Vaginal packing after vaginal hysterectomy: systematic review and recommendations.

Autor: Porta-Roda O; Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Plaça del Dr. Robert, 5, 08221, Barcelona, Terrassa, Spain. oporta@mutuaterrassa.cat., Cornet-Cortada A; Department of Obstetrics and Gynecology, Hospital de Mollet, Barcelona, Spain., Font-Vilamitjana A; Department of Obstetrics and Gynecology, Consorci Sanitari de Terrassa, Barcelona, Spain., Huguet-Galofré E; Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Plaça del Dr. Robert, 5, 08221, Barcelona, Terrassa, Spain., Lleberia-Juanós J; Department of Obstetrics and Gynecology, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain., Solà-Arnau I; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2023 Apr; Vol. 34 (4), pp. 789-796. Date of Electronic Publication: 2022 Aug 26.
DOI: 10.1007/s00192-022-05331-1
Abstrakt: Introduction and Hypothesis: Vaginal packing is often used after vaginal hysterectomy to reduce the risk of haemorrhagic and infectious complications, but the procedure may impair spontaneous bladder emptying and necessitate permanent bladder catheterization, which itself increases the risk of urinary infection, patient bother, delayed discharge, and increased costs. This systematic review was aimed at assessing the complications and outcomes associated with vaginal packing after vaginal hysterectomy.
Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, using the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework to define eligibility. Following data synthesis and subgroup analyses, we assessed the certainty of evidence according to GRADE guidance and formulated a clinical recommendation.
Results: The review included four clinical trials (involving 337 participants). These provided no clear evidence that vaginal packing led to clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection. Overall, the intervention produced no clear benefit regarding the predefined outcomes.
Conclusions: Routine vaginal packing after vaginal hysterectomy had no clear benefit on outcomes. We therefore advise against this procedure.
(© 2022. The International Urogynecological Association.)
Databáze: MEDLINE
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