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Vaginal cuff dehiscence after hysterectomy

INTRODUCTION

Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy. After removal of the uterus, the vaginal incision (vaginal cuff) or the peritoneal defect is closed. Vaginal cuff dehiscence refers to separation of the vaginal incision.

After dehiscence of the vaginal cuff, abdominal or pelvic contents may be expelled through the vaginal opening. Bowel evisceration can lead to serious sequelae, including peritonitis, bowel injury and necrosis, and sepsis. Prompt surgical and medical intervention are required to prevent such complications.

Incidence, risk factors, and management recommendations for vaginal dehiscence that occurs after total hysterectomy will be reviewed here. Other complications of gynecologic surgery are discussed separately. (See "Complications of gynecologic surgery".)

INCIDENCE

The reported incidence of vaginal cuff dehiscence following hysterectomy ranges from 0.14 to 0.28 percent [1,2]. In the largest case series, there were 10 vaginal cuff dehiscences among 7039 patients (0.14 percent) who underwent total hysterectomy [1]. The incidence of vaginal rupture after any type of pelvic surgery is 0.032 percent [3].

The reported incidence of cuff dehiscence varies according to surgical approach. The rate is higher after laparoscopic hysterectomy (0.79 to 3.42 percent) compared with abdominal (0.06 to 0.26 percent) or vaginal (0.16 to 0.25 percent) [1,2,4,5].
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References Top
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