Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture.

Study Objective: To estimate whether a new surgical technique is associated with lower incidence of postoperative breakdown of the vaginal cuff after laparoscopic hysterectomy or trachelectomy, compared with previous methods of closure.
Design: Retrospective cohort study, Canadian Task Force Classification II-3.
Setting: Tertiary-care university-based teaching hospital.
Patients: Patients who underwent laparoscopic vaginal closure after removal of the uterus and/or cervix by members of a subspecialty gynecologic laparoscopy division from January 2007 to January 2010 (n = 387).
Interventions: Use of bidirectional barbed suture for laparoscopic vaginal cuff closure.
Measurements and Main Results: A total of 387 patient records were reviewed. The incidence of vaginal cuff dehiscence among those with other methods of closure was 4.2%, while there were no cases of dehiscence among those who had closure with bidirectional barbed suture (p = .008). Postoperative bleeding (OR 2.3, 95% C.I. 1.3-3.9), presence of granulation tissue (OR 1.9, 95% C.I. 0.92-3.9), and cellulitis (OR 4.6, 95% C.I. 1.0-21.1) all occurred more frequently in patients without barbed suture closure.
Conclusion: Dehiscence of the vaginal cuff after laparoscopic closure is a rare but important complication in gynecologic surgery. Use of bidirectional barbed suture eliminated the problem in our first year of experience with the technique. We also observed a decreased incidence of other common problems of the vaginal cuff. This method is easy to learn and inexpensive and does not require advanced skills such as laparoscopic knot-tying.
(Published by Elsevier Inc.)