Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy

Abstract

Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI < 25) to experience a dehiscence (p = 0.02). When stratified by hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.

Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy

“…32 Of note, in a retrospective study on 31 patients with vaginal dehiscence following hysterectomy, older age and obesity were associated with a lower incidence of cuff breakdown. 33 Our results do not confirm the protective role of body mass index (BMI), however, we emphasize that our population had a generally low incidence of obesity (approximately 15%), likely due to the fact that the prevalence of BMI >30 is rather low in Italy. Therefore, our findings should be applied with caution to populations with a higher mean BMI.…”

Delayed Presentation of Vaginal Cuff Dehiscence after Robotic Hysterectomy for Gynecologic Cancer: A Case Series and Review of the Literature

“…Unexpectedly, obesity and age were associated with a decreased risk of VCD following robotic and laparoscopic hysterectomies but not vaginal or abdominal routes. Obese women (BMI ≥ 30 kg/m 2 ) were 86% less likely than women of normal weight (BMI < 25 kg/m 2 ) to experience a VCD following laparoscopic surgery [ 24 ]. The BMIs for our three patients were within normal limits.…”

Prolapsed epiploica of bowel after robotic hysterectomy: A case report

“…Systemic disease such as poor controlled diabetes mellitus, immune suppressive status or currently receiving chemotherapy treatment may also play roles on poor tissue healing and caused vaginal stump dehiscence. As for the protective factor, obese women (BMI ≥ 30 kg/m2) were 70% less likely than women of normal weight (BMI < 25 kg/m2) to experience vaginal cuff dehiscence after hysterectomy whether it was performed laparoscopically or laparotomy [ 4 ].…”