Published: 2018-11-26

Vaginal cuff dehiscence after laparoscopic trachelectomy post hysterectomy: a case report and brief review of the literature

Sotirios Kalogeropoulos, Elpiniki Chronopoulou, Evangelos Iliopoulos, Georgios Decavalas


Vaginal cuff dehiscence (VCD) is a serious complication of total laparoscopic hysterectomy (TLH) or trachelectomy with high morbidity, as it can potentially lead to evisceration/bowel ischemia and sepsis. Authors present a case report of vaginal cuff dehiscence after laparoscopic trachelectomy. The patient reported post-coital onset of symptoms. She presented with acute abdomen and required urgent surgical intervention. In this case surgical management was dictated by the clinical manifestation. However, authors argue that conservative management is also an option for some of these patients and the decision regarding the management plan should be personalized according to the clinical presentation and the patient’s expectations. Emphasis should be given to avoid early onset of sexual activity during the immediate recovery period. Compared to women who underwent an abdominal or vaginal hysterectomy, those who had a laparoscopic procedure have less post-operative pain, shorter recovery period and often they are advised to return early to their normal habits and their work place.  It is expected that this group of patients feel well enough to resume sexual activity soon after their procedure. Therefore, our counselling is of paramount importance as it should be highlighted that sexual intercourse is possibly the most common triggering event for VCD which a serious complication with severe morbidity is. The resumption should, therefore, follow medical consultation and be individualized according to co-morbidities which could affect healing, intraoperative findings and evaluation of the whole recovery progress.


Laparoscopy, Laparoscopic hysterectomy, Laparoscopic trachelectomy, Vaginal cuff dehiscence

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Ala-Nissila S, Laurikainen E, Makinen J, Jokimaa V. Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy. Acta Obstet Gynecol Scand. 2018;10:13459.

Cronin B, Sung VW, Matteson KA. Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol. 2012;4:284-8.

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, Schmeler KM, Schlumbrecht MP, et al. Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy. Gynecol Oncol. 2011;120:47-51.

Hur HC, Donnellan N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118:794-801.

Uccella S, Ceccaroni M, Cromi A, Malzoni M, Berretta R, De Iaco P, et al. Vaginal cuff dehiscence in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol. 2012;120:516-23.

Aydogmus H, Aydogmus S, Gencdal S, Kelekci S. Cuff closure by vaginal route in TLH: case series and review of literature. J Clin Diagn Res. 2017;11:3.

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;57:136-43.

Uccella S, Casarin J, Marconi N, Gisone B, Sturla D, Alluvion CP, et al. Incidence and prevention of vaginal cuff dehiscence following laparoscopic and robotic hysterectomy: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2015;22:S40.

Misirlioglu S, Boza A, Arslan T, Urman B, Taskiran C. Unidirectional barbed suture for vaginal cuff closure without backward stitch in total laparoscopic hysterectomy. J Obstet Gynaecol Res. 2018;44:1793-9.

Jokinen E, Brummer T, Jalkanen J, Fraser J, Heikkinen AM, Mäkinen J, et al. Hysterectomies in Finland in 1990-2012: comparison of outcomes between trainees and specialists. Acta Obstet Gynecol Scand. 2015;94:701-7.

Beran BD, Shockley M, Padilla PF, Farag S, Escobar P, Zimberg S, et al. Laser angiography to assess the vaginal cuff during robotic hysterectomy. JSLS. 2018;22:e2018.00001.

Iaco PD, Ceccaroni M, Alboni 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 Reprod Biol, 2006;125:134-8.

Hamal S, Hui JW, Rong WX, Hui L. Evaluation of post hysterectomy vaginal cuff related complications and their management after different modes of hysterectomy. Int J Reprod Contracept Obstet Gynecol. 2017;4(2):447-52.