Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy

Abstract

Objectives: The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic surgeons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. Material and methods: A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. Results: Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraoperative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups. Conclusions: We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures.