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

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

scholarly journals Evisceration after vaginal cuff dehiscence: A case report and review

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Sonia De-Miguel-Manso ◽  
◽  
Dakota Viruega-Cuaresma ◽  
Elena García-García ◽  
Carmen E Badillo-Bercebal ◽  
...  
Keyword(s):  
Intestinal Resection ◽  
Genital Prolapse ◽  
Medical Emergency ◽  
Definitive Treatment ◽  
Barbed Suture ◽  
Intestinal Loop ◽  
Vaginal Cuff ◽  
Vaginal Evisceration ◽  
Vaginal Repair ◽  
Vaginal Cuff Dehiscence

Introduction: Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Clinical case: 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Results: 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: VE requires vaginal, abdominal or mixed repair, generally deferring the definitive treatment of the prolapse to a second stage. We recommend being very careful with vaginal vault closure after any type of hysterectomy, avoiding electrosurgery, infection and bleeding, performing the colporrhaphy with bidirectional barbed suture or two layers with braided suture and facing enough tissue at the suture. Keywords: Vaginal evisceration; Vaginal cuff dehiscence; Complications after hysterectomy; Long-standing pessary.

scholarly journals Recurrent vaginal cuff dehiscence after surgery for endometriosis: a technique for laparoscopic repair with an omental flap

2021 ◽  
Vol 14 (3) ◽  
pp. e239540
Author(s):  
Gerard-Peter Frank ◽  
Johann Rhemrev ◽  
Marinke Westerterp ◽  
Jim English
Keyword(s):  
Laparoscopic Approach ◽  
Omental Flap ◽  
Sexually Active ◽  
Management Options ◽  
Vaginal Cuff ◽  
Vaginal Evisceration ◽  
Tissue Healing ◽  
Laparoscopic Excision ◽  
Vaginal Cuff Dehiscence

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.

scholarly journals Vaginal Treatment of Vaginal Cuff Dehiscence with Visceral Loop Prolapse: A New Challenge in Reparative Vaginal Surgery?

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Salvatore Andrea Mastrolia ◽  
Edoardo Di Naro ◽  
Luca Maria Schonauer ◽  
Maria Teresa Loverro ◽  
Beatrice Indellicati ◽  
...  
Keyword(s):  
Vaginal Surgery ◽  
Medical Intervention ◽  
Vaginal Vault ◽  
Intestinal Loop ◽  
Vaginal Cuff ◽  
Postmenopausal Patient ◽  
Total Hysterectomy ◽  
Vaginal Cuff Dehiscence ◽  
Long Time ◽  
Vaginal Cuff Closure

Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication.

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

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.

scholarly journals Impact of a Revised Cuff Closure Technique on the Rate of Vaginal Cuff Dehiscence with Endoscopic Hysterectomy

2020 ◽  
Vol 27 (7) ◽  
pp. S105
Author(s):  
S. Behbehani ◽  
E. Suarez-Salvador ◽  
H. Kosiorek ◽  
J. Yi ◽  
J.F. Magrina
Keyword(s):  
Vaginal Cuff ◽  
Closure Technique ◽  
Vaginal Cuff Dehiscence

scholarly journals A COMPARISON BETWEEN SYNTHETIC AND BIOSYNTHETIC MESHES IN THE SURGICAL TREATMENT OF SEVERE GENITAL PROLAPSE: RESULTS AND COMPLICATIONS

2010 ◽  
Vol 23 (3) ◽  
pp. 21
Author(s):  
S. Dati ◽  
V. De Lellis ◽  
P. Palermo ◽  
G. Carta
Keyword(s):  
Genital Prolapse ◽  
Pelvic Organ ◽  
Wilcoxon Test ◽  
Type I ◽  
Replacement Surgery ◽  
Group A ◽  
Group B ◽  
Work Up

The effectiveness, tolerability and complications of two surgical procedures using prosthetic materials with different physical and structural properties were assessed with a full Urogynecology work-up, through a retrospective study of 158 patients with severe genital prolapse (POP-Q staging III-IV) selected from November 2006 to April 2009. Eighty-six patients underwent fascial replacement surgery with ProliftTM System with a dual transobturator access in the anterior district and a transperineal posterior access with a synthetic polypropylene type I mesh (Group A). Seventy-two patients who underwent pelvic organ prolapse surgery with Avaulta/Avaulta PlusTM System with a dual transobturator access in the anterior district and a dual transperineal posterior access with a biosynthetic polypropylene type I mesh coated with a film of hydrophilic porcine collagen were placed in Group B. There were no intra and postoperative complications. Results of mean 20.8 month follow-up showed an effective anatomical cure rate of 89.5% in group A and 86.1% in group B and a low percentage of erosive complications, 8.1% and 5.6% respectively. Validated questionnaires for prolapse, the UDI 6 s.f., the IIQ7 s.f. and the PISQ-12 all showed a statistically significant improvement of quality of life in patients undergoing the two procedures (Wilcoxon test: P<0.001).

scholarly journals EXPERIENCE OF USING SYNTHETIC PROSTHESES PROLIFT ® (GYNECARE) FOR CORRECTION OF GENITAL PROLAPSE

2010 ◽  
Vol 1 (3) ◽  
pp. 32-37
Author(s):  
S A Levakov ◽  
N S Wanke ◽  
O R Shablovskiy ◽  
A G Kedrova ◽  
V N Shirshov ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Prospective Observational Study ◽  
Vaginal Surgery ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Safe Procedure ◽  
Prolapse Repair ◽  
Specific Outcome ◽  
One Year

The aim was to evaluated anatomical and symptom specific outcome measures of prolapse repair with PROLIFT ® (Gynecare). In this longitudinal prospective observational study we collected data on a total of 85 women with pelvic organ prolapse stage 2 or more. Objective success rate was 85.9% at 6 months respectively. Patients required a blood more 500 ml - 7,1% and need transfusion. The mesh erosion rate or the displacement of the mesh were 3,5%. Vaginal surgery with prolift mesh® is an effective and safe procedure to correct pelvic organ prolapse over one year follow up.

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