Vaginal packing after vaginal hysterectomy with or without colporrhaphy:
systematic review and recommendations.
Background. 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 that itself increases the risk of
urinary infection, patient bother, delayed discharge, and increased
costs. Objectives. This systematic review aimed to assess the
complications and outcomes associated with vaginal packing after vaginal
hysterectomy (with or without colporrhaphy). Search Strategy. We
conducted a systematic review following the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Selection
Criteria. We used the Population, Interventions, Comparators, Outcomes,
and Study design (PICOS) framework to define eligibility. Predefined
outcomes were: i) vaginal bleeding and blood loss, ii) postoperative
pain, iii) acute urinary retention, iv) hospital length of stay, and v)
mid-term complications, such as vaginal cuff collection or infection.
Data Collection and Analysis. Following data synthesis and subgroup
analyses, we assessed the certainty of evidence according to GRADE
guidance and formulated a clinical recommendation. Main 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 on the predefined outcomes.
Conclusions. Routine vaginal packing after vaginal hysterectomy had no
clear benefit on outcomes. We therefore advise against this procedure.
Funding. The Catalan Society of Obstetrics and Gynaecology granted
funding to conduct this work.