Impact of Early Packing Removal After Pelvic Reconstructive Surgeries

Co-Author(s)

EA

Ekhlas Abdulraheem, MBBCh (she/her/hers)

PGY-3 OBGYN Resident
Catholic Health, Sisters of Charity Hospital
Buffalo, New York, United States

Presenting Author(s)

Janine A. Meurer, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences
Buffalo, New York, United States

Co-Author(s)

Salma Attai, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Buffalo, New York, United States
Alyssa N. Sheedy, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Clarence, New York, United States
AE

Abeer Eddib, MD

Urogynecologist
Kaleida Health
Getzville, New York, United States

Objectives: Study

Objective:
Patients undergoing pelvic reconstructive surgery frequently have a vaginal pack inserted to reduce risk of bleeding and hematoma formation. The data are conflicting regarding the impact of vaginal packing on postoperative pain and the appropriate timing of the packing removal. There are different approaches to vaginal packing duration, as some surgeons remove the vaginal pack a few hours after surgery, others keep the vaginal pack overnight. There is concern that overnight vaginal packing is associated with more pain and less successful voiding trials. Our aim is to evaluate the impact of earlier packing removal on postoperative pain and voiding function.

Methods:

Design: Retrospective case control study

Setting: Academic-affiliated community hospital

Patients or Participants: All patients (N=1260) undergoing robotic sacrocolpopexy with transobturator midurethral sling by a single urogynecologist at a single institution between January 2012 and March 2023 were evaluated. Patients were initially on an overnight vaginal packing protocol until recently, where they were switched to a shorter (approximately 4 hour) vaginal packing protocol to facilitate earlier discharge. The outcomes of interest are pain and voiding function.

Interventions: Patients were grouped to the case group who had overnight vaginal packing (N=1114) and to the control group who had early packing removal (N=146).

Results: Measurements and Main

Results:

The demographics between the cases (overnight vaginal packing) and controls (early packing removal) were similar except that the overnight packing group had slightly more obese patients BMI 28.6 vs 27.7, p < 0.05.

Comparison of other variables between groups showed the overnight packing group were less likely to have a concomitant hysterectomy 678 (60.9%) vs 112 (76.7%), p< 0.05 and were more likely to have a concomitant perineorrhaphy 829 (74.9%) vs 73 (50%), p < 0.05, and longer operative time, 110 [80-141] vs 91 [57;128], p< 0.05.

The overnight packing group had higher mean PVRs (post void residual) 163 [56.5;264] vs 130 [55;193], p< 0.05 and were more likely to fail their voiding trial 464 (41.7%) vs 35 (24%), p< 0.01, OR 0.55 [0.35;0.84]. There was less total pain MME (Morphine milligram equivalents) in the early packing removal group 8 [1.5;19] vs 15 [4.0;27.4], p< 0.01.

Conclusions:

Conclusion:

Early vaginal packing removal is associated with less postoperative pain and a better likelihood of successful voiding attempts after sacrocolpopexy procedures. This case-control study demonstrated the safety and advantage of early vaginal pack removal following pelvic reconstructive surgeries.