Granulation Tissue Formation at the Vaginal Cuff after Total Laparoscopic Hysterectomy or Davinci Assisted Total Hysterectomy with Uterosacral Ligament Colpopexy for Surgical Correction of Pelvic Organ Prolapse

Aim: To assess the incidence and risk factors of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy (TAH). Methods: A retrospective chart review of women who underwent TAH for benign conditions from January 2015 to December 2015 at Ramathibodi Hospital was conducted. The primary outcome was the incidence of complete vaginal cuff healing at 6 and 8 weeks after operation as determined by complete vaginal mucosal approximation without the presence of suture material or granulation tissue. Results: The medical records of 235 patients who underwent TAH for benign conditions were reviewed. The incidence of complete vaginal cuff wound healing at 6 and 8 weeks after operation were 189 and 225 cases, respectively (80.4% vs 95.7%, P value <0.001). Forty-six (19.6%) patients had incomplete vaginal cuff healing at 6 weeks after operation. Of those, 33 patients had vaginal cuff granulation. Spontaneous regression of lesions had occurred in 69.7% at 8 weeks. Independent risk factors of delay vaginal cuff healing were the used of electrosurgery for vaginal incision (adjusted odds ratio 13.4, 95% confidence interval 2.63-67.74) and suturing cuff with continuous technique (adjusted odds ratio 9.1, 95% confidence interval 2.12-39.01). Conclusion: The incidence of complete vaginal cuff wound healing was significantly higher at 8 weeks than at 6 weeks after TAH for benign conditions. Therefore, 8 weeks after operation would be an appropriate time for the first vaginal cuff examination.

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“…Many previous studies have described methods for reducing the incidence of granulation tissue formation at the vaginal vault . Manyonda et al .…”

Section: Discussionmentioning

confidence: 99%

“…It might be result of more tissue damage and impair wound healing. However, Azadi et al . found that the incidence of vaginal cuff granulation was 6.4% after the use of the electrosurgical technique.…”

Section: Discussionmentioning

confidence: 99%

Incidence of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy

Watcharaprapapong

Treetampinich

Ayudhya

et al. 2018

J of Obstet and Gynaecol

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“…This in view of the researchers may be due to the intraperitoneal placement of suture knot, causes less exposure of vaginal epithelium to the suture material. 32 Treating any pre-operative vaginal infection also lowers the incidence of post-operative vaginal infection , discharge and persistence of granulation tissue.…”

Section: Vault Granulation Tissuementioning

confidence: 99%

Preventable gynecological surgeries in hysterectomized women : a review of causes and measures of prevention

Anant

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Hysterectomy, the most common gynaecologic surgery performed around the world. however, repeat gynaecologic intervention / surgery may be required for some conditions, adding cost and morbidity for patients and posing a burden on healthcare systems. The objective of the present study was to find out the incidence of and types of surgical intervention required post hysterectomy. Methods: A retrospective analysis of hospital records was done for gynecologic operative procedures done in post hysterectomy patients 2014-2016. Results: Out of a total of 1028 in the year 2014-2016 in our centre, 75 (7.3%) surgeries were performed for benign conditions in hysterectomized women. Hydrosalpinx(29%) was most common condition for surgery, followed by endometriosis(24%) with 31-40 years age group women undergoing the maximum surgeries. Vault prolapse(16%) in elderly and vaginal vault granulation(16%) in younger women also underwent a repeat gynecological procedure post hysterectomy. Conclusions: Some measures can be taken during the primary surgery(hysterectomy) to prevent a repeat gynaecological surgery in these women. Concurrent salpingectomy can prevent benign and malignant fallopian tube lesions and ovarian cancer . Endometriosis surgery should be precise to prevent any remnant ovarian or endometriotic foci. McCall's culdoplasty in primary hysterectomy is proven to prevent vaginal vault prolapse. Most genitourinary fistulas can be prevented by detailed knowledge of pelvic anatomy, preoperative risk stratification of patients at higher risk of ureteric and urinary bladder injuries, meticulous surgical technique and judicious use of electrosurgical energy. Prevention is always better than a repeat surgery.

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Granulation Tissue Formation at the Vaginal Cuff after Total Laparoscopic Hysterectomy or Davinci Assisted Total Hysterectomy with Uterosacral Ligament Colpopexy for Surgical Correction of Pelvic Organ Prolapse

Cited by 2 publications

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Incidence of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy

Incidence of complete vaginal cuff wound healing at sixth and eighth week after total abdominal hysterectomy

Preventable gynecological surgeries in hysterectomized women : a review of causes and measures of prevention

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