Abstract
Objective:
This article reviews the epidemiology, diagnosis, and management of vaginal vault dehiscence, and illustrates a 5-step surgical approach to laparoscopic vault repair.
Methods:
At a tertiary care center, surgical footage was obtained from the case of a 34-year-old female who presented 8 weeks after a total laparoscopic hysterectomy with a complete vault dehiscence.
Results:
Vaginal vault dehiscence complicates 0.64% to 1.35% of laparoscopic hysterectomies, and can be categorized as complete cuff dehiscence, partial cuff dehiscence; or partial thickness. Protective factors include using barbed sutures, compared to nonbarbed sutures, and laparoscopic closure, compared to vaginal closure. Smoking and low body mass index have been associated with an increased risk of dehiscence. The surgical approach to a laparoscopic repair of cuff dehiscence can be standardized in 5 reproducible steps: (1) abdominal survey; (2) bladder and/or rectal dissection; (3) vault debridement; (4) vault closure; and (5) cystoscopy.
Conclusion:
While uncommon, vaginal vault dehiscence is a serious complication following laparoscopic hysterectomy that requires prompt evaluation and surgical repair. (J GYNECOL SURG 39:300)
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