To Pack or Not to Pack? A Randomized Trial of Vaginal Packing After Vaginal Reconstructive Surgery

Westermann, Lauren B.; Crisp, Catrina C.; Oakley, Susan H.; Mazloomdoost, Donna; Kleeman, Steven D.; Benbouajili, Janine M.; Ghodsi, Vivian; Pauls, Rachel N.

doi:10.1097/01.ogx.0000484271.73030.55

Cited by 2 publications

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“…66 A second small RCT showed similar pain on a visual analog scale but less use of ketorolac in the first 24 hours and nursing-reported pain in the packing group. 67 Two RCTs investigated the length of time for packing and found no difference between 3 hours and 24 hours; there was no difference in febrile morbidity and complications, but shorter packing was associated with nonsignificantly higher urinary retention rates. 68,69 Although no specific research has been conducted for patients undergoing laser treatment of the vulva, several studies have examined the role of occlusive dressings after laser skin resurfacing.…”

Section: Postoperative Dressing Carementioning

confidence: 99%

Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations

Altman

Robert

Armbrust

et al. 2020

American Journal of Obstetrics and Gynecology

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This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.

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Section: Postoperative Dressing Carementioning

confidence: 99%

Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations

Altman

Robert

Armbrust

et al. 2020

American Journal of Obstetrics and Gynecology

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“…Three RCTs compared vaginal packing with no packing in a population of women undergoing vaginal hysterectomy (n5395) with good study quality. [51][52][53] There were no apparent net benefits to vaginal packing for postoperative pain, satisfaction, bleeding, or infections (moderate strength of evidence). In addition, vaginal packing did not have an effect on the presence of a cuff hematoma 6 weeks after surgery (low strength of evidence).…”

Section: Bladder Functionmentioning

confidence: 99%

Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications: A Systematic Review

Jeppson

Balgobin

Rahn

et al. 2017

Obstetrical &Amp; Gynecological Survey

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for the Society of Gynecologic Surgeons Systematic Review Group OBJECTIVE: To create evidence-based clinical practice guidelines based on a systematic review of published literature regarding the risks and benefits of available preoperative, intraoperative, and postoperative technical steps and interventions at the time of vaginal hysterectomy for benign indications. DATA SOURCES:We systematically searched the literature to identify studies that compared technical steps or interventions during the preoperative, intraoperative, and postoperative periods surrounding vaginal hysterectomy. We searched MEDLINE, Cochrane Central Register of Controlled Trials, Health Technology Assessments, and ClinicalTrials.gov from their inception until April 10, 2016, using the MeSH term "Hysterectomy, Vaginal" and associated text words. We included comparative studies, singlegroup studies, and systematic reviews published in English. METHODS OF STUDY SELECTION:We doublescreened 4,250 abstracts, identifying 60 eligible studies. Discrepancies were adjudicated by a third reviewer. We followed standard systematic review methodology and the Grades for Recommendation, Assessment, Development and Evaluation approach to evaluate the evidence and generate guideline recommendations. TABULATION, INTEGRATION, AND RESULTS:Because of limited literature, only 16 perioperative risks, technical steps, and interventions were identified: obesity, large uteri, prior surgery, gonadotropin-releasing hormone agonists, vaginal antisepsis, bilateral salpingooophorectomy, morcellation, apical closure, uterine sealers, hemostatic injectants, hot cone, retractor, cystoscopy, vaginal packing, bladder management, and accustimulation. We organized and reported these as four domains: patient selection, preoperative, intraoperative, and postoperative. We did not identify any patient characteristics precluding a vaginal approach; chlorhexidine or povidone is appropriate for vaginal antisepsis; vasopressin decreases blood loss by 130 cc; tissue-sealing devices decrease blood loss by 44 cc and operative time by 15 minutes with uncertain complication implications; vertical cuff closure results in 1-cm increased vaginal length; either peritoneum or epithelium can be used for colpotomy closure; and routine vaginal packing is not advised.CONCLUSION: Minimal data exist to guide surgeons with respect to planning and performing a vaginal hysterectomy. This study identifies available information and future areas for investigation.

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To Pack or Not to Pack? A Randomized Trial of Vaginal Packing After Vaginal Reconstructive Surgery

Cited by 2 publications

References 0 publications

Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations

Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations

Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications: A Systematic Review

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