A RANDOMIZED TRIAL OF OPEN VERSUS CLOSED VAGINAL VAULT IN THE PREVENTION OF POSTOPERATIVE MORBIDITY AFTER ABDOMINAL HYSTERECTOMY

OBJECTIVE: Our purpose was to evaluate the effects of two surgical tec hniques, closed vaginal vault with two layers of continuous 3-0 polygl actin suture versus open vaginal vault with a locking 3-0 polyglactin suture; after abdominal hysterectomy. STUDY DESIGN: A prospective, ran domized trial was performed. During the hospital stay and 4 to 8 weeks after the operation patients were observed for evidence of morbidity. RESULTS: Of the 273 evaluable subjects, 141 had the vaginal vault lef t open whereas 132 were closed. Ten (7.1%) and eight patients (6.1%) h ad infections at the operative site (pelvis or abdominal wound) (p = 0 .92). A urinary tract infection was diagnosed in three (2.1%) and in f our subjects (3.0%) (p = 0.46). A pelvic hematoma developed in two pat ients of each group (p = 0.66). Vault granulations were recorded in 11 % and 12% of subjects (p = 0.97). CONCLUSION: This study failed to sho w some benefit in favor of either of the two surgical policies. A care ful surgical technique and antibiotic prophylaxis seem to remain the m ost important factors in the prevention of postoperative morbidity.