Document Detail

Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study.
MedLine Citation:
PMID:  21723030     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study estimates the incidence of vaginal cuff dehiscence resulting from different approaches to hysterectomy.
STUDY DESIGN: This multicentric study was carried out retrospectively. We retrospectively analyzed 8635 patients; 37% underwent abdominal hysterectomy, 31.2% vaginal hysterectomy, and 31.8% laparoscopic hysterectomy. All the hysterectomies were considered, vaginal evisceration was registered and analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. Continuous variables were compared using the one-way analysis of variance between groups as all data followed a Gaussian distribution, as confirmed by the Kolmogorov-Smirnov test. Differences among subgroups were assessed using the Tukey-Kramer multiple comparisons test. Categorical variables were compared with two tailed Chi-square tests with Yates correction or Fisher's exact test, as appropriate. Pearson's linear correlation was used to verify linear relationships between the dehiscence interval and patient's age at surgery.
RESULTS: Thirty-four patients (0.39%) experienced vaginal evisceration. The laparoscopic route was associated with a significantly higher incidence of dehiscence (p<0.05). No differences were found between the 6027 patients (69.8%) who had closure of the vaginal cuff and the 2608 (30.2%) who had an unclosed cuff closure technique.
CONCLUSION: Vaginal evisceration after hysterectomy is a rare gynecological surgical complication. Sexual intercourse before the complete healing of the vaginal cuff is the main trigger event in young patients, while evisceration presents as a spontaneous event in elderly patients. Surgical repair can be performed either vaginally or laparoscopically with similar outcomes.
Marcello Ceccaroni; Roberto Berretta; Mario Malzoni; Marco Scioscia; Giovanni Roviglione; Emanuela Spagnolo; Martino Rolla; Antonio Farina; Carmine Malzoni; Pierandrea De Iaco; Luca Minelli; Luciano Bovicelli
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2011-07-01
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  158     ISSN:  1872-7654     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-03     Completed Date:  2012-03-15     Revised Date:  2012-04-13    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  308-13     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
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MeSH Terms
Aged, 80 and over
Genital Diseases, Female / surgery
Hysterectomy / adverse effects*
Italy / epidemiology
Middle Aged
Retrospective Studies
Surgical Wound Dehiscence / epidemiology*,  etiology
Vagina / surgery*
Comment In:
Eur J Obstet Gynecol Reprod Biol. 2012 Mar;161(1):113; author reply 113-4   [PMID:  22136883 ]

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