Vaginal scrub-and-paint versus paint-only preparation in total laparoscopic hysterectomy: surgical site infection and postoperative spotting outcomes in a randomised controlled trial

BACKGROUND: No consensus exists regarding optimal vaginal preparation techniques for preventing surgical site infections (SSIs) in laparoscopic hysterectomy. This study aimed to compare SSI incidence between vaginal scrub-and-paint and paint-only preparation methods. METHODS: Assessor-blinded randomised controlled trial in a tertiary care hospital in Thailand. Eligible patients scheduled to undergo total laparoscopic hysterectomy, without immunocompromised status, intraoperative injury to adjacent organs, or contraindication to chlorhexidine gluconate. Participants who provided informed consent were randomised to receive either vaginal scrub-and-paint preparation or paint-only preparation. Data on SSI risk factors, operative parameters, and postoperative outcomes were collected for 30 days post-surgery. Data are presented as numbers (percentages), or medians (interquartile ranges [IQRs]). Categorical and continuous variables were analysed using appropriate statistical tests, with P < 0.05 as the criterion for significance. RESULTS: Among 370 participants, median age was 46.5 years (IQR 43.0-51.0), median operative time was 160 min (IQR 125.0-198.75), and median blood loss was 50 mL (IQR 21.25-100.0). Median hospital stay was 2 days (IQR 2.0-2.0). Twenty-nine patients (7.8%) had malignancy. No SSIs occurred in either group. Thirteen patients (7%) in the scrub-and-paint group experienced vaginal spotting. CONCLUSIONS: Within the limitations of this prematurely discontinued trial and the absence of SSI events, both regimens appeared comparable regarding SSI, while scrub-and-paint was associated with more vaginal spotting. CLINICAL TRIAL REGISTRATION: The study was registered with the Thai Clinical Trials Registry (reference 20230418002) on April 18, 2023. https://www.thaiclinicaltrials.org/show/TCTR20230418002.