Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study.

STUDY OBJECTIVE: To compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Teaching and research hospital, a tertiary center. PATIENTS: Fifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure. INTERVENTIONS: All patients underwent vaginal hysterectomy. MEASUREMENTS AND MAIN RESULTS: Vagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p < .001). At 6 weeks postoperatively, the vagina was still significantly shorter in the horizontal group (6.55 [0.89] cm vs 7.42 (0.73) cm; p < .001). The mean difference in vagina length before and after surgery was also significantly higher in the horizontal group than in the vertical group (-1.26 [0.12] cm vs 0.49 [0.11] cm; p < .001). CONCLUSION: Vertical cuff closure during vaginal hysterectomy seems to preserve vagina length better than does horizontal cuff closure.