PMID- 28383375
DCOM- 20170710
LR  - 20180714
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 129
IP  - 5
DP  - 2017 May
TI  - Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign
      Indications: A Systematic Review.
PG  - 877-886
LID - 10.1097/AOG.0000000000001995 [doi]
AB  - OBJECTIVE: To create evidence-based clinical practice guidelines based on a
      systematic review of published literature regarding the risks and benefits of
      available preoperative, intraoperative, and postoperative technical steps and
      interventions at the time of vaginal hysterectomy for benign indications. DATA
      SOURCES: We systematically searched the literature to identify studies that
      compared technical steps or interventions during the preoperative,
      intraoperative, and postoperative periods surrounding vaginal hysterectomy. We
      searched MEDLINE, Cochrane Central Register of Controlled Trials, Health
      Technology Assessments, and from their inception until April
      10, 2016, using the MeSH term "Hysterectomy, Vaginal" and associated text words. 
      We included comparative studies, single-group studies, and systematic reviews
      published in English. METHODS OF STUDY SELECTION: We double-screened 4,250
      abstracts, identifying 60 eligible studies. Discrepancies were adjudicated by a
      third reviewer. We followed standard systematic review methodology and the Grades
      for Recommendation, Assessment, Development and Evaluation approach to evaluate
      the evidence and generate guideline recommendations. TABULATION, INTEGRATION, AND
      RESULTS: Because of limited literature, only 16 perioperative risks, technical
      steps, and interventions were identified: obesity, large uteri, prior surgery,
      gonadotropin-releasing hormone agonists, vaginal antisepsis, bilateral
      salpingo-oophorectomy, morcellation, apical closure, uterine sealers, hemostatic 
      injectants, hot cone, retractor, cystoscopy, vaginal packing, bladder management,
      and accustimulation. We organized and reported these as four domains: patient
      selection, preoperative, intraoperative, and postoperative. We did not identify
      any patient characteristics precluding a vaginal approach; chlorhexidine or
      povidone is appropriate for vaginal antisepsis; vasopressin decreases blood loss 
      by 130 cc; tissue-sealing devices decrease blood loss by 44 cc and operative time
      by 15 minutes with uncertain complication implications; vertical cuff closure
      results in 1-cm increased vaginal length; either peritoneum or epithelium can be 
      used for colpotomy closure; and routine vaginal packing is not advised.
      CONCLUSION: Minimal data exist to guide surgeons with respect to planning and
      performing a vaginal hysterectomy. This study identifies available information
      and future areas for investigation.
FAU - Jeppson, Peter C
AU  - Jeppson PC
AD  - University of New Mexico, Albuquerque, New Mexico; the University of Texas
      Southwestern Medical Center, Dallas, Texas; Women & Infants Hospital, Warren
      Alpert Medical School of Brown University, Providence, Rhode Island; the
      University of North Carolina, Chapel Hill, North Carolina; the University of
      Alabama at Birmingham, Birmingham, Alabama; ProHealth, Waukesha Memorial
      Hospital, Waukesha, Wisconsin; Columbia University Medical Center and Icahn
      School of Medicine at Mount Sinai, New York, New York; the Center for Evidence
      Based Medicine, Brown University School of Public Health, Providence, Rhode
      Island; and the Institute for Female Pelvic Medicine and Reconstructive Surgery, 
      North Wales, Pennsylvania.
FAU - Balgobin, Sunil
AU  - Balgobin S
FAU - Rahn, David D
AU  - Rahn DD
FAU - Matteson, Kristen A
AU  - Matteson KA
FAU - Dieter, Alexis A
AU  - Dieter AA
FAU - Ellington, David R
AU  - Ellington DR
FAU - Aschkenazi, Sarit O
AU  - Aschkenazi SO
FAU - Grimes, Cara
AU  - Grimes C
FAU - Mamik, Mamta M
AU  - Mamik MM
FAU - Balk, Ethan M
AU  - Balk EM
FAU - Murphy, Miles
AU  - Murphy M
CN  - Society of Gynecologic Surgeons Systematic Review Group
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - IM
MH  - Female
MH  - Humans
MH  - Hysterectomy, Vaginal/*adverse effects
MH  - Outcome Assessment (Health Care)
MH  - Postoperative Complications
MH  - Randomized Controlled Trials as Topic
MH  - Uterine Diseases/*surgery
MH  - Women's Health
EDAT- 2017/04/07 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/04/07 06:00
PHST- 2017/04/07 06:00 [pubmed]
PHST- 2017/07/14 06:00 [medline]
PHST- 2017/04/07 06:00 [entrez]
AID - 10.1097/AOG.0000000000001995 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2017 May;129(5):877-886. doi: 10.1097/AOG.0000000000001995.