Laparoscopic repair of the vaginal cuff dehiscence: Dehiscence occurring after the first sexual intercourse after the laparoscopic modified radical hysterectomy

Suzuki, Yukio; Imai, Yumiko; Ruiz-Yokota, Naho

doi:10.1002/ccr3.1906

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…In our case series, after noting that the herniated bowel was ruddy and peristalsis was good, the protruding bowels of 4 of 11 VCDE patients were smoothly repositioned to the peritoneal cavity with a warm-wet gauze pad without anesthesia in the emergency department. Vaginal bowel reduction has been reported in several studies (5,29,30); however, our study may be the first to propose repositioning of prolapsed organs without anesthesia in the emergency department. Although manual bowel reduction without anesthesia may be slightly painful for patients, it still has numerous benefits.…”

Section: Diagnosis and Treatmentmentioning

confidence: 76%

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

Cao

Dai

2022

Front. Surg.

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PurposeVaginal cuff dehiscence (and evisceration) (VCD(E)) is an extremely rare and late-onset complication of total hysterectomy (TH). Limited evidence is available to guide clinicians in managing VCD(E). This study aimed to summarize the clinical characteristics of patients with VCD(E) treated in our center and share our experience in managing VCD(E).Patients and methodsFrom 1983 to 2020, a total of 14 cases of VCD(E), including 10 cases in our hospital and 4 cases in other hospitals, were included. Medical records were reviewed to summarize the clinical features and management of VCD(E).ResultsThe incidence of VCD(E) in our hospital was 10/46,993 (0.02%), and all 10 patients underwent laparoscopic hysterectomy. The median TH-to-VCD(E) interval was 3.13 months (8 days–27.43 months), and 11/14 (78.57%) patients experienced VCD(E) after coitus. The 3 major symptoms included abdominal pain in 11 patients, irregular vaginal bleeding in 8, and sensation of bulging or prolapsed organs in 4. Except for 2, most patients presented to our hospital within 72 h since the onset of the discomfort. All 14 cases were diagnosed through speculum examination: 3 had simple VCD, and 11 had VCDE. The protruding bowels of 4 patients were immediately manually repositioned in the emergency department without anesthesia. Regarding the surgical approach, 11 patients underwent simple transvaginal, 2 patients underwent laparoscopic-vaginal combined (transvaginal cuff closures), and 1 patient underwent laparoscopic. All but 1 patient did not undergo resection of the eviscerated organs. The median follow-up period was 39.33 (7.9–159.33) months. No patients showed any evidence of recurrence to date.ConclusionsLaparoscopic hysterectomy is a risk factor for VCD(E), and early initiation of sexual intercourse is the most common trigger of VCD(E). Clinicians should educate patients to postpone sexual intercourse for at least 3–6 months after TH. Immediate medical attention and patient-specific surgical management are crucial to avoid serious complications.

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Section: Diagnosis and Treatmentmentioning

confidence: 76%

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

Cao

Dai

2022

Front. Surg.

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“…It is reported that suturing the pelvic peritoneum can reduce the risk of hematoma, infection, and organ evisceration in case of vaginal cuff dehiscence. [3][4][5] However, in cases where suturing the peritoneum requires strong tension, such as in large peritoneal defects, this procedure should be reconsidered. Besides, suturing only the middle part of the pelvic peritoneum to cover the closed vaginal cuff and leaving the side walls open may cause an internal hernia.…”

Section: Discussionmentioning

confidence: 99%

“…Although suturing of the pelvic peritoneum is not a mandatory procedure in laparoscopic hysterectomy, previous case reports and case series have described its utility. It is reported that suturing the pelvic peritoneum can reduce the risk of hematoma, infection, and organ evisceration in case of vaginal cuff dehiscence 3–5 . However, in cases where suturing the peritoneum requires strong tension, such as in large peritoneal defects, this procedure should be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

“…Suturing the pelvic peritoneum is a common technique in laparoscopic hysterectomy to prevent vaginal cuff infection and organ evisceration in case vaginal cuff dehiscence occurs. [3][4][5][6] Here, we report an extremely rare case of a strangulated internal hernia caused by an iatrogenic peritoneal band, which was formed by the procedure of suturing the pelvic peritoneum.…”

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confidence: 99%

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Strangulated internal hernia caused by an iatrogenic peritoneal band after total laparoscopic hysterectomy—A caveat to consider retroperitoneum closure

Sakurai

Suzuki

Nagai

et al. 2022

Clinical Case Reports

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Intestinal obstruction is a considerably rare complication of gynecologic laparoscopy, with an incidence of 0.036%. 1 Regarding laparoscopic hysterectomy for benign disease, the incidence of postoperative intestinal obstruction is reported to be 0.4%. 2 The incidence rate of internal hernia after gynecologic laparoscopy is even lower, due to which the exact numbers are unknown. Suturing the pelvic peritoneum is a common technique in laparoscopic hysterectomy to prevent vaginal cuff infection and organ evisceration in case vaginal cuff dehiscence occurs. [3][4][5][6] Here, we report an extremely rare case of a strangulated internal hernia caused by an iatrogenic peritoneal band, which was formed by the procedure of suturing the pelvic peritoneum. | CASE REPORTA 64-year-old woman, gravida 3, para 3, visited our hospital for treatment of a 17-cm large uterine fibroid in the cervix. The patient was on steroid therapy for neuromyelitis optica. She had no history of any abdominal surgery. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Due to the uterine size and the fibroid location, the surgery required 6 hours, which was over twice as long as our average operation

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“…2021;67(4) 3 también, el material y la técnica al cerrarla. Se incluye, además, la duración de la operación, la experiencia del cirujano y las características de la mujer (6,7) . En mujeres posmenopáusicas, la hiposecreción de estrógenos contribuye a la atrofia vaginal y propensión a la rotura (2) .…”

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Dehiscencia de cúpula vaginal y evisceración postquirúrgica: reporte de caso

Alarcón-Gutiérrez¹,

Uriol-Valverde

Aguilar-Ydiáquez

et al. 2021

Rev peru ginecol obstet.

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La dehiscencia de cúpula vaginal es la separación precoz de la incisión vaginal suturada, que en el 70% de los casos se manifiesta con una evisceración de asas intestinales a través del conducto vaginal. Dentro de sus factores de riesgo, destacan la edad y alteraciones en el lugar postoperatorio de histerectomía. El diagnóstico se realiza mediante un adecuado examen físico, y el tratamiento, netamente quirúrgico, involucra el regresar las vísceras intestinales y corregir la dehiscencia. Describimos el caso de una mujer de 50 años, que presentó dehiscencia de la cúpula vaginal con evisceración de una porción de íleon distal, a quien se le practicó tratamiento quirúrgico y farmacológico.

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Laparoscopic repair of the vaginal cuff dehiscence: Dehiscence occurring after the first sexual intercourse after the laparoscopic modified radical hysterectomy

Abstract: Key Clinical MessageTotal vaginal cuff dehiscence (VCD) is an important adverse event after hysterectomy. Here, we showed two cases in whom laparoscopic repair of VCD was successful. This procedure is effective, safe, and thus minimally invasive for patients after hysterectomy.

Cited by 5 publications

References 7 publications

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

Experience in the Management of Vaginal Cuff Dehiscence and Evisceration: A Retrospective 37-Year Single-Center Study

Strangulated internal hernia caused by an iatrogenic peritoneal band after total laparoscopic hysterectomy—A caveat to consider retroperitoneum closure

Dehiscencia de cúpula vaginal y evisceración postquirúrgica: reporte de caso

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