Vaginal vault dehiscence with evisceration after total laparoscopic hysterectomy

Sinha, Rakesh; Kadam, Pratima; Sundaram, Meenakshi; Mahajan, Chaitali; Shah, Parul T.; Lakhotia, Smita; Rao, Gayatri

doi:10.1007/s10397-010-0602-3

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…However, more importantly, in these cases the peritoneum remained closed and in none (of all our cases) an evisceration occurred. Especially the latter is important, since immediate reoperation is needed and its association with bowel perforation and/or necrosis, peritonitis and general sepsis [ 7 , 9 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

et al. 2012

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Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH.

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Section: Discussionmentioning

confidence: 99%

Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

et al. 2012

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“…It can lead to evisceration (i.e. prolapse) of the abdominal contents, especially of the terminal ileum, which can occur a few weeks or even years after hysterectomy . The incidence of VCD was found to be higher after laparoscopic hysterectomy compared with abdominal or vaginal routes (4.9%, 0.29% and 0.12%, respectively) .…”

Section: Vaginal Vault Complicationsmentioning

confidence: 99%

“…Other factors that may contribute to the occurrence of VCD include postoperative vault infection or haematoma, post‐menopausal state, use of radiotherapy, chronic steroid use, chronic increase in intra‐abdominal pressure, obesity, diabetes, immunosuppression and early return to sexual intercourse …”

Section: Vaginal Vault Complicationsmentioning

confidence: 99%

Issues around vaginal vault closure

Moustafa

Elnasharty

2019

The Obstetric & Gynaecologis

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Key content Vaginal cuff dehiscence (VCD), vault prolapse, vaginal cuff granulation and infected vault haematoma are adverse events following hysterectomy. There are several approaches to closing the vaginal cuff, each using different techniques and sutures. Dehiscence of the vaginal cuff is more common with laparoscopic hysterectomy. Techniques that minimise excessive use of diathermy may reduce the risk of vault dehiscence. The incidence of post‐hysterectomy vault prolapse is estimated to be between 1.8% and 11.6%. McCall culdoplasty seems to be effective in supporting the vaginal vault. Different techniques are used to minimise the development of vault haematoma and granulation tissue. Learning objectives To understand the different techniques used for vault closure during hysterectomy. To understand the different surgical approaches used to reduce the risk of vault dehiscence, vault prolapse and haematoma after hysterectomy. To understand the post‐operative care procedure that should be followed after hysterectomy to minimise the risk of vaginal vault complications. Ethical issues Patients should be aware of the risk of vaginal vault dehiscence, vault prolapse, haematoma and granulation tissue formation after hysterectomy. Trainees should be well trained using simulators, be supervised when performing laparoscopic vaginal vault closure and be made aware that vaginal closure is another safe treatment option.

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Vault Dehiscence – A Rare Gynecological Emergency

Nalam

Uma

Bhojwani

2022

ijsr

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Background: VCD is a rare complication following hysterectomy. Signicance of this condition lies with the potential of evisceration of abdominal and pelvic contents resulting in additional morbidity. Case presentation: A57 years old multiparous female presented to casuality with severe pain abdomen and vaginal discharge. With history of undergoing Total Laparoscopic Hysterectomy 6 months back. On examination small intestines were in vagina, with 2 cms defect in vault. Patient was stabilized and the defect was closed vaginally. Conclusion: VCD is a rare complication that should be kept in mind when patient presents with sudden onset lower abdominal or pelvic pain along with vaginal discharge following hysterectomy. In absence of any bowel pathology, vaginal closure is a safe treatment option.

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Vaginal vault dehiscence with evisceration after total laparoscopic hysterectomy

Cited by 3 publications

References 3 publications

Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

Issues around vaginal vault closure

Vault Dehiscence – A Rare Gynecological Emergency

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