Images in Gynecologic Surgery
Vaginal Cuff Dehiscence After Total Laparoscopic Hysterectomy Katrin Arnolds, MD*, Michael Sprague, MD, and Stephen Zimberg, MD From the Department of Minimally Invasive Gynecological Surgery, Cleveland Clinic Florida, Weston, FL (all authors).
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A 45-year-old woman with abnormal uterine bleeding, endometriosis, history of diethylstilbestrol exposure in utero, and leiomyoma uteri underwent uncomplicated total laparoscopic hysterectomy. At 51 days after surgery, she presented with postcoital abdominal pain and watery vaginal discharge. Vaginal cuff dehiscence with a broken V-Loc suture, without evisceration, was noted (Fig. 1 and Fig. 2). The patient was taken to the operating room for surgical repair, during which interrupted 2-0 PDS stitches were placed vaginally in a figure-eight fashion. Vaginal cuff dehiscence is a rare but potentially morbid postoperative adverse event after total hysterectomy. The
Fig. 2 The vaginal cuff defect is grasped with forceps. The broken barbed suture (V-Loc) is visible.
Fig. 1 Vaginal cuff dehiscence at 51 days after total laparoscopic hysterectomy. A broken barbed suture (V-Loc) is visible.
reported incidence of vaginal cuff dehiscence is low, occurring in only 0.032% of all hysterectomies [1]. The incidence rate of vaginal cuff dehiscence varies by route of hysterectomy, with higher rates reported in laparoscopic and robotic procedures compared with open and vaginal procedures [2,3]. Various surgical techniques for repairing vaginal cuff dehiscence have been described, including vaginal, abdominal, laparoscopic, and combination approaches. References Disclosures:Drs. Sprague and Zimberg are teaching consultants for Covidien. Dr. Arnolds discloses no conflicts of interest. Corresponding author: Katrin Arnolds, MD, 2950 Cleveland Clinic Blvd, Weston, FL 33331. E-mail: [email protected] Submitted March 10, 2015. Accepted for publication March 12, 2015. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2015 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2015.03.010
1. Croak AJ, Gebhart JB, Klingele CJ, Shroeder G, Lee RA, Podratz KC. Characteristics of patients with vaginal rupture and evisceration. Obstet Gynecol. 2004;103:572–576. 2. Uccella S, Ceccharoni M, Cromi M, et al. Vaginal cuff dehiscence in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol. 2012;120:516–523. 3. Hur HC, Donnellen N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118:794–801.
Vaginal Cuff Dehiscence After Total Laparoscopic Hysterectomy Katrin Arnolds, MD*, Michael Sprague, MD, and Stephen Zimberg, MD From the Department of Minimally Invasive Gynecological Surgery, Cleveland Clinic Florida, Weston, FL (all authors).
DISCUSS
You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-22-5-JMIG-D-15-00160
Use your Smartphone to scan this QR code and connect to the discussion forum for this article now* * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
A 45-year-old woman with abnormal uterine bleeding, endometriosis, history of diethylstilbestrol exposure in utero, and leiomyoma uteri underwent uncomplicated total laparoscopic hysterectomy. At 51 days after surgery, she presented with postcoital abdominal pain and watery vaginal discharge. Vaginal cuff dehiscence with a broken V-Loc suture, without evisceration, was noted (Fig. 1 and Fig. 2). The patient was taken to the operating room for surgical repair, during which interrupted 2-0 PDS stitches were placed vaginally in a figure-eight fashion. Vaginal cuff dehiscence is a rare but potentially morbid postoperative adverse event after total hysterectomy. The
Fig. 2 The vaginal cuff defect is grasped with forceps. The broken barbed suture (V-Loc) is visible.
Fig. 1 Vaginal cuff dehiscence at 51 days after total laparoscopic hysterectomy. A broken barbed suture (V-Loc) is visible.
reported incidence of vaginal cuff dehiscence is low, occurring in only 0.032% of all hysterectomies [1]. The incidence rate of vaginal cuff dehiscence varies by route of hysterectomy, with higher rates reported in laparoscopic and robotic procedures compared with open and vaginal procedures [2,3]. Various surgical techniques for repairing vaginal cuff dehiscence have been described, including vaginal, abdominal, laparoscopic, and combination approaches. References Disclosures:Drs. Sprague and Zimberg are teaching consultants for Covidien. Dr. Arnolds discloses no conflicts of interest. Corresponding author: Katrin Arnolds, MD, 2950 Cleveland Clinic Blvd, Weston, FL 33331. E-mail: [email protected] Submitted March 10, 2015. Accepted for publication March 12, 2015. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2015 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2015.03.010
1. Croak AJ, Gebhart JB, Klingele CJ, Shroeder G, Lee RA, Podratz KC. Characteristics of patients with vaginal rupture and evisceration. Obstet Gynecol. 2004;103:572–576. 2. Uccella S, Ceccharoni M, Cromi M, et al. Vaginal cuff dehiscence in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol. 2012;120:516–523. 3. Hur HC, Donnellen N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118:794–801.
