TY - JOUR
T1 - Vaginal Vault Dehiscence after Hysterectomy
AU - Agdi, Mohammed
AU - Al-Ghafri, Wadha
AU - Antolin, Rommel
AU - Arrington, Jeff
AU - O'Kelley, Kenneth
AU - Thomson, Angus J.M.
AU - Tulandi, Togas
PY - 2009/5
Y1 - 2009/5
N2 - Study Objective: The purpose of our study was to evaluate factors predisposing vault dehiscence after hysterectomy and its manifestation. Design: Case series and review of the literature (Canadian Task Force classification II-3). Setting: Multicenter study. Patients: Retrospective analysis of 16 unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy from physicians who participated in the exchange on the topic of vaginal vault dehiscence at the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and review of 38 reported cases in the literature (group B). Interventions: The participating physicians were asked to complete a detailed questionnaire related to vault dehiscence. In addition, we performed literature search using the keywords "vault dehiscence," "vaginal vault dehiscence," "vault prolapse," and "hysterectomy," and conducted the search in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. Measurements and Main Results: We estimated risk factors and characteristic features for vaginal vault dehiscence. The incidence of vault dehiscence was higher after laparoscopic hysterectomy (1.14%) than after abdominal hysterectomy (0.10%, p <.0001, OR 11.5) and after vaginal hysterectomy (0.14%, p <.001, OR 8.3). The time interval between hysterectomy and occurrence of vault dehiscence in the laparoscopic group (8.4 ± 1.2 weeks) was significantly shorter than in the abdominal hysterectomy (112.7 ± 75.1 weeks, p = .01) and in vaginal hysterectomy (136.5 ± 32.2 weeks, p <.0001) groups, respectively. It appears that sexual intercourse was the main triggering event for vault dehiscence (58.8%). Vaginal bleeding (50%) and vaginal evisceration (48.1%) were the main symptoms. Conclusion: Our data suggest that vaginal vault dehiscence is rare but may occur more often after laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the technique of laparoscopic suturing is unclear. Other risk factors such as early resumption of regular activities and sexual intercourse may play a role.
AB - Study Objective: The purpose of our study was to evaluate factors predisposing vault dehiscence after hysterectomy and its manifestation. Design: Case series and review of the literature (Canadian Task Force classification II-3). Setting: Multicenter study. Patients: Retrospective analysis of 16 unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy from physicians who participated in the exchange on the topic of vaginal vault dehiscence at the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and review of 38 reported cases in the literature (group B). Interventions: The participating physicians were asked to complete a detailed questionnaire related to vault dehiscence. In addition, we performed literature search using the keywords "vault dehiscence," "vaginal vault dehiscence," "vault prolapse," and "hysterectomy," and conducted the search in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. Measurements and Main Results: We estimated risk factors and characteristic features for vaginal vault dehiscence. The incidence of vault dehiscence was higher after laparoscopic hysterectomy (1.14%) than after abdominal hysterectomy (0.10%, p <.0001, OR 11.5) and after vaginal hysterectomy (0.14%, p <.001, OR 8.3). The time interval between hysterectomy and occurrence of vault dehiscence in the laparoscopic group (8.4 ± 1.2 weeks) was significantly shorter than in the abdominal hysterectomy (112.7 ± 75.1 weeks, p = .01) and in vaginal hysterectomy (136.5 ± 32.2 weeks, p <.0001) groups, respectively. It appears that sexual intercourse was the main triggering event for vault dehiscence (58.8%). Vaginal bleeding (50%) and vaginal evisceration (48.1%) were the main symptoms. Conclusion: Our data suggest that vaginal vault dehiscence is rare but may occur more often after laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the technique of laparoscopic suturing is unclear. Other risk factors such as early resumption of regular activities and sexual intercourse may play a role.
KW - Hysterectomy
KW - Laparoscopic hysterectomy
KW - Vaginal vault dehiscence
KW - Vault dehiscence
KW - Vault prolapse
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U2 - 10.1016/j.jmig.2009.01.006
DO - 10.1016/j.jmig.2009.01.006
M3 - Article
C2 - 19285921
AN - SCOPUS:65449121029
SN - 1553-4650
VL - 16
SP - 313
EP - 317
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 3
ER -