The influence of suture material on vaginal vault granulations following abdominal hysterectomy.

A questionnaire was circulated to 1147 members (consultant status) and fellows of the Royal College of Obstetricians and Gynaecologists to survey the current management of the vaginal vault following abdominal hysterectomy. Of the 56% who responded, the majority (87%) routinely close the vault. An interrupted mattress suture is used by 60%, a continuous suture by 43% and the Lembert suture by 2%. Chromic catgut is favoured by 60%, a synthetic polymer by 33% and plain catgut by 6%. We then organized a prospective, randomized trial involving 114 women who underwent total abdominal hysterectomy for benign indications. No. 1 polygalactide (Vicryl) was used in 58 women, and No. 1 chromic catgut in 56. Overall, 37 (32%) had vault granulations 6 weeks post-operatively. Chromic catgut had been used in 25 (68%) and polygalactide in the remaining 12 (32%) (P = 0.01). Only 2 (5%) of these women denied any symptoms, while the rest complained of vaginal discharge, bleeding or both. Neither the patients' age, weight or parity, nor the status of the surgeon influenced the occurrence of granulations. We conclude that the widespread use of chromic catgut revealed by our survey is unacceptable: polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut.