Comparison of The Laparoscopic Approach Versus The Vaginal Route Closure of Vaginal Cuff during Total Laparoscopic Hysterectomy

Background: One significant procedure in the field of gynaecology with several indications is the hysterectomy. Hysterectomy has become less intrusive and has less risks thanks to improvements in surgical technique and materials. Total laparoscopic hysterectomy (TLH) is currently a popular practise in gynecologic surgery.
Objective: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy.  
Patients and methods: The present study was a randomized controlled study conducted on 40 women attending the outpatient gynecology clinic of Al-Azhar University Hospital (New Damietta) and were planned to undergo hysterectomy for benign causes according to the inclusion/exclusion included in the study. The present study was conducted on two groups Group A had vaginal suturing for vaginal vault after total laparoscopic hysterectomy; Group B had laparoscopic suturing for virginal vault after total laparoscopic hysterectomy.
Results: Operative time in minutes and suturing time showed significant increase in group 2 (laparoscopic suture) when compared to group A (vaginal suture) (P=0.012 and >0.001) respectively. VAS score show significant increase in group A when compared to group 2 (p < 0.001). Post-operative complications, post-operative vaginal bleeding, Vaginal cuff hematoma, Vaginal dehiscence, post-operative infection showed significant increase in group A when compared to group 2. Blood loss showed significant increase in group A when compared to group 2 (p=<0.001). Previous CS and BMI didn’t significant correlation with operative time in minutes (p>0.05).
Conclusion: Laparoscopic vaginal cuff closure for complete laparoscopic hysterectomy appears to be secure, simple, and efficient. However, it requires more time than vaginal suture closure.