Vaginal antisepsis for hysterectomy: A review of the literature

Infectious complications of hysterectomy remain common despite the use of prophylactic antibiotics. Most are caused by contamination of the surgical site by vaginal bacteria which are not controlled by current methods of pre-operative antisepsis. The medical literature concerning antiseptic preparation of the vagina for surgery was reviewed to discover the evidence on which practice may be based. A search using Medline, Current Contents, the Cochrane Library and the reference lists of articles on the subject and of major gynaecology textbooks produced 13 comparative studies. No conclusive randomized controlled trials were found and most of the studies had severe methodological problems limiting interpretation of their results. The scant available data suggest that use of vaginal antiseptics before the patient arrives in the operating room is probably not useful, and that application of povidone-iodine vaginal gel at the beginning of abdominal hysterectomy is sufficiently promising to justify further investigation.