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.