ABSTRACT: Antiseptic vaginal packing after vaginal hysterectomy with or without a pelvic floor repair has been routinely used in an attempt to reduce postoperative complications. It is believed that insertion of the pack into the vagina reduces postoperative bleeding and hematoma formation, as well as infectious morbidity. However, there are no data from controlled or uncontrolled studies that support routine use of vaginal packs. Moreover, anecdotal evidence suggesting that vaginal packing increases postoperative pain has led to a debate over overall benefits of packing; as a result, its routine use has decreased.
The primary aim of this double-blind randomized study was to determine the effect of vaginal packing following pelvic floor surgery on postoperative pain, bleeding, and infection. Subjects were 190 women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynecology unit. The short-form McGill Pain score was used to assess the main study outcome, postoperative pain at day 1. Secondary outcomes, infectious and hematologic postoperative morbidity, were assessed preoperatively and postoperatively at day 2 and at 6 weeks. To exclude pelvic hematoma, transvaginal ultrasound was performed at 6 weeks in all women who underwent vaginal hysterectomy. The mean age of the patients was 58.3 years (range, 27–91 years), mean body mass index was 27.4 kg/m2, and median parity was 3. Subjects were randomized into “pack” (n = 86) and “no pack” (n = 87) groups. Patient demographics were similar in the 2 groups.
There were no significant differences between groups in postoperative pain scores, secondary outcome measures, or in the incidence of hematoma formation (no pack 14.8% vs pack 7.3%, P = 0.204). No clinically significant complications occurred in the pack group; 3 occurred in the no-pack group.
The findings of this randomized controlled study provide no evidence that vaginal packing increases postoperative pain scores or morbidity. Because vaginal packing is safe and may provide benefits, it may be argued that packing should be recommended as routine clinical practice.
Urogynaecology Department, King’s College Hospital (G.T.), St George’s Hospital (A.K.), and King’s College Hospital (L.C., S.S., G.L., D.R.), London, United Kingdom