Vaginal cuff dehiscence is an infrequent complication of hysterectomy, with the potential for evisceration and additional morbidity. This review aims to describe the incidence, risk factors, preventative measures, and management. Identification of specific risk factors is problematic because many studies either lack comparison groups or are underpowered as a result of the rarity of this complication. Good surgical technique to optimize vaginal cuff healing and minimize the risk of postoperative cuff infection are important as is avoidance of early intercourse, traumatic vaginal penetration, or excess strain on the vaginal cuff during the postoperative period. Judicious use of electrocautery or other thermal energy, use of delayed absorbable sutures, and adequate tissue bites can further decrease the risk of dehiscence. Prompt recognition and management are critical to achieve best outcomes.
A review of risk factors and preventive measures for vaginal cuff dehiscence and evisceration after hysterectomy.
Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California; Nezhat Medical Center, Atlanta, Georgia; Nezhat Surgery for Gynecology/Oncology, and Weill Cornell Medical College of Cornell University, New York, New York; Stony Brook University School of Medicine, Stony Brook, New York; and NYU Winthrop Hospital, Mineola, New York.
Corresponding author: Camran Nezhat, MD, FACS, Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, 900 Welch Road, Suite 403, Palo Alto, CA 94304; email: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.
Presented at the Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists, May 14–17, 2016, Washington, DC; and at the Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists, May 6–9, 2017, San Diego, California.
Each author has indicated that he or she has met the journal's requirements for authorship.
Received April 30, 2018
Received in revised form June 15, 2018
Accepted June 28, 2018