Is it necessary to close the visceral peritoneum over the vaginal vault during total abdominal hysterectomy ?

Abstract EN

Aim of the Work: To assess whether the outcome after closing the visceral peritoneum covering the vaginal vault during total abdominal hysterectomy (TAH) is better compared to non-closure.

Design^ A controlled randomized trial.

Subjects and Methods: Seventy-three patients undergoing TAH for various indications were randomized to either closure (n = 36) or non-closure (n = 37) of the visceral peritoneum covering the vaginal vault.

Post-operative assessment of vaginal bleeding, occurrence of urinary complications, fever, vaginal vault haematoma and granuloma was done.

Follow-up after 6 and 12 months was done looking for vault granuloma and/or prolapse.

Results: There was no statistically significant difference in post-operative vaginal bleeding in the 2 groups, as well as the incidence of urinary complications, fever, or vaginal vault granuloma.

The incidence of vaginal vault haematoma was higher in the closure group (13/36) compared to the non-closure group (5/37) (P< 0.05).

After 6 and 12 months, there were no vault granulomata or prolapse recorded.

Conclusion: Leaving the visceral peritoneum covering the vaginal vault unclosed causes no harm to the patient.

It may even decrease the incidence of vaginal vault haematoma.