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) 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 . The largest multi-institution 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 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 . 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 .
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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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