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Medline ® Abstract for Reference 9

of 'Vaginal cuff dehiscence after hysterectomy'

9
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Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature.
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Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M, Bolis P
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Am J Obstet Gynecol. 2011;205(2):119.e1.
 
OBJECTIVE: To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy.
STUDY DESIGN: We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used.
RESULTS: In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6).
CONCLUSION: Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.
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Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. stefucc@libero.it
PMID