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.