Evaluation of post hysterectomy vaginal cuff related complications and their management after different modes of hysterectomy
Keywords:Vaginal cuff bleeding, Vaginal cuff infection, Vaginal cuff dehiscence
Background: Aim: To update the incidence of vaginal cuff related complications after different modes of hysterectomy and their management.
Methods: The study was conducted in Jingzhou central hospital, Jingzhou, Hubei, China. Patient’s case files were reviewed who had undergone Hysterectomy from 1st Jan. 2013 - 31st Dec. 2014. The incidence of vaginal cuff related complications were retrospectively evaluated by different approaches. Data were collected according to our inclusion criteria and statistically analyzed its significance (P <0.05).
Results: 887 patients underwent hysterectomy during 2 years of study period. Mean age was 54 ± 4 years. Overall incidence of vaginal cuff related complications were 34 (3.83%) which included vaginal cuff bleeding 12 (1.35%), vaginal cuff infections 16 (1.80%) and vaginal cuff dehiscence 6 (0.67%) without evisceration. Laparoscopic hysterectomy had higher incidence (6.12%), than open abdominal (2.56%) and vaginal (3.22%) hysterectomy. Incidences were significant (P = 0.032) to approaches of hysterectomy. The Incidence of vaginal cuff dehiscence between Laparoscopic and Open abdominal hysterectomy were significant (P = 0.015) but the incidence of vaginal cuff bleeding (P = 0.90) and vaginal cuff infection (P = 0.74) were not significant. Over all incidences were higher in malignancy (61%) than benign (20%).Conclusions: Study suggests that vaginal cuff bleeding, cuff infection, cuff dehiscence and evisceration are rare but not negligible which may lead into catastrophic conditions. Early diagnosis and appropriate management reduces further complications. Partial cuff dehiscence can be managed conservatively without surgical repair with satisfactory outcome.
Shin JW, Lee HH, Lee SP, Park CY. Total laparoscopic hysterectomy and laparoscopy-assisted vaginal hysterectomy. JLAS. 2011;15:218-21.
Clarke-Pearson, Daniel L. Geller, Elizabeth J. Complications of hysterectomy. Obstet Gynecol. 2013;121(3):654-73.
Cronin B, Sung VW, Matteson KA. Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol. 2912;206(4):284-8.
Kim MJ, Kim S, Bae HS, Lee JK, Lee NW, Song JY. Evaluation of risk factors of vaginal cuff dehiscence after hysterectomy. Obstet Gynecol Sci. 2014;57(2):136-43.
Kho RM, Akl MN, Cornella JL, Magtibay PM, Wechter ME, Magrina JF. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures. Obstet Gynecol. 2009;114:231-5.
Nick AM, Lange J, Frumovitz M, Soliman PT, Schlumbrecht MP, dos Reis R, et al. Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy. Gynecol Oncol. 2011;120(1):47-51.
Hur HC, Guido RS, Mansuria SM, Hacker MR, Sanfilippo JS, Lee TT. Incidence and Patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol. 2007;14(3):311-7.
Iaco PD, Ceccaroni M, Albonic C, Roset B, Sansovini M, D’Alessandro L, et al. Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk? Eur J Obstet Gynecol Repord Biol. 2006;125(1):134-8.
Avcıoğlu SN, Altınkaya SÖ, Küçük M, Yüksel H, Demircan-Sezer S. Vaginal repair of vaginal vault dehiscence after postpartum hysterectomy. J Surg Case Rep. 2014;2:1-2.
Medina BC, Giraldo CH, Riaño G, Hoyos LR, Otalora C. Barbed suture for vaginal cuff closure in laparoscopic hysterectomy. JSLS. 2014;18:83-8.
Cardosi RJ, Hoffman MS, Roberts WS, Spellacy WN. Vaginal evisceration after hysterectomy in premenopausal women. Obstet Gynecol. 1999;94:859.
Moen MD, Desai M, Sulkowski R. Vaginal evisceration managed by transvaginal bowel reaction and vaginal repair. Int Urogynecol J Plevic Floor Dysfunct. 2003;14(3):218-20.
Falcone T. Vaginal cuff dehiscence after hysterectomy. Obstet Gynecol. 2012;120:511-2.
Croak AJ, Gebhart JB, Klingele CJ. Characteristics of patients with vaginal rupture and evisceration. Obstet Gynecol. 2004;103(3):572-6.
Medical Paper, Clinical Medicine Papers. Microwave Baofukang clinical observation of treating cervical erosion suppository, 2011. Available at: http://anpaper.com/medical/microwave-baofukang-clinical-observation-of-treating-cervical-erosion-suppository.html. Accessed 12 February 2015.
LIU Lin Jun. Baofukang Suppository and western Medicine in treating 30 cases of chronic cervicitis. West J Trad Chin Med. 2013;(9):1004-12.
Zhi-ping Y, Xin W. Effects on LEEP combined with Interferon suppository and Baofukang suppository on treating cervical erosion. Chin J Experiment Trad Med Form. 2011;17(10):287.