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 singleport 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.

Figure 1

Operative view of single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH). (A) Home-made single-port platform made of a wound retractor, a glove and three trocars (12 mm, 5 mm, and 5 mm): a uterine manipulator is inserted to facilitate visualization of the pelvis. (B) Immediate postoperative view following SPA-LAVH with vault drain.

Figure 2

JP drain insertion through the vaginal vault after single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH). (A) Insertion of sutured drain through the apex of the vault. (B) Placement of drain in peritoneal cavity. (C) Fixation of drain in posterior vaginal vault.