Vaginal Cuff Dehiscence after Hysterectomy and One Minute Technique of Laparoscopic Vault Closure

Abstract

Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.

An Audit of Indications, Complications, Correlation of Preoperative Diagnosis with the Histopathology Report of Hysterectomies at Shalamar Hospital Lahore

“…Vaginal hysterectomy was chosen for cases with prolapse in 6% of cases. This observation is comparable to those of previous studies conducted in different countries 6,8,11,12,14 . 70.6% of our patients had no immediate or late post operative morbidity.…”

“…The rest had a variety of complications listed in table 4. The commonest morbidities noted were anemia and post operative wound infection, this is similar to the findings of other studies 8,11,12 . One case of ureteric injury following an abdominal hysterectomy and bladder injury following a vaginal hysterectomy, this was lower than the 2.58% reported in other studies 10,13,14,15 .…”

“…They included Total and Subtotal abdominal hysterectomy. The reason for this was presence of an enlarged and well supported uterus; similar observations were made in other studies conducted in different countries 5,8,11,12 . Subtotal hysterectomy was performed as a result of extensive pelvic adhesions after previous surgeries or obstetric reasons like massive postpartum hemorrhage 8,13 .…”

“…Like any other operative procedure it has it's own morbidity and risk of mortality with potential implications on the operator. The indication has to be clear, and the operator experienced 9,11,12 . This study was embarked upon in our centre to determine the indications, complications, correlation of preoperative diagnosis and justification of hysterectomies.…”

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital

“…If we can overcome this hurdle, there is a great place for laparoscopic hysterectomy, as seen in the study by Karki et al, where he reported 1012 cases of TLH in two years, from a private institute in eastern Nepal. 17 This disparity was also seen in the study from Finland (n=10,110) where the rate of Laparoscopic hysterectomy was high in a private hospital (LH=67%) compared to the local hospital (LH 19%). 6 Abdominal hysterectomy remains the common route ranging from 47.8% to 83.6%.…”