Laparoscopic Versus Vaginal Cuff Closure During Laparoscopic Hysterectomy in Benign Gynecological Lesions

Elashry, Ahmed Mahmoud; Youssef, H M; Elshamy, Maged Rageb; Abdelhafez, Mohamed Sayed; Awad, Mahmoud Mohamed

doi:10.21608/ebwhj.2024.316049.1355

Laparoscopic Versus Vaginal Cuff Closure During Laparoscopic Hysterectomy in Benign Gynecological Lesions

Document Type : Original Article

Authors

¹ department of obstetrics and gynecology , Mansoura universuty ,Egypt

² Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

10.21608/ebwhj.2024.316049.1355

Abstract

Objective: To compare endoscopic Bakay technique with transvaginal suturing technique for vaginal cuff closure in total laparoscopic hysterectomy (TLH).
Patients and Methods: Randomized study conducted on women who were planned to undergo TLH for benign gynecological lesion. All participants were randomly allocated into 2 groups; 1) Bakay group, in which vaginal cuff was closed by endoscopic Bakay technique, and 2) transvaginal group, in which vaginal cuff was closed by transvaginal suturing technique. Primary outcome measure was estimated amount of blood loss, and secondary outcome measures were operative time (including vaginal cuff closure time), preoperative and postoperative vaginal length, and intraoperative and postoperative complications.
Results: A total of 40 women (20 per group) were subjected to final analysis. Estimated amount of blood loss was lower in Bakay than in transvaginal group but without significant difference (P = 0.080). Total operative time was significantly shorter in transvaginal than in Bakay group (47.80 ± 6.0 vs 55.10 ± 9.6 min; P = 0.007). This was mainly attributed to highly significantly longer vaginal cuff closure time in Bakay than in transvaginal group (15.20 ± 4.3 vs 6.87 ± 0.8 min; P < 0.001). Postoperative vaginal length was highly significantly preserved in Bakay group (P = 0.001). No recorded major complications in both groups.
Conclusion: Use of Bakay technique for vaginal cuff closure during TLH is generally safe, and ensures better vaginal length preservation, less intraoperative blood loss and better vaginal cuff support, however; it requires advanced surgical skills to shorten the operation time.

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