First, to evaluate the effect of MVT (Flagyl 250 mg, Fuji Pharma Co., Ltd., Tokyo, Japan), we divided the patients into two groups according to the presence or absence of the use of this tablet (425 versus 95 cases). In our hospital, we administered three vaginal tablets to the former patients, timed at 1 day before TLH, immediately after completion of the operation, and 3 days after the operation. In these two groups, we compared the 17 indices presented in Table
1 by using Student’s
t-test and Pearson’s chi-square test. Second, to confirm the effect of vaginal tablets on VBRPC, we tried to identify risk factors for VBRPC. To control confounding factors, we divided the patients into two groups according to the presence or absence of each factor, and performed multivariate logistic regression analysis. In this analysis, we assessed the influence of the following 17 factors: (1) advanced age, defined as an age ≥ 50 years; (2) high body mass index (BMI), defined as a BMI ≥ 25 (kg/m
2); (3) nulliparity, defined as no previous delivery; (4) gynecological operation history; (5) menstrual disorder, defined as patients with menstruation-related symptoms such as dysmenorrhea, menostaxis, menorrhagia, anemia or abnormal vaginal bleeding; (6) abdominal distension, defined as patients with abdominal symptoms such as abdominal pressure, pelvic pain, dysuria, or dyschezia; (7): GnRH analog, defined as treatment with gonadotropin-releasing hormone analog (GnRHa) before TLH; (8) concomitant LC; (9) concomitant PLA; (10) long-time operation, defined as an operation lasting over 240 minutes according to the average and standard deviation of 520 cases; (11) massive blood loss, defined as loss of over 500 mL of blood; (12) heavy uterus, defined as a resected uterine weight ≥ 500 g; (13) abdominal adhesion, defined as abdominal adhesion detected by laparoscopic inspection immediately after the start of surgery; (14) blood transfusion, defined as the need for blood transfusion, including both autologous and allogeneic blood transfusion, during or after the operation; (15) large leiomyoma, defined as a dominant leiomyoma ≥ 8 cm by magnetic resonance imaging (MRI); (16) large uterus, defined as an average uterine length ≥ 10 cm by transvaginal ultrasound (TVUS) before surgery; and (17) MVT use, defined as treatment with vaginal tablets. The criteria for “massive blood loss,” “large leiomyoma,” and “heavy uterus” were determined on the basis of past reports [
11‐
13]. Statistical analyses were performed using Microsoft Excel (Microsoft Corporation, Redmond, WA) and JMP version 12 for Windows (SAS Institute, Inc., Tokyo, Japan) to determine the correlations between patient characteristics and VBRPC. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to determine the strength of the correlations.
p < 0.05 was considered statistically significant.
Table 1
Effect of metronidazole vaginal tablet
Age (years old) | 47.9 ± 7.7 (35–81) | 47.3 ± 5.4 (54–73) | NS |
BMI (kg/m2) | 23.0 ± 3.6 (15.9–37.8) | 22.9 ± 3.9 (15.1–46.5) | NS |
Nulliparity | n 28/95 | n 168/425 | NS |
Gynecological operation history | n 20/95 | n 88/425 | NS |
Menstrual disorder | n 76/95 | n 330/425 | NS |
Abdominal distension | n 13/95 | n 119/425 | < 0.01 |
GnRH analog | n 47/95 | n 306/425 | < 0.01 |
Concomitant LC | n 6/95 | n 23/425 | NS |
Concomitant PLA | n 6/95 | n 20/425 | NS |
Operation time (minutes) | 198.2 ± 53.1 (94–361) | 206.0 ± 56.2 (99–504) | NS |
Blood loss (mL) | 135.7 ± 185.6 (0–1189) | 121.6 ± 200.9 (0–2003) | NS |
Uterine weight (g) | 257.5 ± 155.8 (50–925.2) | 324.4 ± 234.7 (28–1454) | < 0.05 |
Abdominal adhesion | n 35/95 | n 182/425 | NS |
Blood transfusion | n 5/95 | n 19/425 | NS |
Leiomyoma size (cm) | 5.7 ± 2.4 (1.7–12.5) | 6.5 ± 3.1 (1.1–20.0) | < 0.05 |
Uterine size (cm) | 7.0 ± 1.7 (2.9–11.9) | 7.4 ± 2.0 (3.0–15.5) | NS |
VBRPC | n 6/95 | n 10/425 | < 0.05 |