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Comparison of Mechanical Characteristics of Commonly Used Vaginal Packing Materials
Abstract
Introduction: Clinically, vaginal packing provides the benefit of hemostasis and is designed to prevent the formation of postoperative hematomas. Despite the common use of vaginal packing in pelvic surgery, there is limited data to indicate which material has the ideal characteristics for vaginal packing. Materials and Methods: Three packing materials were used: DeRoyal ® Fluftex ™ (DeRoyal Industries, Inc., Powell, Tennessee), NHP Surgi-Pak ™ vaginal packing (NHP Industries, Inc., City of Industry, California), and Curad ® Plain Packing Strips (Medline Industries, Inc., Northfield, Illinois). A fluid with similar viscosity to human blood, defibrinated sheep's blood (Remel Laboratories, Nenexa Kansas) was used to saturate the materials. The primary outcome was the amount of fluid absorbance of each product in both the handpacked and unpacked state. The number of drops used to saturate each material were counted and converted to mL/g. Each product was tested three times and the results were measured by counting the number of drops needed to saturate the material in each experiment. Experiment: Three materials were obtained and conducted into two different experiments to test absorbance.
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BACKGROUND
: Utero-vaginal prolapse is a common condition in ag
ed women and
often they come to us with decubitus ulcer. Prolong
ed vaginal packing not only will heal the
decubitus ulcer but also it may help in returning th
e normal rugosity of the vaginal skin.
AIMS:
To assess the role of prolonged moist vaginal packing
in utero-vaginal prolpase.
SETTINGS &
DESIGN:
It was an OPD based prospective study conducted at t
he gynecology OPD of College of
Medicine & JNM Hospital, WBUHS, Kalyani, Nadia, West
Bengal and Jawaharlal Nehru Institute
of Medical Sciences, Porompat, Imphal, Manipur.
METHODS & MATERIAL:
Hundred (100)
patients of utero-vaginal prolapse with decubitus ulce
r were studied. After initial staging (POP-
Q staging), daily moist (5% povidone-iodine solution
soaked gauze) vaginal packing at home
was advised. After 2 weeks, re-examination done for
decubitus ulcer healing. Packing continued
till operation (interval 1- 1½ month). Preoperative s
taging and modification of operation were
noted. On follow up complication (mainly recurrence)
was noted.
RESULTS:
Initial staging was
stage 3 - 39%, stage 4 - 61%. Preoperative scoring r
evealed stage 3 became stage 2 in 54% cases
and stage 4 became stage 3 in 49% cases. This improv
ement helped us to avoid excessive
excision of vaginal mucosa.
CONCLUSION:
Prolonged pre-operative moist gauze vaginal
packing may improve the outcome of the disease.
Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse.
A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse.
The age range of the women was 33-59 years, uterine volume was 300-900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30-60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ(2) = 17.367; P = 0.002).
This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.
Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity.
We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity.
The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group.
Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.
Objective:
Vaginal packs are commonly inserted after pelvic organ prolapse (POP) surgery to absorb excess blood loss and to reduce haematoma formation. Randomised trials have shown little benefit in terms of reduced haematoma formation. However, the amount of blood loss absorbed on the pack has not been studied. The use of packs has financial costs and is associated with catheterisation and may delay hospital discharge. If packs are not effective in reducing blood loss and haematoma formation there could be an argument that packs should not be used at all. This study was designed to identify how much blood is actually absorbed onto packs after POP surgery.
Study design:
Consecutive patients undergoing elective vaginal surgery for POP were prospectively recruited by the lead author. Demographics were recorded. Vaginal packs inserted after POP surgery in 63 women were weighed before insertion and at the time of removal the day after surgery. Pain score were noted and the difference in the weight of packs recorded. Any complications were reported by the patients at the 6 week routine post operative visit and cross referenced with the clinical records.
Results:
There was a statistically significant increase in pack weight of 6.7g (p<0.01). Five percent of the patients had a bleed of more than 25g into the pack. Removal of the pack was associated with minor discomfort. Complications in the post operative period were low with 11% of patients seen in the first 6 weeks with bleeding or discharge.
Conclusion:
The majority of women undergoing prolapse surgery have minimal bleeding onto a routinely introduced vaginal pack placed after POP surgery. Packs are probably not required for controlling post operative blood loss in the majority of patients.
Every great operation in surgery has a period of evolution of varying duration. Each marked advance in medicine and surgery is preceded by attempts which led to the elucidation of old ideas or the conception of new ones. All great discoveries are overshadowed by the labors of a host of earnest and progressive workers which ultimately crown the efforts of a favored few. Nearly all of the improvements in medicine and surgery which have characterized the present progressive age are only a repetition of the work of our professional ancestors. Many a so-called modern operation is only a recent and not always an improved edition of the operative technique as devised and described by one of the old masters. These remarks apply with special force to vaginal hysterectomy. The operation of removing the carcinomatous uterus through the vagina, so recently developed to its present state of perfection, was planned and
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.
To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity.
Retrospective, longitudinal cohort study.
Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery.
All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008.
Register data were collected prospectively using doctors' forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors.
Infectious morbidity within 6-8 weeks postoperatively.
No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery.
Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.
This randomised prospective study in 53 women having vaginal hysterectomy for benign conditions compared a closed vault technique with an open technique. Twenty-seven had the vault closed (group A) whereas 26 patients had an open vault (group B). The primary outcomes include, vault haematoma (as detected by ultrasound on day 3) and fever. Secondary outcomes are haemorrhage, urinary tract infection, urinary retention and vault granulation tissue. The study did not show any statistical difference between either group. Prolapse of the fallopian tube was recorded in one case in the open vault group. A randomised controlled study on a larger scale is recommended.
Vaginal hysterectomy is associated with significant risk of vaginal vault haematoma (40%) and febrile morbidity (30%). Numerous interventions have been used to try and avoid these complications but very few have been shown to be effective.