4.1. Main findings
There was no clear evidence that vaginal packing was associated with clinically meaningful reductions in adverse effects such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection.
With regards to vaginal bleeding, Westerman et al. (15) found a difference in postoperative vaginal blood loss of about 11 g between groups, which was statistically significant but clinically irrelevant. When a decrease in haemoglobin was considered, both Westerman (15) and Thiagamoorthy (16) found no significant differences among these groups.
As for vault hematoma formation, results from three studies (Thiagamoorthy, Baumgarten, Urzua) indicated a trend towards higher incidence of vaginal hematoma as a mid-term complication when the vagina was not packed, although differences were not statistically significant. The studies by Yoong (18) and Ottesen (21), evaluating fast track protocols, showed no differences in relevant outcomes between women with and without vaginal packing. Moreover, in the systematic reviews by Jeppson (22) in 2017 and Rachaneni (23) in 2018, vaginal packing was not recommended as a preventive measure against vault hematoma, whereas Ottesen (21) suggested that the vagina could be packed only when the surgeon deemed it necessary.
Thiagamoorthy studied postoperative vaginal cuff infection by microscopic analysis and found no differences between the groups with and without packing (16). A case-control study by Yoong also found no difference on this outcome (18). Furthermore, both Jeppson’s review (22) and our analysis concluded that there was no difference in the incidence of vaginal cuff infection based on moderate-quality evidence.
Vaginal packing did not affect patient bother or postoperative pain significantly. We aimed to assess whether vaginal packing was associated with increased postoperative pain or discomfort in comparison with no vaginal packing. In all three studies evaluating pain, the variable was analysed using the pain VAS or the McGill Pain Questionnaire, but none reported a statistically significant difference between the two groups. The study by Westermann (15) reported a significant increase in the number of complaints expressed verbally to nurses by patients not wearing vaginal packing compared to those wearing tampons. In the same study, an increased demand for ketorolac was quantified in the vaginal packing group, though without a statistically significant difference. In addition to these findings, there was insufficient information on the type of anaesthesia during surgery to make comparisons between groups based on this variable. Among the patients who participated in the studies, the higher observed rate of complications in patients who did not use vaginal packing probably translated into greater pain and discomfort.