for morbidity during hospitalization, and 1 and 6 weeks and 6 months postoperatively. No significant differences were found among the groups for length of surgery, operative blood loss, postoperative hematocrit, length of hospital stay, postoperative febrile morbidity, frequency of pelvic and urinary tract infection, dyspareunia, postcoital spotting, vaginal discharge, and morbidity of the cuff (cellulitis, abscess formation, bleeding, hematoma, dehiscence). Operating time was greatest for two-layer closure. The frequency of postoperative granulation of cuff tissue and vaginal discharge was greater for group 1 than for the other two groups.
  
  
  CONCLUSIONS
  Two-layer closure of the vaginal cuff during laparoscopic-assisted vaginal hysterectomy is associated with fewer instances of vaginal vault granulation and vaginal discharge than either one-layer closure or open vaginal cuff.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 4F-4, 123-6, Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan.
authors.forename: Chung-Chang
authors.initials: CC
authors.lastname: Shen
authors.forename: Te-Yao
authors.initials: TY
authors.lastname: Hsu
authors.forename: Fu-Jen
authors.initials: FJ
authors.lastname: Huang
authors.forename: Cherng-Jau
authors.initials: CJ
authors.lastname: Roan
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Chang
authors.forename: Shiuh-Young
authors.initials: SY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013528:Surgical Staplers; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D014945:Wound Healing / Q000502:physiology