Vaginal cuff dehiscence after hysterectomy
- Hye-Chun Hur, MD, MPH, FACOG
Hye-Chun Hur, MD, MPH, FACOG
- Director, Division of Minimally Invasive Gynecologic Surgery
- Beth Israel Deaconess Medical Center
- Assistant Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
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) or the peritoneal defect is 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 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 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 0.24 to 0.31 percent [1-4]. In a United States study, there were 28 cases of vaginal cuff dehiscence among 11,606 patients (0.24 percent) who underwent total hysterectomy at one institution . Another large multi-institutional European study included 12,398 patients and reported 38 cases (0.31 percent) of dehiscence after hysterectomy . Both studies included patients undergoing hysterectomy for benign and malignant indications. While one study reported the incidence of vaginal cuff dehiscence to be nearly 1 percent, the sample size was much smaller (n = 2382 women), which makes the findings less reliable . The incidence of vaginal cuff dehiscence after any type of pelvic surgery is 0.03 percent and varies by surgical approach .
The rate of vaginal cuff dehiscence is higher after laparoscopic hysterectomy (0.64 to 0.75 percent) compared with abdominal (0.15 to 0.26 percent) or vaginal (0.08 to 0.25 percent) approaches [1-4,7-9]. Among laparoscopic hysterectomies, those with vaginal closure of the cuff have a lower reported incidence of dehiscence (0.18 to 0.30 percent) than laparoscopic hysterectomies with laparoscopic closure of the cuff (0.64 percent) . While there have been concerns about a markedly high rate of cuff dehiscence following laparoscopic hysterectomy (4.93 percent) , a follow-up study suggests a lower dehiscence rate of 0.75 percent .
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- RISK FACTORS
- Role of laparoscopic hysterectomy
- Preoperative preparation
- Surgical technique
- Postoperative period
- CLINICAL MANIFESTATIONS
- DIAGNOSIS AND EVALUATION
- Choosing a surgical approach
- Cuff closure
- Postoperative care and follow-up
- SUMMARY AND RECOMMENDATIONS