Comparison of one- and two-layer vaginal cuff closure and open vaginal cuff during laparoscopic-assisted vaginal hysterectomy.
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.
Shen
Chung-Chang
CC
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 4F-4, 123-6, Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan.
Hsu
Te-Yao
TY
Huang
Fu-Jen
FJ
Roan
Cherng-Jau
CJ
Weng
Hsu-Huei
HH
Chang
Hsueh-Wen
HW
Chang
Shiuh-Young
SY
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