Search

Key Clinical Message: Vaginal cuff dehiscence post‐hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second‐look laparotomy in cases of uncertain bowel viability. Vaginal cuff dehiscence (VCD) is a rare but potentially life‐threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life‐threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second‐look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection. [ABSTRACT FROM AUTHOR]

ABSTRACTA 31-year old female with a history of laparoscopic assisted vaginal hysterectomy presented by ambulance to the emergency department with acute onset of abdominal pain and a vaginal protrusion which occurred while straining to pass a bowel movement.  Physical examination was notable for a flat but slightly tender abdomen, normal bowel sounds, scant vaginal bleeding, and a 15cm long, blood-tinged mass protruding from the vagina.  A brief and unsuccessful attempt at reduction was made by the emergency physician.  Obstetrics and Gynecology was consulted, and the patient was taken to the operatingDIAGNOSISOmental prolapse through vaginal cuff dehiscence.  Following vaginal hysterectomy, the vaginal cuff is closed surgically1.  Occasionally, this site can dehisce, allowing abdominal contents to enter the vagina or protrude through the vaginal canal. Vaginal cuff dehiscence is estimated to have a rate of 0.39%. It is more commonly seen after total laparoscopic hysterectomy (1.35%) compared with laparoscopic-assisted vaginal hysterectomy, (0.28%)2.Risk factors include trauma from sexual intercourse, repetitive Valsalva maneuvers, smoking, malnutrition, anemia, diabetes, immunosuppression, and corticosteroid use2.  Cases typically present as vaginal spotting or post-coital bleeding, and occasionally pelvic pressure or protrusion2.  Most cases occur within weeks to months after the procedure, but some can present years later. Patients are at risk for infection due to exposure of peritoneal contents to vaginal and skin flora.  Management includes administration of broad-spectrum antibiotics.  Partial dehiscence can be managed with rest, but large dehiscence is usually managed surgically.This case highlights the importance of the pelvic exam in patients with vaginal bleeding and abdominal pain, and care should be taken to not mistake protruding omental tissue for prolapsed vaginal mucosa. REFERENCES1.     Binz NM, et al. Complications of Gynecologic Procedures. Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020.2.     Clarke-Pearson D, & Geller E. Complications of Hysterectomy. Obstetrics & Gynecology, 121 (3), 654-673; 2013.

To compare rates of vaginal cuff dehiscence (VCD) in transgender patients with cisgender patients after minimally invasive hysterectomy (MIH). We performed a single-surgeon, retrospective cohort analysis comparing the rates of VCD in patients undergoing MIH for gender affirmation with other indications (benign, malignant, prophylactic) with our study surgeon between January, 2015, and December, 2021. Major, urban, academic tertiary care hospital in the United States. 166 patients met inclusion criteria with 49 of those patients undergoing MIH (29.5%) for gender affirmation. Of the remaining 117 patients, 92 (78.6%) underwent MIH for cancer, 15 (12.8%) for prophylaxis, and 10 (8.5%) for benign indications. Not applicable. We assessed included patients for baseline demographics, presence of risk factors for VCD, details of index hysterectomy, and details of cuff dehiscence events. Transgender patients tended to be younger at the time of surgery, but demographics were otherwise similar between both groups. Most transgender patients (n = 36, 73.5%) had both ovaries removed at the time of hysterectomy, 100% were on testosterone therapy pre- and postoperatively, and none used supplementary estrogen. Three of the 49 transgender patients (6.1%) experienced postoperative dehiscence of the vaginal cuff compared with 2 of the 117 cisgender patients (1.7%). This failed to reach statistical significance; however, our descriptive analysis showed that all cases of dehiscence in the cisgender group had identifiable precipitating factors (i.e., trauma). By comparison, all cases of dehiscence in the transgender group were spontaneous with few identifiable risk factors. Transgender patients undergoing MIH may be at increased risk of VCD, although the rarity of this surgical complication precluded determination of statistical significance in our data set. We propose testosterone exposure as a possible risk factor for VCD, although we cannot exclude other factors, such as young age, as drivers of VCD in this population. Future studies of biospecimens are needed to evaluate for cellular differences in these patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential. [ABSTRACT FROM AUTHOR]

Key Clinical Message Vaginal cuff dehiscence post‐hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second‐look laparotomy in cases of uncertain bowel viability. Abstract Vaginal cuff dehiscence (VCD) is a rare but potentially life‐threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life‐threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second‐look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection.

Case Presentation: A 31-year-old female presented to the emergency department with abdominal pain and a 15-centimeter bloody vaginal protrusion, which resulted during an attempted bowel movement. Reduction of the mass was unsuccessful, and the patient was taken to the operating room for examination.Discussion: In patients with a history of vaginal hysterectomy, the vaginal cuff can dehisce and abdominal contents may protrude through the vaginal canal. In this case presentation, the vaginal mass was found to be omental tissue, which could be mistaken for a prolapse of vaginal mucosa. Therefore, a proper pelvic exam is imperative, as prolapse through a cuff dehiscence can lead to severe complications.

Vaginal cuff dehiscence with small bowel evisceration is uncommon but a serious postoperative complication of radical cystectomy. A 70-year-old Japanese woman noticed the sensation of a mass emerging from her vagina and visited our department. Her surgical history included radical cystectomy for muscle-invasive bladder cancer with a hysterectomy 9 months earlier. The small bowel showed edematous change and had prolapsed out through her vagina. Computed tomography confirmed that the small bowel had prolapsed through the vagina and had a sub-ileus-like appearance. The surgeons considered that the small bowel was free from necrosis and moved it back to within the pelvis. The patient was kept in hospital for follow-up, but developed a fever of 38 ℃ on hospital admission day 2. We noticed that there was no improvement in the abnormal reddish tone of the returned small bowel and considered the possibility of small bowel necrosis and peritonitis. Emergency surgery was performed. The portion of the small bowel with the abnormal reddish color was resected and the vaginal cuff was repaired with a two-layer continuous closure. There were no further postoperative complications and the patient was discharged on postoperative day 12. [ABSTRACT FROM AUTHOR]

Vaginal evisceration is a rare surgical emergency in which intra-abdominal contents protrude through a dehisced vaginal cuff, which can lead to bowel ischemia and abdominal sepsis. This condition occurs due to vaginal cuff weakness secondary to prior surgeries or trauma. Recurrence after repair is rare and few cases have been documented. Here we present a young woman with multiple prior gynecologic surgeries who presented with eviscerated small bowel and omentum from her vagina five months following surgical treatment of a previous vaginal evisceration. Via a transabdominal surgical approach, general surgery and gynecology teams reduced the intra-abdominal contents, resected a pedicle of necrotic omentum, suture repaired the vaginal cuff, and placed a dehydrated placental allograft. This extremely rare case of recurrent vaginal evisceration demonstrates the importance of taking appropriate preventative surgical measures, maintaining a healthy level of suspicion for recurrence, knowing potential complications, and educating patients to prevent recurrent vaginal evisceration. [ABSTRACT FROM AUTHOR]

To analyze hysterectomy trends and vaginal cuff dehiscence (VCD) rates by mode of surgery at a tertiary care medical center and to describe characteristics of VCD cases. Observational retrospective cohort study. Large academic hospital and affiliated community hospital. 4722 patients who underwent hysterectomy at Columbia University Irving Medical Center between January 2010 and August 2021. Current Procedural Terminology and International Classification of Diseases codes identified hysterectomies and VCD cases. Hysterectomy trends and VCD rates were calculated by mode of surgery. Relative risks of VCD for each mode were compared with total abdominal hysterectomy (TAH). Clinical characteristics of VCDs were reviewed. There were 4059 total hysterectomies. Laparoscopic hysterectomies, including total laparoscopic hysterectomies (TLHs), laparoscopic-assisted vaginal hysterectomies, and robot-assisted TLHs (RA-TLHs), increased from 41.9% in 2010 to 65.9% in 2021 (p <.001). RA-TLH increased from 5.7% in 2010 to 40.2% in 2021. Supracervical hysterectomies followed similar trends and were excluded from VCD analysis. There were 15 VCDs (overall rate 0.37%). VCD was highest after RA-TLH (0.66%), followed by TLH (0.32%) and TAH (0.27%), with no VCDs after laparoscopic-assisted vaginal hysterectomy or total vaginal hysterectomy. Compared with TAH, the relative risk for VCD after RA-TLH was 2.44 (95% confidence interval 0.66–9.00) and after TLH was 1.18 (95% confidence interval 0.24–5.83), which were not statistically significant. The mean time to dehiscence was 39 days (range 8–145 days). The most common trigger event was coitus (41%). VCD rates were low (<1%) for all modes of hysterectomy, and rates after robotic and laparoscopic hysterectomy were much lower than previously reported. Although VCD rates trended higher after robotic and laparoscopic hysterectomy compared with abdominal hysterectomy, the difference was not significant. It is difficult to determine whether this finding represents true lack of difference vs a lack of power to detect a significant difference given the rarity of VCD. [ABSTRACT FROM AUTHOR]

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

Vaginal vault dehiscence leading to bowel evisceration is a rare but potentially lethal surgical emergency. Various aetiologies have been reported in the literature, but the condition is most commonly seen after hysterectomy in post-menopausal women. Prompt reduction of the bowel is necessary to prevent ischaemic complications. Although most cases in the past have been managed by exploratory laparotomy, the condition may be managed laparoscopically if the prolapsed bowel is viable, giving the benefit of minimally invasive surgery to the patient. A hybrid approach of laparoscopic bowel reduction and per vaginal repair of the vault is technically simple and can be performed even by non-expert surgeons in an emergency setting.

Objective: This article describes the incidence, presentation, management, and outcome of posthysterectomy vaginal cuff evisceration over a 2-year timeperiod at a major cancer center. Materials and Methods: This was a retrospective chart review of patients who developed vaginal cuff evisceration after prior hysterectomy. The denominator of hysterectomies performed by the department between May 1, 2020 and April 30, 2022, was included in the analysis. The cases of vaginal evisceration were well-known to the practice. Results: Three women who had undergone hysterectomy during the 2-year timeperiod developed vaginal cuff evisceration. This incidence was 0.3%. All 3 women underwent surgical repair (1 with bowel resection) without subsequent complications. Conclusions: Vaginal evisceration is a rare complication of hysterectomy at a major cancer center. This report adds to the body of knowledge regarding diagnosis and management of this dramatic and life-threatening event. (J GYNECOL SURG 39:49) [ABSTRACT FROM AUTHOR]

Background: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. Method: All patients with indication of total laparoscopic hysterectomy during the study period were included. These were randomly divided in to two groups A and B. Group A was performed upon the conventional interrupted figure of 8 vault suturing and group B with continuous, running, double layered suturing. Keeping the demographics almost same the frequency of a known but rare complication of vaginal cuff dehiscence (VCD) was determined. Results: A total of 195 patients were enrolled. Of these 87 were in group A and 108 in group B. The results were unequivocal as only one patient had the said complication. Conclusion: The morbid complication has no relation with the technique of vault suturing. [ABSTRACT FROM AUTHOR]

Vaginal vault dehiscence leading to bowel evisceration is a rare but potentially lethal surgical emergency. Various aetiologies have been reported in the literature, but the condition is most commonly seen after hysterectomy in post-menopausal women. Prompt reduction of the bowel is necessary to prevent ischaemic complications. Although most cases in the past have been managed by exploratory laparotomy, the condition may be managed laparoscopically if the prolapsed bowel is viable, giving the benefit of minimally invasive surgery to the patient. A hybrid approach of laparoscopic bowel reduction and per vaginal repair of the vault is technically simple and can be performed even by non-expert surgeons in an emergency setting. [ABSTRACT FROM AUTHOR]

Abstract Background Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis. Case presentation We report a case of vaginal cuff dehiscence in a 45-year-old multiparous Taiwanese woman who had undergone abdominal total hysterectomy and presented with vaginal cuff dehiscence precipitated by sexual intercourse. Immediate laparoscopic repair was done. Few authors have reported the utilization of the laparoscopic approach. It allows thorough inspection, visualization, and irrigation of the abdominal cavity. It is also associated with fewer intraoperative and postoperative complications. Conclusion Laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after total hysterectomy.

Small bowel evisceration from dehiscent vaginal cuff is unusual subsequent to laparoscopic hysterectomy. This complication is seldom cited in studies and reviews. We present an uncommon case of evisceration of small bowel from vaginal cuff dehiscence (VCD). The event occurred approximately 2 hours subsequent to the first act of coitus performed 3 months after the laparoscopic hysterectomy. Patient was brought to the emergency department for primary treatment. Urgent surgical intervention was planned. Small intestine was reposed after saline wash. Repairing of the vault was done with continuous suture by polyglactin-910 braided synthetic absorbable suture no.1. Patient was sent to home after 5 days of surgery. The strength of vaginal vault in laparoscopic hysterectomy depends on technique of vaginal cuff closure and types of suture materials used during surgery. Postoperative counseling of patients for recommencing physical activity and sexual intercourse is also of utmost significance.

Purpose: Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up. Methods: All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database. Results: VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0–9.38; p = 0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98–0.99; p = 0.02) were associated positively with the risk of VCD. Conclusion: In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic hysterectomy is increasingly replacing abdominal hysterectomy in many countries. The advantages of laparoscopic approach include short postoperative recovery time and hospitalisation time. However, vaginal cuff closure during laparoscopic hysterectomy can be challenging, especially for beginners. Barbed sutures have been found to be superior to conventional sutures for vaginal cuff closure during laparoscopic hysterectomy in several studies. However, studies comparing different barbed sutures are lacking. Aim: To compare vaginal cuff closure time, operative time and complications between unidirectional and bidirectional barbed suture during Total Laparoscopic Hysterectomy (TLH). Materials and Methods: A randomised, controlled clinical trial was conducted from November 2017 to March 2019, in a Medical College in Puducherry, India that involved 46 women, who underwent TLH for benign pathology. After TLH, vaginal cuff closure method was randomised to unidirectional barbed suture or bidirectional barbed suture. The vaginal cuff closure time, total operative time and complications were recorded. The patients were evaluated postoperatively at 4 weeks after the surgery and by phone interview at 6 months. The comparison between the continuous variables was done with independent Students t-test or Mann-Whitney U Test and categorical variables with Chi-square or fisher-exact test. A p-value of

Vaginal cuff dehiscence (VCD) is a rare postoperative complication of total hysterectomy. Presenting symptom is acute pelvic or abdominal pain accompanied by nausea and vomiting. Immediate recognition and surgical repair are crucial for successful management. A 40-year-old para 1+0 presented with complaints of pelvic pain associated with sexual activity, three months after a total laparoscopic hysterectomy. Speculum examination revealed the presence of bowel into the vagina. Diagnostic laparoscopic assessment combined with VCD repair through the transvaginal route. The occurrence of VCD after laparoscopic hysterectomy has been linked to overuse of electrocautery, prolonged inflammatory response and suturing methods. Laparoscopic, abdominal and vaginal approaches are the routes for repairing VCD. However, it depends on the clinical presentation and surgeon expertise. Careful history, and physical examination are vital factors in guiding clinicians to diagnose and treat VCD. Nevertheless, an ideal modality remains variable to each case.

Introduction: Laparoscopic hysterectomy is increasingly replacing abdominal hysterectomy in many countries. The advantages of laparoscopic approach include short postoperative recovery time and hospitalisation time. However, vaginal cuff closure during laparoscopic hysterectomy can be challenging, especially for beginners. Barbed sutures have been found to be superior to conventional sutures for vaginal cuff closure during laparoscopic hysterectomy in several studies. However, studies comparing different barbed sutures are lacking. Aim: To compare vaginal cuff closure time, operative time and complications between unidirectional and bidirectional barbed suture during Total Laparoscopic Hysterectomy (TLH). Materials and Methods: A randomised, controlled clinical trial was conducted from November 2017 to March 2019, in a Medical College in Puducherry, India that involved 46 women, who underwent TLH for benign pathology. After TLH, vaginal cuff closure method was randomised to unidirectional barbed suture or bidirectional barbed suture. The vaginal cuff closure time, total operative time and complications were recorded. The patients were evaluated postoperatively at 4 weeks after the surgery and by phone interview at 6 months. The comparison between the continuous variables was done with independent Students t-test or Mann-Whitney U Test and categorical variables with Chi-square or fisher-exact test. A p-value of <0.05 was considered as statistically significant. Results: The mean time taken for vaginal cuff closure by unidirectional barbed suture group was 6.8±1.6 minutes and bidirectional barbed suture was 11.3±1.46 minutes (p<0.001). The mean operative time in the unidirectional barbed suture group was 139±48.3 minutes and in the bidirectional barbed suture group was 150.6±42.7 minutes (p=0.39). The frequency of postoperative complications such as bleeding, infection and cuff dehiscence were not statistically significant between the two groups. Conclusion: Vaginal cuff closure time using unidirectional barbed suture is significantly less when compared to bidirectional barbed suture during TLH. [ABSTRACT FROM AUTHOR]

Background: Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis.Case Presentation: We report a case of vaginal cuff dehiscence in a 45-year-old multiparous Taiwanese woman who had undergone abdominal total hysterectomy and presented with vaginal cuff dehiscence precipitated by sexual intercourse. Immediate laparoscopic repair was done. Few authors have reported the utilization of the laparoscopic approach. It allows thorough inspection, visualization, and irrigation of the abdominal cavity. It is also associated with fewer intraoperative and postoperative complications.Conclusion: Laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after total hysterectomy. [ABSTRACT FROM AUTHOR]

Vaginal cuff dehiscence (VCD) is a rare postoperative complication of total hysterectomy. Presenting symptom is acute pelvic or abdominal pain accompanied by nausea and vomiting. Immediate recognition and surgical repair are crucial for successful management. A 40-year-old para 1+0 presented with complaints of pelvic pain associated with sexual activity, three months after a total laparoscopic hysterectomy. Speculum examination revealed the presence of bowel into the vagina. Diagnostic laparoscopic assessment combined with VCD repair through the transvaginal route. The occurrence of VCD after laparoscopic hysterectomy has been linked to overuse of electrocautery, prolonged inflammatory response and suturing methods. Laparoscopic, abdominal and vaginal approaches are the routes for repairing VCD. However, it depends on the clinical presentation and surgeon expertise. Careful history, and physical examination are vital factors in guiding clinicians to diagnose and treat VCD. Nevertheless, an ideal modality remains variable to each case. [ABSTRACT FROM AUTHOR]

Study Objective: The effect of the different types of vaginal cuff closures on posthysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal versus a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire.Design: Secondary analysis of a prospective randomized controlled trial.Setting: Three academic research centers.Patients: Women consenting to telephone interviews on their sexual life before and after undergoing TLH were included.Interventions: Patients were randomly assigned to a laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications.Measurements and Main Results: A validated questionnaire (the Female Sexual Function Index [FSFI]) was used to explore sexuality before and after the operation. Of the 1408 patients enrolled in the primary study, 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and postoperative FSFI scores between groups. Patients with a low preoperative FSFI score (<26.55) had a significantly higher likelihood of having a postoperative sexual disorder (p <.001). Women who received bilateral adnexectomy before menopause and those with postoperative vaginal cuff hematoma had a significantly lower postoperative FSFI score (p = .001 and p = .04, respectively). After multivariable analysis, both variables maintained at least a tendency toward an association with a lower postoperative FSFI score (odds ratio, 2.696; 95% confidence interval, 1.010-7.194; p = 0.048 and p = 0.053; odds ratio, 13.2; 95% confidence interval, .966-180.5, respectively).Conclusion: Transvaginal and laparoscopic cuff closures after TLH have similar sexual postoperative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI score postoperatively. Premenopausal patients undergoing bilateral ovariectomy and those with postoperative vaginal cuff hematoma have a worse postoperative sexual life. (Clinicaltrials.gov, protocol number NCT02453165, registration date May 25, 2015.). [ABSTRACT FROM AUTHOR]

Study Objective: To compare the rate of spontaneous and complete vaginal cuff dehiscence (VCD) using absorbable versus nonabsorbable sutures for vaginal cuff closure.Design: Retrospective comparative cohort design.Setting: Freestanding ambulatory surgery center in suburban Maryland.Patients: Women age >18 years old who underwent hysterectomy for benign conditions between October 2013 and April 2018.Intervention: Laparoscopic retroperitoneal hysterectomy was performed by 2 gynecologic surgical specialists. Transvaginal cuff closure was performed using either absorbable Vicryl (polyglactin 910) sutures (n = 881) or nonabsorbable Ethibond (polyester) sutures (n = 574). The nonabsorbable sutures were surgically removed after 90 days.Measurements and Main Results: No statistically significant differences in age, race, weight, body mass index, parity, uterine weight, or number of comorbidities were noted between the nonabsorbable and absorbable suture groups. Spontaneous vaginal cuff dehiscence (VCD) occurred in 3 patients (0.52%) in the nonabsorbable group and in 12 patients (1.4%) in the absorbable group (p = .183). Eleven of the 12 cases of VCD in the absorbable group were precipitated by intercourse and occurred within 90 days of surgery.Conclusion: Our data suggest that use of a nonabsorbable suture may be an effective approach to prevent spontaneous VCD, but the benefits should be weighed against the inherent risk associated with a second procedure to remove sutures. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal cuff dehiscence is a rare complication following hysterectomy. The condition coexisting with intraabdominal organ evisceration occurs even rarer. Nevertheless this should not be neglected owing to high morbidity and mortality. Case presentation: The reported case is a 48-year-old widow presenting with vaginal cuff dehiscence and small bowel evisceration after undergoing a total abdominal hysterectomy (TAH) in the past 14 months due to myoma uteri. She denied having a history of sexual intercourse after the operation. The exposed bowel, 60 cm in length, appeared viable and no peritoneal sign was observed. There was a vaginal cuff defect approximately 3 cm in length. An exploratory laparotomy was then carried out. Eviscerated bowel was reduced back in the abdominal cavity and the vaginal cuff defect was repaired. No complications such as recurrent dehiscence were observed during one year follow-up. Conclusion: To minimize the incidence of vaginal cuff dehiscence after hysterectomy, surgical techniques should be of concern. Patient instructions, including delaying sexual intercourse and avoiding all possible causes of increased intra-abdominal pressure should be provided postoperatively.

Objectives: To assess the effect of monopolar coagulation vs cut mode during colpotomy at total laparoscopic hysterectomy on vaginal cuff dehiscence.Study Design: We conducted this randomized controlled trial at a university hospital's department of obstetrics and gynecology from September 2016 through January 2018. Enrolled women were randomized 1:1 to monopolar coagulation or cut modes during colpotomy. We followed up 100 participants in the coagulation arm and 99 in the cut arm for ongoing data collection for 12 weeks after surgery. Exclusion criteria were suspicion of pregnancy, previous radiation therapy, uterine size exceeding 20 weeks' gestation, contraindication for high intraabdominal pressure, clinical advanced stage malignant disease, and conversion to laparotomy before completion of colpotomy. Differences between groups for categorical variables were analyzed by chi-square test and the comparisons of continuous variables between groups were analyzed by Student's t-test RESULTS: The study groups were comparable regarding demographics and perioperative parameters. The rate of vaginal cuff dehiscence in coagulation group (1%) was similar to that of cut group (0%) (p = 0.995). The other vaginal cuff related complication rates were also similar.Conclusion: Monopolar coagulation and cut modes during colpotomy at total laparoscopic hysterectomy have similar vaginal cuff dehiscence rates and both energy modes seem acceptable for colpotomy. [ABSTRACT FROM AUTHOR]

Introduction: Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal.Material and Methods: A total of 13 645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH.Results: Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n = 15) occurred after TLH (n = 1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n = 2853), vaginal (n = 4150), and abdominal (n = 5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P < 0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies.Conclusions: Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence. [ABSTRACT FROM AUTHOR]

Objective: We report a rare case of vaginal cuff dehiscence with small bowel evisceration at 7 months post robotic-staging surgery. Case Report: A 41-year-old woman was sent to the emergency room with sudden onset of abdominal pain, vaginal bleeding, and vaginal protruding mass after sexual activity. She had a history of synchronous uterine and ovarian cancer treated with robotic-staging surgery 7 months before. Then she received six courses of postoperative adjuvant chemotherapy, and the last chemotherapy ended 1 month ago. At the operation room, some small bowel loops were noted in the vaginal tip with cuff dehiscence and bleeding. After repositioning of the small bowel, a 2.5-cm vaginal cuff dehiscence was repaired transvaginally. The patient recovered well, and is free of disease and has normal sexual activity 2 months after repairs. Conclusion: Unusual delayed-type vaginal cuff dehiscence hints the possibility that a combination of robotic surgery and postoperative chemotherapy might result in delayed healing of the vaginal cuff.

The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p < .05). V-Loc™ 180 unidirectional barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications. [ABSTRACT FROM AUTHOR]

Purpose: To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure.Methods: A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups.Results: A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P = 0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate.Conclusion: Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material. [ABSTRACT FROM AUTHOR]

Introduction Vaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis. Presentation of case A 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff. Discussion In this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique. Conclusion Laparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive. [ABSTRACT FROM AUTHOR]

Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess. [ABSTRACT FROM AUTHOR]

Objective: This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy.Study Design: Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty® (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding.Results: The study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed.Conclusions: The type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons' preference and cost effectiveness. [ABSTRACT FROM AUTHOR]

Study Objective: To determine feasibility of using laser angiography with indocyanine green (ICG) to assess vaginal cuff vascular perfusion during total laparoscopic hysterectomy (TLH).Design: Pilot feasibility trial (Canadian Task Force classification II-2).Setting: Academic-affiliated hospital.Patients: Twenty women undergoing TLH for benign disease.Interventions: Participants underwent 1:1 randomization of energy method used for colpotomy (ultrasonic vs monopolar) and vaginal cuff closure suture (barbed vs nonbarbed). After intravenous administration of ICG, laser angiography was used to capture images of the vaginal cuff before and after closure. Three reviewers analyzed fluorescent images of vaginal cuffs to determine percent of cuff perimeter with adequate perfusion when open and length of vaginal cuff adequately perfused when closed.Measurements and Main Results: ICG fluorescence was visible at the vaginal cuff in all participants. Mean time to appearance of ICG in the pelvis after administration was 19.8 ± 6.8 seconds (mean ± SD) preclosure, and 26.0 ± 22.2 seconds postclosure. With ultrasonic energy 67.5% ± 17.4% of open cuff perimeter and 74.4% ± 20.5% of closed cuff length were adequately perfused, whereas with monopolar energy use 59.1% ± 17.4% of the open cuff perimeter and 66.3% ± 15.4% of closed cuff length were adequately perfused. Cuffs closed with barbed suture showed adequate perfusion along 71.5% ± 15.1% of the length, whereas those closed with nonbarbed suture showed 68.9% ± 20.9% adequate perfusion. When normalized to cervical cup circumference, ultrasonic energy required 1.0 ± .2 s/mm, whereas monopolar energy required .8 ± .3 s/mm (p = .162). Linear regression showed no association of normalized time of energy activation to percentage of perimeter of open cuff (R2 = .007) or length of closed cuff (R2 = .005) with adequate perfusion. No complications related to intravenous ICG administration occurred.Conclusion: Laser angiography with ICG allows evaluation of vascular perfusion at the vaginal cuff during TLH. This technique may facilitate future prospective studies examining causes for vaginal cuff dehiscence, a complication with potential for severe morbidity. [ABSTRACT FROM AUTHOR]