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/spv.0000000000000238

Cited by 20 publications

(9 citation statements)

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“…). After duplicates had been excluded, we identified 31 trials including 27 primary interventional RCTs and four follow‐up studies . Seventeen studies were included in the posterior repair group (14 first studies and 3 follow‐up studies) and 14 in the multicompartmental group (13 first studies and one follow‐up study).…”

Section: Resultssupporting

confidence: 77%

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

Lourenço

Pergialiotis

Durnea

et al. 2020

Intl J Gynecology & Obste

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Background: Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets. Objective: To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials. Search strategy: We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Selection criteria: Randomized trials evaluating the efficacy and safety of different surgical interventions for posterior compartment vaginal prolapse.Data collection and analysis: Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. Methodological quality, outcome reporting quality and publication characteristics were evaluated.

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Section: Resultssupporting

confidence: 77%

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

Lourenço

Pergialiotis

Durnea

et al. 2020

Intl J Gynecology & Obste

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“…Data regarding the utility of vaginal packing are mixed [185], and in circumstances of suspected bleeding it may be beneficial, but in general it should be avoided because it causes discomfort, delays urinary catheter discontinuation, and limits ambulation [173]. Options for discontinuation of urinary catheters and/or vaginal packing among patients otherwise meeting discharge milestones include return to an outpatient nursing clinic or a homecare nursing visit depending on insurance.…”

Section: The Postoperative Care Phasementioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.

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“…We obtained data from two trials, which included women undergoing similar surgical procedures and receiving similar postoperative care, exclusively from conference abstracts (13,14). The other two trials assessed pain as the main outcome (15,16), and one of these also assessed postoperative blood loss (16). The risk of bias from the trials varied, and of note, the trials reported as conference abstracts provided little detail on their study design but were described as randomized (13,14).…”

Section: Descriptive Analysismentioning

confidence: 99%

“…The risk of bias from the trials varied, and of note, the trials reported as conference abstracts provided little detail on their study design but were described as randomized (13,14). Risk of selection bias was low in the other two trials, which also implemented strategies to blind the participants and the staff responsible for the outcome evaluation (15,16).…”

Section: Descriptive Analysismentioning

confidence: 99%

“…Vaginal packing may have little or no effect on vaginal bleeding. In a study involving 77 women, postoperative blood loss was greater in the group receiving vaginal packing (median, 16 [interquartile range, 13.4] g) compared with the control group (5 [8.2] g; p < 0.01) (15). In another study involving 173 participants, the rate of vaginal bleeding was similar among groups (one outcome without packing, relative risk [RR] = 0.34; 95%CI 0.14-8.16) (16).…”

Section: Impact Of Routine Vaginal Packing After Vaginal Hysterectomymentioning

confidence: 99%

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Vaginal packing after vaginal hysterectomy with or without colporrhaphy: systematic review and recommendations.

Porta-Roda

Cornet-Cortada²,

Font-Vilamitjana

et al. 2022

Preprint

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Background. Vaginal packing is often used after vaginal hysterectomy to reduce the risk of haemorrhagic and infectious complications, but the procedure may impair spontaneous bladder emptying and necessitate permanent bladder catheterization that itself increases the risk of urinary infection, patient bother, delayed discharge, and increased costs. Objectives. This systematic review aimed to assess the complications and outcomes associated with vaginal packing after vaginal hysterectomy (with or without colporrhaphy). Search Strategy. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Selection Criteria. We used the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework to define eligibility. Predefined outcomes were: i) vaginal bleeding and blood loss, ii) postoperative pain, iii) acute urinary retention, iv) hospital length of stay, and v) mid-term complications, such as vaginal cuff collection or infection. Data Collection and Analysis. Following data synthesis and subgroup analyses, we assessed the certainty of evidence according to GRADE guidance and formulated a clinical recommendation. Main Results. The review included four clinical trials (involving 337 participants). These provided no clear evidence that vaginal packing led to clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection. Overall, the intervention produced no clear benefit on the predefined outcomes. Conclusions. Routine vaginal packing after vaginal hysterectomy had no clear benefit on outcomes. We therefore advise against this procedure. Funding. The Catalan Society of Obstetrics and Gynaecology granted funding to conduct this work.

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

Abstract: Although there was no difference based on VAS, women receiving vaginal packing had lower nursing documented pain and used less ketorolac than packed women. Vaginal packing may provide benefit and can remain part of the surgical practice.

Cited by 20 publications

References 9 publications

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Vaginal packing after vaginal hysterectomy with or without colporrhaphy: systematic review and recommendations.

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