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Vaginal cuff dehiscence after hysterectomy

Hye-Chun Hur, MD, MPH, FACOG
Section Editors
Tommaso Falcone, MD, FRCSC, FACOG
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy (surgical removal of the uterus and cervix). After removal of the uterine specimen, the vaginal incision (vaginal cuff) is typically sutured closed. Vaginal cuff dehiscence refers to separation of the vaginal incision. The term vaginal cuff dehiscence is frequently interchanged with the terms cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of initial hysterectomy.

After dehiscence of the vaginal cuff, abdominal or pelvic contents are at risk of evisceration (expulsion) through the vaginal opening. Bowel evisceration can lead to serious sequelae, including peritonitis, bowel injury and necrosis, and sepsis. Prompt surgical and medical intervention is required.

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".)


Vaginal cuff dehiscence following hysterectomy is a rare event with an estimated incidence of 0.39 percent (0.27 to 0.96 percent) [1-6]. In the largest single-center study, 28 cases of vaginal cuff dehiscence were reported among 11,606 patients (0.24 percent) who underwent total hysterectomy [2]. The largest multi-institution study included 12,398 patients and reported 38 cases (0.31 percent) of dehiscence after hysterectomy [3]. Both studies included patients undergoing hysterectomy for benign and malignant indications. While one study reported a nearly 1 percent incidence of vaginal cuff dehiscence after total hysterectomy, the study sample size was much smaller (n = 2382 women), which may make the findings less reliable [4]. The incidence of vaginal cuff dehiscence after any type of pelvic surgery (as opposed to hysterectomy) is approximately 0.03 percent and varies by surgical approach [7].

The true incidence of vaginal cuff dehiscence after hysterectomy is difficult to determine since this complication is likely underreported. Also, patients with cuff dehiscences may present to a different physician or hospital than for the initial hysterectomy, thereby making data collection difficult. Further, case reports of vaginal cuff dehiscence generally do not include for comparison the number of hysterectomies that were NOT associated with this complication. Lastly, the rate of dehiscence appears to vary by type of hysterectomy.

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Literature review current through: Nov 2017. | This topic last updated: Sep 29, 2017.
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  1. Iaco PD, Ceccaroni M, Alboni C, et al. Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk? Eur J Obstet Gynecol Reprod Biol 2006; 125:134.
  2. Hur HC, Donnellan N, Mansuria S, et al. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol 2011; 118:794.
  3. Uccella S, Ceccaroni M, Cromi A, et al. Vaginal cuff dehiscence in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol 2012; 120:516.
  4. Fuchs Weizman N, Einarsson JI, Wang KC, et al. Vaginal cuff dehiscence: risk factors and associated morbidities. JSLS 2015; 19.
  5. Hur HC, Lightfoot M, McMillin MG, Kho KA. Vaginal cuff dehiscence and evisceration: a review of the literature. Curr Opin Obstet Gynecol 2016; 28:297.
  6. Ceccaroni M, Berretta R, Malzoni M, et al. Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study. Eur J Obstet Gynecol Reprod Biol 2011; 158:308.
  7. Croak AJ, Gebhart JB, Klingele CJ, et al. Characteristics of patients with vaginal rupture and evisceration. Obstet Gynecol 2004; 103:572.
  8. Hur HC, Guido RS, Mansuria SM, et al. Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol 2007; 14:311.
  9. Uccella S, Ghezzi F, Mariani A, et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol 2011; 205:119.e1.
  10. Kho RM, Akl MN, Cornella JL, et al. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures. Obstet Gynecol 2009; 114:231.
  11. Kashani S, Gallo T, Sargent A, et al. Vaginal cuff dehiscence in robotic-assisted total hysterectomy. JSLS 2012; 16:530.
  12. Siedhoff MT, Yunker AC, Steege JF. Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture. J Minim Invasive Gynecol 2011; 18:218.
  13. Nick AM, Lange J, Frumovitz M, et al. Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy. Gynecol Oncol 2011; 120:47.
  14. Agdi M, Al-Ghafri W, Antolin R, et al. Vaginal vault dehiscence after hysterectomy. J Minim Invasive Gynecol 2009; 16:313.
  15. Ramirez PT, Klemer DP. Vaginal evisceration after hysterectomy: a literature review. Obstet Gynecol Surv 2002; 57:462.
  16. Kowalski LD, Seski JC, Timmins PF, et al. Vaginal evisceration: presentation and management in postmenopausal women. J Am Coll Surg 1996; 183:225.
  17. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 1990; 163:1016.
  18. Cardosi RJ, Hoffman MS, Roberts WS, Spellacy WN. Vaginal evisceration after hysterectomy in premenopausal women. Obstet Gynecol 1999; 94:859.
  19. Walsh CA, Sherwin JR, Slack M. Vaginal evisceration following total laparoscopic hysterectomy: case report and review of the literature. Aust N Z J Obstet Gynaecol 2007; 47:516.
  20. Donnellan NM, Mansuria S, Aguwa N, et al. Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy. Gynecol Surg 2015; 12:89.
  21. Yüce K, Dursun P, Gültekin M. Posthysterectomy intestinal prolapse after coitus and vaginal repair. Arch Gynecol Obstet 2005; 272:80.
  22. Purakal J, Moyer G, Burke W. Vaginal cuff dehiscence after hysterectomy in a woman with systemic lupus erythematosus: a case report. J Reprod Med 2008; 53:305.
  23. Kim MJ, Kim S, Bae HS, et al. Evaluation of risk factors of vaginal cuff dehiscence after hysterectomy. Obstet Gynecol Sci 2014; 57:136.
  24. MacDermott RI. Bacterial vaginosis. Br J Obstet Gynaecol 1995; 102:92.
  25. Fanning J, Kesterson J, Davies M, et al. Effects of electrosurgery and vaginal closure technique on postoperative vaginal cuff dehiscence. JSLS 2013; 17:414.
  26. Teoh D, Lowery WJ, Jiang X, et al. Vaginal cuff thermal injury by mode of colpotomy at total laparoscopic hysterectomy: a randomized clinical trial. J Minim Invasive Gynecol 2015; 22:227.
  27. Lawlor ML, Rao R, Manahan KJ, Geisler JP. Electrosurgical Settings and Vaginal Cuff Complications. JSLS 2015; 19.
  28. Nawfal AK, Eisenstein D, Theoharis E, et al. Vaginal cuff closure during robotic-assisted total laparoscopic hysterectomy: comparing vicryl to barbed sutures. JSLS 2012; 16:525.
  29. Rettenmaier MA, Abaid LN, Brown JV 3rd, et al. Dramatically reduced incidence of vaginal cuff dehiscence in gynecologic patients undergoing endoscopic closure with barbed sutures: A retrospective cohort study. Int J Surg 2015; 19:27.
  30. Jeung IC, Baek JM, Park EK, et al. A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy. Arch Gynecol Obstet 2010; 282:631.
  31. Zambrano D. Clindamycin in the treatment of obstetric and gynecologic infections: a review. Clin Ther 1991; 13:58.
  32. Kirsner RS, Eaglstein WH. The wound healing process. Dermatol Clin 1993; 11:629.
  33. Vesna A, Neli B. Benefit and safety of 28-day transdermal estrogen regimen during vaginal hysterectomy (a controlled trial). Maturitas 2006; 53:282.
  34. Pushkar' DIu, D'iakov VV, Godunov BN, Gvozdev MIu. [Ovestin in preparation for transvaginal surgeries]. Urologiia 2002; :34.
  35. Nezhat CH, Nezhat F, Seidman DS, Nezhat C. Vaginal vault evisceration after total laparoscopic hysterectomy. Obstet Gynecol 1996; 87:868.
  36. Joy SD, Phelan M, McNeill HW. Postcoital vaginal cuff rupture 10 months after a total vaginal hysterectomy. A case report. J Reprod Med 2002; 47:238.
  37. Cronin B, Sung VW, Matteson KA. Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol 2012; 206:284.
  38. Moen MD, Desai M, Sulkowski R. Vaginal evisceration managed by transvaginal bowel resection and vaginal repair. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:218.
  39. Nasr AO, Tormey S, Aziz MA, Lane B. Vaginal herniation: case report and review of the literature. Am J Obstet Gynecol 2005; 193:95.
  40. Kambouris AA, Drukker BH, Barron J. Vaginal evisceration. A case report and brief review of the literature. Arch Surg 1981; 116:949.
  41. Matthews CA, Kenton K. Treatment of vaginal cuff evisceration. Obstet Gynecol 2014; 124:705.