A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy.
OBJECTIVE
We compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications.


METHODS
We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary's Hospital of Korea from March 2007 through February 2009. We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture.


RESULTS
All operations were completed successfully by laparoscopy. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248).


CONCLUSIONS
The two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.
Jeung
In Cheul
IC
Department of Obstetrics and Gynecology, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea.
Baek
Jong Min
JM
Park
Eun Kyung
EK
Lee
Hae Nam
HN
Kim
Chan Joo
CJ
Park
Tae Chul
TC
Lee
Yong Seok
YS
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013536:Suture Techniques; D014621:Vagina / Q000601:surgery*