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Grand Rounds

Does a Two-Layer Closure During Laparoscopic Hysterectomy Reduce Postoperative Complications?

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BACKGROUND AND PURPOSE:

  • Peters et al. (Obstetrics & Gynecology, 2021) assessed whether two-layer vs 1-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy was associated with a lower rate of postoperative complications

METHODS:

  • Retrospective cohort study
  • Population
    • Total laparoscopic hysterectomies
    • Performed by gynecologic surgeons
  • Exposures
    • Two-layer cuff closure
    • One-layer cuff closure
  • Study design
    • Covariates addressed: Age | Postmenopausal status | BMI | Tobacco use | Immunosuppressant medications
    • Data standardized for: Surgeon skill | Colpotomy technique | Suture material
  • Primary outcome
    • Composite of total postoperative complications
      • All medical and surgical complications within 30 days
      • Vaginal cuff complications within 180 days

RESULTS:

  • 2,973 women
    • Two-layer closures: 40.8%
    • One-layer closures: 59.2%
  • Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications
    • Two-layer closure: 3.5%
    • One-layer closure: 5.7%
    • P<0.01
  • The primary difference in total postoperative complications was due to fewer vaginal cuff complications within 180 days
    • Two-layer closure: 0.9%
    • One-layer closure: 2.6%
    • P<0.01
  • There were no differences in 30-day medical and surgical postoperative complications between groups
    • Two-layer closure: 2.6%
    • One-layer closure: 3.1%
    • P=0.77
  • No patients in the two-layer closure group experienced a vaginal cuff dehiscence
    • Two-layer closure: none
    • One-layer closure: 1.0%
    • P<0.01
  • Compared with a one-layer closure, a two-layer closure was protective for postoperative complications
    • Adjusted odds ratio 0.38 (95% CI, 0.19 to 0.74)

CONCLUSION:

  • Two-layer vaginal cuff closure during laparoscopic hysterectomy was associated with fewer postoperative complications vs one-layer closure
  • This difference was driven by a reduction in vaginal cuff dehiscence

The authors state

Hence, implementation of two-layer laparoscopic vaginal cuff closures during total laparoscopic hysterectomy could lower patient morbidity if implemented for all total laparoscopic hysterectomies

Learn More – Primary Sources:

Two-Layer Compared With One-Layer Vaginal Cuff Closure at the Time of Total Laparoscopic Hysterectomy to Reduce Complications

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Related ObG Topics:

Transvaginal vs Laparoscopic Cuff Closure to Prevent Dehiscence
Recognition, Evaluation and Treatment of Vaginal Cuff Separation

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