Closure of the peritoneum during vaginal hysterectomy and repair (VH & R)

Abstract

INTRODUCTION : Standard VH & R involves closure of the peritoneum with a purse string suture. Potential benefits are prevention of Fallopian tube prolapse, prolapse of intestines, vault prolapse and recurrence of the cntcrocoele. However, damage to the ureters, blood vessels and intestines is possible with this method. OBJECTIVES : To assess the usefulness of a technique which does not involve closure of the peritoneum with a purse string suture. DESIGN :Case control study. Setting : The Professorial Gynaecology Unit of the North Colombo General Hospital, Ragama. MAIN OUTCOME MEASURES :Post operative febrile morbidity, vault haematoma and abscess formation, and prolapse of viscera. Follow up for recurrence of components of prolapse. RESULTS : Over a period of 15 months from June 1995, 115 women awaiting VH & R were randomly allocated to two groups viz. A and B. conventional VH & R was carried out in group A. In group B the peritoneum was not closed separately but the pedicles except the vascular one were tied together in the midline. In spite of prophylactic antibiotics 3 out of 56 in group A and 4 out of 59 in group B developed post operative fever which lasted more than 48 hours. The incidence of postoperative haematoma and abscess formation was not different between the two groups and there were no cases of fallopian tube prolapse or intestinal prolapse. Apart from two cases each of recurrent cystocoele in the two groups, there were no other relevant morbidity during the follow up of upto two years. CONCLUSION : In this series closure of the peritoneum during VH & R with a purse string suture does not appear to be of any extra benefit. This step can be safely omitted during this procedure without adding to morbidity.