3.3. Recommendation
Table 3 shows the EtD framework that we discussed to formulate a
recommendation. We recommend against routinely placing a vaginal pack
after vaginal hysterectomy with or without colporrhaphy. This was a
conditional recommendation because packing likely results in little or
no benefit in terms of vaginal bleeding and other postoperative
complications or pain, indicating that routine care should favour
minimal intervention. However, although the available evidence was not
consistent, we observed a trend towards an increased rate of hematomas
in the mid-term when packing was not used. For that reason, we emphasize
that it may be appropriate to consider the intervention if haemostasis
cannot be confirmed during the surgical procedure. We also considered
indirect data from Enhanced Recovery After Surgery (ERAS) pathways,
which often exclude vaginal packing and show that this approach may
shorten hospitalization, lead to fewer readmissions, and reduce costs
(18–20).