Vaginal cuff dehiscence: risk factors and management

Abstract

Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, presenting symptoms, precipitating events, and management options for patients who present with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence.

Vaginal Cuff Dehiscence; Risk Factors and Associated Morbidities

“…4,5,10 Both laparoscopic and, in particular, robotic-assisted laparoscopic hysterectomies were associated with higher odds of dehiscence. These findings correlate with the available literature 1,12,13 and may reflect the accumulation of more experience with laparoscopic hysterectomy than with robotic-assisted hysterectomy at our institution.…”

“…The incidence of this condition as reported in the literature is 0% to 7% and appears to be higher after laparoscopic and robotic approaches compared with vaginal and abdominal approaches. [1][2][3][4][5] Uccella et al 1 previously reported the incidence to be 0.13% when the procedure is performed by the vaginal approach, 0.2% when performed abdominally, and 0.64% when performed by the laparoscopic approach. Risk factors are ill-defined 5 and include factors that influence wound healing, as well as mechanical factors such as early resumption of sexual activity, trauma, and increased intra-abdominal pressure.…”

“…[1][2][3][4][5] Uccella et al 1 previously reported the incidence to be 0.13% when the procedure is performed by the vaginal approach, 0.2% when performed abdominally, and 0.64% when performed by the laparoscopic approach. Risk factors are ill-defined 5 and include factors that influence wound healing, as well as mechanical factors such as early resumption of sexual activity, trauma, and increased intra-abdominal pressure. [5][6][7][8][9] Limited data exist about the effect of different approaches to colpotomy creation, suture materials, 2 or suturing techniques 10,11 on the risk of vaginal cuff separation.…”

“…Risk factors are ill-defined 5 and include factors that influence wound healing, as well as mechanical factors such as early resumption of sexual activity, trauma, and increased intra-abdominal pressure. [5][6][7][8][9] Limited data exist about the effect of different approaches to colpotomy creation, suture materials, 2 or suturing techniques 10,11 on the risk of vaginal cuff separation. 12 Furthermore, the available retrospective reports often lack clear descriptions of the technique of colpotomy used, especially in abdominal and vaginal hysterectomies.…”

Robotic Surgery in Gynecology

“…Bu nedenle daha az hemostazı yapılmış bir vajinal kaf, sıfır kanamalı kuru bir vajinal kaf tercih edilmelidir (12). herhangi bir histerektomiden sonra kaf dehisensi %0,14-4,1 oranlarında görüle-bilirken, vajinal kafın vajinal yoldan kapatılması dehisens riskini 3 ile 9 kat oranında azaltmaktadır (13,14). ayrıca son zamanlarda tek yönlü gömülen dikişlerin kullanıldığı robotik olgularda vajinal kaf dehisensinin dramatik bir şekilde azaldığı gösterilmiştir (15 (5,6).…”