What is it about?
Study objective: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). Design: A randomized, controlled, triple-blind, multicenter clinical trial. Setting: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. Patients: A total of 574 patients were taken to TLH because of benign diseases. Intervention: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). Measurements and main results: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). Conclusion: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.
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Why is it important?
Hysterectomy is the most frequently performed gynecologic surgery. Moreover, the use of laparoscopic techniques has become more prevalent in recent years owing to their effectiveness, safety, and lower incapacity. For instance, total laparoscopic hysterectomy (TLH) is classified as a clean-contaminated surgery, its infectious complication rate is 9.0% and pelvic cellulitis (PC) of the vaginal cuff and pelvic abscess (PA) are documented in 0.5% to 2% of patients
Perspectives
The clinical relevance of our results includes the epidemiologic support to discourage the common practice of the unnecessary use of antibiotics in the postoperative period of TLH to prevent infectious complications of the pelvic.
Elsa Vasquez-Trespalacios
Universidad CES
Read the Original
This page is a summary of: Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial, Journal of Minimally Invasive Gynecology, July 2023, Elsevier,
DOI: 10.1016/j.jmig.2023.07.007.
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