OUTCOME OF VAGINAL CUFF CLOSURE FOLLOWING TOTAL LAPAROSCOPIC HYSTERECTOMY USING UNIDIRECTIONAL BARBED SUTURE VERSUS VAGINAL APPROACH FOR BENIGN UTERINE CONDITIONS

Adil Bangash, Ayaz Gul, Ahmad Faraz, Nargis Gulab

Abstract


Background: Multiple factors influence the outcome following a vaginal cuff closure such as the use of instruments for the intracorporeal suturing, the skill of the surgeon and more importantly the indication for surgery and pre-existing factors such as diabetes, obesity and smoking. The objective of this study was to compare intra-operative vaginal cuff closure following total laparoscopic hysterectomy using unidirectional barbed suture or vaginal approach, for benign uterine conditions.

Materials & Methods: It was a prospective interventional study conducted at obstetrics and gynecology department of northwest general hospital and Lady Reading Hospital Department of Surgery from 1st January 2018 till 31 December 2022. All patients presenting to Out-patient department with benign pathology and needing laparoscopic surgery were put alternatively in two groups. A total of 84 patients were included in this study 42 in each group. Group A included patients where hysterectomy was performed laparoscopically and uterus was delivered vaginally followed by closure of the vault over the manipulator in continuous fashion with PDS 2/0 or Vicryl V-LockR (Covidien). In Group B the Uterine Manipulator was removed and vaginal closure was performed in two layers bidirectionally using Vicryl 2/0.Data was collected, placed on SPSS version 16. and was analyzed.

Results: Eighty four (84) patients were subjected to TLH and were alternately placed in to either Group A or B. The mean age and BMI of patients were similar with no statistical differences. The most frequent indication for Hysterectomy in both groups was Fibroid uterus. Eighteen patients (43.9%) from Group A and 21 patients (51.2%) from group B were post-menopausal. Lower operative times was observed in Group B with a mean difference in operative times of approximately 27 minutes was observed ranged between 39.5 and 118.5 minute. Vaginal cuff hematoma was observed more frequently in group A (4 patients). In contrast only two patients (4.8%) from group B had evidence of small hematomas.

Conclusion: There is a non-significant difference with Regards to Mean operating time following Laparoscopic Hysterectomy with lesser time taken for Vaginal Cuff repair vaginally as compared to Laparoscopic repair. There is no difference in outcomes between groups for the choice of material used except that the incidence of Vaginal Dehiscence was higher in patients with Laparoscopic repair (Barbed suture Single Layer Continuous Repair).


Keywords


Total laparoscopic hysterectomy; Vaginal cuff repair; Unidirectional barbed suture.

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DOI: https://doi.org/10.46903/gjms/22.02.1597

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