[Contemporary views on perioperative complications and adhaesion formation after vaginal hysterectomy, in relation to peritoneal closure vs. non-closure in combination with open vs. closed vaginal cuff].

There exists few evidence about peritoneal closure vs. non-closure at vaginal hysterectomy as well as only scanty evidence for open vs. sutured vaginal cuff. It seems that non-closure of the peritoneum at vaginal hysterectomy holds no risks and probably some advantages, e.g. faster resumption of bowel function. In the light of the rare direct evidence from vaginal surgery and the strong evidence from cesarean section and abdominal hysterectomy, we recommend abandoning the routine closure of the peritoneum at vaginal hysterectomy. The vaginal cuff left open is probably also a safe procedure, if the hemostasis has been done carefully. The most promising modification of the vaginal incision-and-closure seems to be the "Benenden-Hospital technique" (V-shaped posterior incision and running longitudinal closure of the vaginal skin with partially non-sutured peritoneum).