Refining surgical technique to prevent occurrence of vault haematoma after vaginal hysterectomy.

We set out to analyse the effect of refinement of incision and closure technique of the vaginal vault on the incidence of vault haematoma after hysterectomy. All the surgery was performed in the Gynaecology Department, Benenden Hospital, Kent, UK. This was initially a retrospective study followed by a prospective analysis of postoperative morbidity related to vaginal vault haematomas and critical review of surgical technique over 5 years in all cases undergoing vaginal hysterectomy within our unit. Following refinement in surgical technique a significant reduction in the incidence of clinically significant vaginal vault haematomas from 15.7% to 1.7% (P<0.001) was observed over a 4-year period. Adoption of the described surgical techniques is recommended to minimise the risk of clinically significant vaginal vault haematomas after vaginal hysterectomy.