Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study.

STUDY OBJECTIVE

To compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy.

DESIGN

Prospective randomized study (Canadian Task Force classification I).

SETTING

Teaching and research hospital, a tertiary center.

PATIENTS

Fifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure.

INTERVENTIONS

All patients underwent vaginal hysterectomy.

MEASUREMENTS AND MAIN RESULTS

Vagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p < .001). At 6 weeks postoperatively, the vagina was still significantly shorter in the horizontal group (6.55 [0.89] cm vs 7.42 (0.73) cm; p < .001). The mean difference in vagina length before and after surgery was also significantly higher in the horizontal group than in the vertical group (-1.26 [0.12] cm vs 0.49 [0.11] cm; p < .001).

CONCLUSION

Vertical cuff closure during vaginal hysterectomy seems to preserve vagina length better than does horizontal cuff closure.