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).