The incidence of vaginal vault hematoma after vaginal hysterectomy varies in studies and depends upon the diagnostic modalities used.(1)  The aim of our study was to evaluate the incidence of ultrasound detected vaginal vault hematoma and associated post-operative co-morbidities after vaginal hysterectomy with or without concomitant pelvic floor reconstructive surgery at our center.

A prospective cross sectional study of women undergoing vaginal hysterectomy with or without concomitant pelvic floor reconstructive surgery at our center was performed. The demographic data and intra-operative details of the patients were compared. Data regarding post-operative complications such as febrile morbidity, drop in hemoglobin, need for blood transfusions, duration of hospital stay, voiding dysfunction, urinary tract infections, rate and reason for readmission and management of patients with vault hematoma was obtained. Statistical analysis was performed using chi-square test and the Mann-Whitney U test with the help of the SPSS V 16.0 software.

One hundred and seven patients were recruited in the study. The mean age of the patients was 63 years and 87 percent were postmenopausal. Thirty six (33.6%) had post-operative vault hematoma, of which 25 (69.4%) had hematomas less than 5 cm in diameter. The indication for vaginal hysterectomy was uterovaginal prolapse in 91.7% of the patients with vault hematoma (Group A) and 90.1% of the patients without vault hematoma (Group B). Concomitant pelvic floor reconstructive surgery was performed in 91.7% of patients in group A and in 93% of the patients in group B. Concomitant vaginal mesh (Elevate®) insertion was performed in 14 patients (38.9%) in Group A and in 24 patients (33.8%) in Group B. The average diameter of vault hematoma was 4.3cm (range 1.5-8.4cm). All the patients with symptomatic vaginal vault hematoma associated with fever were managed conservatively with intravenous antibiotics and none required surgical drainage of the hematoma.

Patients with vault hematomas had a significantly higher mean duration of surgery (98.3 minutes), a significantly higher drop in hemoglobin value post-operatively (2.1 g/dL) and a significantly higher incidence of post-operative fever. There was no statistically significant difference in the mean blood loss between the two groups.  Although not statistically significant, the incidence of urinary tract infection (13.9%), mean duration of indwelling catheter use (4.3 days) and mean duration of hospital stay (4.3 days) was higher in the group with vault hematoma.

Post-operative vaginal vault hematoma after vaginal hysterectomy with or without concomitant pelvic floor reconstructive surgery is very common and maybe associated with prolonged duration of surgery, significant drop in hemoglobin value and febrile morbidity post-operatively. Most vault hematomas are asymptomatic and resolve spontaneously. Further studies are needed to explore the risk factors and techniques to reduce the risk of vault hematoma formation.

Kwok Shuk-Tak. Vault Haematoma following Hysterectomy: Three year Experience. Hong Kong J Gynaecol Obstet Midwifery 2016; 16(2):121-8