Normal saline solution is as effective as povidone iodine in preoperative vaginal cleansing before short duration gynecological laparoscopy

Abstract

Laparoscopy is a minimally invasive method used for diagnostic and therapeutic purposes. Our objective was to compare the postoperative vaginal irritation symptoms and infection rates after using povidone-iodine (PI) and normal saline (NS) solution in vaginal cleansing before short duration gynecological laparoscopy. Randomized, single-blind clinical trial. All eligible participants who scheduled for short duration gynecologic laparoscopic procedures included diagnostic laparoscopy, bilateral ovarian drilling, and tubal sterilization were invited to participate in the study. Eligible participants were randomly allocated in a 1:1 ratio to two groups. Group I "PI group" where they subjected to PI for vaginal cleansing before laparoscopy and group II "NS group” where they subjected to the standard saline solution for vaginal cleansing. Two sponges of the same size and type were used for cleansing by both preparations. The primary outcome of the study was the difference in the rate of self-reported postoperative vaginal irritation symptoms after using PI and NS for vaginal cleansing. The secondary outcomes included the rate of postoperative fever ≥38 °C during the first 24 hours, persistent vaginal irritation symptoms, urinary tract infection, candidal vaginitis and bacterial vaginosis and endometritis at one-week post-procedure. The outcome variables were calculated using an unpaired t-test and chi-square test. Two-hundred forty-four women were analyzed in both groups (121 women in the arm). Both groups were similar regarding the mean age, residency, woman's education, parity, BMI and operative time. Diagnostic laparoscopy was the most common laparoscopic procedure performed during the study period (84.29%), tubal sterilization (7.85%) then bilateral ovarian drilling (7.43%). The mean overall vaginal irritation symptoms in PI group were significantly more than that observed in the NS group (p=0.0001). The overall infection rates in the PI group were 15.9%, while in the NS group was 10.16 % without a statistically significant difference in both groups (p=0.567). Both groups were quite similar in the rate of postoperative fever (p=0.505), urinary tract infection (p=0.654), vaginal candidiasis (p=0.254), bacterial vaginosis (p=0.366) and postoperative endometritis (p=0.749). Being less irritant, normal saline can substitute iodide solution as a vaginal cleansing tool before short duration gynecologic laparoscopy without increasing the risk of postoperative infection.