Incidence of Vaginal Cuff Dehiscence after Different Modes of Hysterectomy: A Follow-Up Study to a Single Institution's Experience

Vaginal evisceration is a rare but severe complication after hysterectomy or colpotomy and is generally successfully repaired by reapproximating healthy tissue edges of the vagina. Recurrent vaginal cuff dehiscence is problematic especially in sexually active women. We describe two cases of recurrent vaginal cuff dehiscence. The first patient had a hysterectomy for endometriosis. The second patient underwent laparoscopic excision of an endometriotic nodule at the vaginal vault. The vaginal cuff dehiscence was repaired by a laparoscopic approach employing an omental flap to enhance tissue healing. This closure technique turned out to be successful at follow-up in both cases. In case of recurrent vaginal cuff dehiscence, management options are limited. Our case report offers a laparoscopic treatment option by using an omental flap. This procedure can be used when conventional repair fails.

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Intestinal Loop Evisceration after Vaginal Cuff Dehiscence: A Case Report and Review

Women Health Care and Issues ◽

10.31579/2642-9756/042 ◽

2021 ◽

Vol 04 (01) ◽

pp. 01-06

Author(s):

Sonia Manso

Keyword(s):

Intestinal Resection ◽

Genital Prolapse ◽

Medical Emergency ◽

Intestinal Loop ◽

Vaginal Cuff ◽

Vaginal Evisceration ◽

Vaginal Repair ◽

Vaginal Cuff Dehiscence ◽

Omentum Flap

Background: Intestinal loop evisceration complicates 35-67% of vaginal cuff dehiscence, constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Complications associated with the use of a pessary are rare. They are usually due to loss of patient follow-up or negligent use of the device. Clinical presentation: We present the case of a 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: EV requires vaginal, abdominal, or mixed repair, generally deferring definitive prolapse treatment to a second stage and we recommend being very careful with the closure of the vaginal vault after any type of hysterectomy

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Incidence of and risk factors for vaginal cuff dehiscence following total laparoscopic hysterectomy: a monocentric hospital analysis

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06064-0 ◽

2021 ◽

Author(s):

Julia Caroline Radosa ◽

Marc Philipp Radosa ◽

Julia Sarah Maria Zimmermann ◽

Eva-Marie Braun ◽

Sebastian Findeklee ◽

...

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Laparoscopic Hysterectomy ◽

Incidence Rates ◽

Total Laparoscopic Hysterectomy ◽

University Hospital ◽

Vaginal Cuff ◽

Gynecology And Obstetrics ◽

Vaginal Cuff Dehiscence

Abstract Purpose Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up. Methods All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database. Results VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0–9.38; p = 0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98–0.99; p = 0.02) were associated positively with the risk of VCD. Conclusion In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication.

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Electron Microscopy of Human Gallstones

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100065523 ◽

1971 ◽

Vol 29 ◽

pp. 296-297

Author(s):

C. Wolpers ◽

R. Blaschke

Keyword(s):

Electron Microscopy ◽

Room Temperature ◽

Bile Pigment ◽

X Ray Diffraction ◽

Triclinic Crystal System ◽

X Ray ◽

Follow Up Study ◽

Infra Red ◽

Main Components

Scanning microscopy was used to study the surface of human gallstones and the surface of fractures. The specimens were obtained by operation, washed with water, dried at room temperature and shadowcasted with carbon and aluminum. Most of the specimens belong to patients from a series of X-ray follow-up study, examined during the last twenty years. So it was possible to evaluate approximately the age of these gallstones and to get information on the intensity of growing and solving.Cholesterol, a group of bile pigment substances and different salts of calcium, are the main components of human gallstones. By X-ray diffraction technique, infra-red spectroscopy and by chemical analysis it was demonstrated that all three components can be found in any gallstone. In the presence of water cholesterol crystallizes in pane-like plates of the triclinic crystal system.

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