An ultrasound-guided minimally invasive treatment for vaginal vault collections following major gynaecological surgery: a case series.

Introduction: Post-hysterectomy vaginal vault collections, often infected haematomas, cause significant morbidity requiring resource-intensive and invasive management. Our proposed method for vault drainage, a novel ultrasound-guided technique, aims to provide a minimally invasive treatment for refractory collections. This is a proof-of-concept case series that describes the technique and evaluates its potential efficacy. Methods: Retrospective case series of nine patients with vaginal vault collections (eight infected haematomas, one lymphocyst) refractory to, or unsuitable for conservative management with intravenous antibiotics. Transvaginal drainage with blunt sponge holding forceps was performed under transabdominal ultrasound-guidance, taking 3-5 min with minimal discomfort. Prior transvaginal ultrasound was performed to confirm collection anatomy. The primary outcomes were symptom resolution and inflammatory marker reduction. All patients were seen and treated at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. Results: All patients had their vaginal vault collection successfully drained with subsequent resolution of their symptomatic illness (e.g., pyrexia, pain, discharge). One patient required repeat drainage. Inflammatory markers decreased significantly post-drainage. No procedure-related complications occurred. Discussion: The proposed procedure treated all patients' vaginal vault collections. This technique offers a minimally invasive, ultrasound-guided alternative to interventional radiology or surgery. This may particularly benefit high-risk patients such as we describe (e.g., high BMI, complex surgery, cancer diagnoses) who are less suitable for invasive intervention. Conclusions: We present an ultrasound-guided, minimally invasive technique for the treatment of refractory post-hysterectomy vaginal vault collections that avoids the need for sharp instruments or surgical intervention.