Vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy

Abstract

Study objective: To evaluate the feasibility and safety of vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH). Design: Retrospective cohort study. Setting: Ulsan University Hospital (tertiary teaching hospital), South Korea. Patients: A total of 359 women underwent SPA-LAVH for the following conditions: benign uterine tumor, preinvasive uterine lesion, and microinvasive cervical cancer. Interventions: The participants included 124 women with vault drains and 235 women without drains. Measurements: Surgical outcomes, perioperative complications and morbidity, postoperative febrile morbidity. Results: There were no differences in background features between drain and no-drain groups. In surgical outcomes, mean uterine weight (364.2±184.9 g vs. 263.7±138.6 g; p<0.001), operation time (87.4±21.5 min vs. 73.0±17.6 min; p<0.001), blood loss (225.3±122.2 mL vs. 150.4±95.2 mL; p<0.001), and hemoglobin decline (1.97±0.96 g/dL vs. 1.42±0.89 g/dL; p<0.001) were significantly larger for the drain group compared with the no-drain group. However, with regard to postoperative morbidity and complications, there were no group differences in the transfusion rates (6.5% vs. 3.8%; p=0.300), intraoperative complications (2.4% vs. 1.3%; p=0.420), perioperative complications (2.4% vs. 0.9%; p=0.345), and febrile morbidity ≥ 37.5°C (8.9% vs. 11.5%; p=0.477), although the drain group was more prone to the development of pelvic fluid collection and febrile morbidity than the no-drain group. Conclusion: Vaginal vault drainage could be a safe alternative that allows for the management of postoperative morbidity and retains the advantages of minimally invasive surgery after complicated SPA-LAVH.

Keywords

• febrile morbidity
• hysterectomy
• pelvic fluid collection
• single-port access laparoscopy
• vaginal vault drainage