The Incidence of Vaginal Vault Granulations after Vaginal Vault Closed by Polyglactin Compared with Chromic Catgut: A Randomized Controlled Trial

Abstract

Objective To compare the incidence of vaginal vault granulations after vaginal vault closure by
No. 1 polyglactin with No. 1 chromic catgut.
Study designs A randomized controlled trial.
Setting Operating room and gynecological clinic, Department of Obstetrics and Gynecology,
Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University.
Subjects and Methods Eighty eight women underwent total abdominal hysterectomy for myoma
uteri were randomly divided into 2 groups; the study group (44 cases) and the control group (44
cases). Standard surgical technique of total abdominal hysterectomy was employed except for
closure of the vaginal vault performed by interrupted figure-of-eight sutures using No. 1
polyglactin (the study group) or No. 1 chromic catgut (the control group). All patients were
prospectively followed-up at 4 weeks and 8 weeks postoperatively and vaginal vault
granulations were diagnosed as present or absent, where appropriate, treated with silver
nitrate cauterization.
Results The overall incidence of vaginal vault granulation was 19.3 percent (17 cases), with
an incidence of 31.8 percent (14 cases) where the vaginal vault was closed with No. 1 chromic
catgut ( the control group) and a significantly lower incidence of 6.8 percent (3 cases) where
the vaginal vault was closed with No. 1 polyglactin ( the study group) (p < 0.05).
Conclusion The widespread use of chromic catgut for vaginal vault closure following total
abdominal hysterectomy revealed by our study is unacceptable; Polyglactin, a synthetic
polymer, is associated with fewer vaginal vault granulations than chromic catgut.