Which vaginal cuff closure route produces better clinical results after laparoscopic hysterectomy? Laparoscopic or the vaginal route

INTRODUCTION: The aim of this study was to compare the complications and clinical outcomes of laparoscopic closure of the vaginal cuff and cuff closure through the vaginal route after total laparoscopic hysterectomy (TLH).
METHODS: This retrospective study conducted from February 2012 to December 2021 involved a total of 362 patients who underwent TLH. Of these patients, 148 received vaginal cuff closure using no. 0 Vicryl™ (polyglactin 910), which is endoscopically absorbable, and 214 received vaginal cuff closure through the vaginal route using the same suture material. The gynecological examination findings 1 and 6 months after the operation were obtained from the electronic medical records of the postoperative treatment interventions and from the patients’ files. Together with the major complications that occurred, complications such as vaginal cuff dehiscence, hematoma, cuff cellulitis, granulation, spotting, vaginal discharge, and cuff prolapse were recorded.
RESULTS: The operation duration was found to be significantly shorter for the patients whose vaginal cuffs were sutured through the vaginal route than for the patients whose vaginal cuffs were endoscopically sutured (107.75±7.19 and 83.55±8.44, respectively; p<0.01). It was also found that laparoscopic suturing is more advantageous than suturing through the vaginal route in terms of the formation of vaginal cuff granulation, abnormal vaginal discharge, and abnormal mucosal band-shaped adhesion in the vaginal cuff.
DISCUSSION AND CONCLUSION: Laparoscopic suturing and knotting is a process that requires much experience and skill and that may lengthen the operation duration. However, the laparascopically closure of the vaginal cuff seems safer.