Impact of Peritoneal Closure on Postoperative Inflammatory Response and Infection Risk in Total Laparoscopic Hysterectomy

Objective: This study aimed to evaluate the impact of double-layer suturing, achieved through peritoneal closure, on postoperative infections and vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Materials and Methods: A retrospective observational case series (Canadian Task Force classification II-3) was conducted at a community hospital. A total of 154 patients who underwent TLH at Fukuchiyama City Hospital in Japan between July 2019 and June 2021 were included. Peritoneal closure was performed in 126 cases, while it was omitted in 28 cases, based on the surgeon’s discretion. Results: Postoperative infections were observed in 7 out of 154 cases (4.5%). Postoperative infection occurred in 3.2% (4/126) of patients with peritoneal closure and 10.7% (3/28) of patients without peritoneal closure. Although the infection rate was lower in the peritoneal closure group, the difference was not statistically significant (odds ratio 0.36, 95% confidence interval 0.08–2.26, p = 0.15). However, inflammatory markers on postoperative day 3, including white blood cell (WBC) count and C-reactive protein (CRP), were significantly lower in the peritoneal closure group (WBC: 6,215 vs. 7,750, p = 0.001; CRP: 1.99 vs. 3.81, p = 0.003). Conclusions: Peritoneal closure at the vaginal cuff in TLH may reduce early postoperative inflammatory responses and subsequently reduce the risk of infection. Future multi-institutional studies would further delineate the optimal surgical technique for TLH and the significance of including peritoneal closure, as well as help to further define the utility of postoperative testing.