Vaginal packing after laparoscopic sacrocolpopexy: postoperative pain and satisfaction – RCT

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Objective: Vaginal packing following vaginal reconstructive surgery and vaginal hysterectomy was well explored. However, data regarding laparoscopic reconstructive surgery is lacking. No data concerning effect on early postoperative pain and patient satisfaction after laparoscopic sacrocolpopexy (LSC) exist. The primary aim of this randomized controlled trial was to compare subjective impressions of pain in women after LSC treated with and without packing. The secondary aims included comparison of patient satisfaction with the surgery on day 1 and with the overall postoperative course on day 4. Design: Double-blind randomized controlled trial Setting: Tertiary urogynecology care center, Faculty of Medicine in Pilsen, Charles University Participants: Women after LSC for stage > 2 pelvic organ prolapse were included. Women undergoing any other surgery, concomitant vaginal surgery including suburethral sling or where vagina was opened during the surgery (e.g. during concurrent hysterectomy) were excluded. Women with lost or incompletely filled-in McGill pain questionnaire were additionally excluded from this postoperative pain and satisfaction analysis. Interventions: Vaginal packing after the surgery with a sterile gauze. The primary outcome was measured by the McGill Pain Questionnaire filled-in day after surgery before pack extraction. Satisfaction was measured using VAS on postoperative day 1 and 4. Results: In total, 274 women were included in analysis, vaginal pack was inserted in 132 (48%) women. The groups did not differ in basic preoperative nor surgical characteristics. Very low and comparable values of all scores of the McGill Pain Questionnaire were observed (VAS pain 3.2 ±1.8 vs. 3.4±1.9,p=.330). Similarly, patient satisfaction on day one (7.3±1.8 vs. 7.4±1.7,p=.633) nor overall satisfaction on day 5 (8.7±1.3 vs. 8.8±1.1,p=.719) did not differ. Conclusion: Laparoscopic sacrocolpopexy is a safe surgery associated with low levels of pain and high patient satisfaction regardless of vaginal pack insertion. Vaginal packing does not seem to do any harm to our patients.

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