Vaginal packing after vaginal hysterectomy with or without colporrhaphy: systematic review and recommendations.

Background. Vaginal packing is often used after vaginal hysterectomy to reduce the risk of haemorrhagic and infectious complications, but the procedure may impair spontaneous bladder emptying and necessitate permanent bladder catheterization that itself increases the risk of urinary infection, patient bother, delayed discharge, and increased costs. Objectives. This systematic review aimed to assess the complications and outcomes associated with vaginal packing after vaginal hysterectomy (with or without colporrhaphy). Search Strategy. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Selection Criteria. We used the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework to define eligibility. Predefined outcomes were: i) vaginal bleeding and blood loss, ii) postoperative pain, iii) acute urinary retention, iv) hospital length of stay, and v) mid-term complications, such as vaginal cuff collection or infection. Data Collection and Analysis. Following data synthesis and subgroup analyses, we assessed the certainty of evidence according to GRADE guidance and formulated a clinical recommendation. Main Results. The review included four clinical trials (involving 337 participants). These provided no clear evidence that vaginal packing led to clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection. Overall, the intervention produced no clear benefit on the predefined outcomes. Conclusions. Routine vaginal packing after vaginal hysterectomy had no clear benefit on outcomes. We therefore advise against this procedure. Funding. The Catalan Society of Obstetrics and Gynaecology granted funding to conduct this work.