An innovative approach to reduce vaginal cuff infectious morbidity post total laparoscopic hysterectomy

Abstract

Objective: We investigated the effectiveness of switching cefazolin (CEZ) to cefmetazole (CMZ) for preoperative antimicrobial prophylaxis and the role of preoperative vaginal preparation using normal saline to reduce vaginal cuff infectious morbidity after total laparoscopic hysterectomy (TLH).Methods: We retrospectively investigated 1476 patients who underwent TLH at our hospital between April 2010 and December 2020. The vaginal cuff infectious morbidity and the causative bacteria were analyzed. The CEZ group included 1095 women who received a preoperative intravenous drip injection of CEZ, the CMZ group included 221 women who received a preoperative intravenous drip injection of CMZ, and the vaginal cleaning group included 160 women who received a preoperative intravenous drip injection of CMZ and additionally underwent preoperative vaginal preparation using normal saline. We analyzed post-TLH data to determine the causative bacteria associated with vaginal cuff infection.Results: Postoperative vaginal cuff infection occurred in 2.38%, 2.26%, and 1.25% of women in the CEZ, CMZ, and the vaginal cleaning groups, respectively. Intergroup comparison did not show a significant difference in vaginal cuff infectious morbidity. The causative bacteria associated with post-TLH vaginal cuff infection predominantly belonged to the Enterococcus species (10/38 cases). Conclusion:Our study showed no significant intergroup difference in vaginal cuff infectious morbidity; however, further studies are warranted to conclusively establish the effectiveness of preoperative vaginal preparation using normal saline.