Funding:
This work was funded by Charles University, Cooperatio Program, research area Maternal and Childhood Care. The funders did not have a role in the collection, analysis and interpretation of data and in the writing of the manuscript
Introduction :
The current evidence strongly supports laparoscopic sacrocolpopexy (LSC) as the gold standard for the surgical repair of apical vaginal prolapse1. Over last decades, LSC has advanced significantly in its outcomes, surgical technique, concomitant surgeries, and surgical proficiency decreasing the risk of complications. However, there remains significant variation amongst surgeons in some surgical steps when performing LSC, usually owing to a lack of evidence on the matter2. One of these steps is packing the vagina with a sterile gauze after the procedure.
Vaginal packing was traditionally used to reduce the risk of haemorrhagic and infectious complications after vaginal reconstruction surgery 3. However, it may be associated with urinary tract infection from bladder catheterization, patient bother and pain upon extraction of the pack 4. Vaginal packing after vaginal reconstructive surgery has become a well explored topic. It was demonstrated, that it was not associated with increased pain scores or postoperative morbidity 4, 5. However, it was also not associated with any clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection after vaginal hysterectomy 3.
Vaginal packing was recommended after LSC by some authors6-8, however, no evidence regarding vaginal packing after laparoscopic reconstruction exist. The primary objective of this randomized controlled trial was to compare subjective impressions of pain in women after LSC treated with and without packing. The secondary aims included comparison of patient satisfaction with the surgery on day 1 and satisfaction with the overall postoperative course, bacteriuria and anaemia on day 4.