Predictive risk factors of vaginal cuff infection and vaginal cuff dehiscence in Egyptian female patients undergoing total laparoscopic hysterectomy for benign gynecological conditions

Abstract

Objective. A reported complication after total laparoscopic hysterectomy (TLH) is vaginal cuff infection (VCI) that needs readmission, antibiotic therapy and worsen post-operative quality of life in patients. Another bad complication of TLH is occurrence of vaginal cuff dehiscence (VCD), which is the separation of sutured vaginal incision. Identification of possible risk factors of VCI and VCD after TLH could help in reducing such annoying complications of patients and health care system. Aim of the present work was assessment of prevalence, preoperative, operative and postoperative risk factors of VCI and VCD after performing TLH for treatment of benign pathological uterine conditions in Egyptian patients. M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o nPatients and Methods. We conducted this prospective cohort study and included 200 females with clinical and radiological evidence of benign pathological conditions in the uterus that underwent TLH. We followed up all patients for 6 weeks post-operatively by performing full gynecological examination in addition to transvaginal sonography then followed up by telephone to assess occurrence of VCI or VCD.Results. 14 of the 200 included patients (7%) were diagnosed with VCI and 8 of the 200 included patients developed VCD (4%) during the 30 days after TLH.There is statistically significant relation between occurrence of vaginal cuff infection and specimen weight, high CRP, vaginal cuff hematoma, complications, suturing technique (p<0.001).There is statistically significant relation between occurrence of vaginal cuff dehiscence and specimen weight (lower with dehiscence) and vaginal cuff hematoma (associated with dehiscence) (p<0.001).Conclusions. We concluded that high post-operative CRP level and occurrence of postoperative vaginal cuff hematoma without sufficient prophylactic antibiotic therapy were significant risk factors of VCI while smaller uterine size is a predictor risk factor of VCD.