The study aimed to determine whether adding vaginal metronidazole to conventional antibiotic prophylaxis with cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). A randomized, controlled, triple-blind, multicenter clinical trial was conducted involving 574 patients who underwent TLH due to benign diseases. The patients were divided into two groups: the treatment group (cefazolin plus metronidazole) and the control group (cefazolin plus placebo). The frequency of PC and PA and their relationship with bacterial vaginosis (BV) were measured. The study found no significant difference in the frequency of PC and PA between the two groups. However, the incidence of BV was higher in the metronidazole group compared to the placebo group. Therefore, the study concluded that adding vaginal metronidazole to conventional antibiotic prophylaxis does not modify the risk of PC and PA after TLH.

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