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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