Vaginal Cuff Dehiscence After Endometriosis Surgery

Abstract

Background and Objectives: Laparoscopic hysterectomy is one of the surgical treatment options for endometriosis. A rare complication of this surgical procedure is vaginal cuff dehiscence, with an incidence of 0.03% to 0.30%. Sexual intercourse may be the main triggering event. It is unclear if patients with endometriosis are more prone to develop vaginal cuff dehiscence than other women undergoing laparoscopic hysterectomy. Methods: We present the cases of women aged 35 to 46 years who underwent laparoscopic endometriosis surgery. In all patients the vaginal cuff was opened with a high-energy surgical device and closed with an absorbable suture. After 60 to 194 d, the patients developed symptoms including acute abdominal pain and fever shortly after or during coitus and were diagnosed with vaginal cuff dehiscence. Results: Patients undergoing surgical treatment for endometriosis may experience poor wound healing of the vaginal cuff due to the frequent use of gonadotrophin-releasing hormone analogues before surgery. Contributing to this may be the use of a high-energy surgical device when opening the vaginal cuff. Resuming sexual activities before proper healing of the wound has occurred may then trigger vaginal cuff dehiscence. Conclusion: Women with endometriosis might be prone to develop vaginal cuff dehiscence, not because of the endometriosis itself but because of a combination of patient-specific factors present in women with endometriosis. Surgeons treating women with endometriosis should be aware of this.

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

“…coagulation instead of cutting mode for vaginal incision [ 111 ]), transvaginal closure of the vault, use of single instead of continuous stiches, postoperative infection and supravaginal hematoma [ 106 , 108 ]. Patient-related risks for developing VCD are: premenopausal status, smoking habit, and preexistent endometriosis [ 103 , 105 – 113 ]. No differences in the frequency of VCD were noted in relation to the use of barbed versus non-barbed suture (polyglactin 910) [ 114 ] or single-layer versus double-layer barbed suture [ 108 , 115 ], with the exception of RALS, where the use of barbed sutures was associated with better healing and fewer separations of the vaginal cuff [ 108 , 116 ].…”

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

“…We categorized the risk factors for VCD(E) into three groups: external force on the vaginal cuff, patient factors (physiological or pathological), and TH-related factors. Vaginal trauma during coitus is the most common trigger of VCD(E) ( 1 , 4 ). Transvaginal procedures can also lead to VCD(E), including transvaginal ultrasonography ( 7 ) and intracavitary brachytherapy ( 8 ).…”

“…It mainly involves hemostasis (hemostatic and local compression), activity restriction, and prophylactic antibiotics. Zoë Boersen et al ( 1 ) reported two cases that were successfully managed conservatively. Notably, if the patient’s condition worsens, surgical intervention should be considered.…”

“…Total hysterectomy (TH) is one of the most common gynecological procedures ( 1 ) and is widely applied in various benign and malignant diseases. Genitourinary and gastrointestinal tract injury, bleeding, infection, and vaginal cuff dehiscence (VCD) are the most common complications of TH ( 2 ).…”

Prevention and management of vaginal cuff dehiscence: an updated review

“…The bladder and rectum may require further dissection to allow at least 1 cm of full-thickness bite during closure [4,5]. Similar to the management of initial cuff closure, there is no one recommended way to close the cuff after a dehiscence has occurred [1,2,[39][40][41]. Some authors favor monofilament sutures for the theoretical advantage of reducing infection [42,48,49].…”