Vaginal cuff dehiscence is a rare, but a potentially critical complication after total laparoscopic hysterectomy (TLH). TLH has been reported as having a higher incidence of dehiscence compared with the abdominal and/or vaginal hysterectomy. This complication causes the abdominal content to fall through the vaginal possibly leading to serious infection.
The cause of vaginal dehiscence after TLH is not clear. The possible causes may be early resumption of regular activities, the use of thermal energy for vaginal incision and reduced suturing width due to not enough tissue involvement causing poor blood perfusion. Magnification and low quality of laparoscopic suturing skills also plays a role.
We performed 677 cases of TLH for benign diseases such as fibroids or adenomyosis from January 2007 to December 2008 in our institute. We experienced 4 cases (0.6%) of vaginal cuff dehiscence. Sexual intercourse was the triggering event for 3 cases (96 days, 103 days, 47 days after TLH) and another 1 case occurred during defecation (18 days and no sexual intercourse after TLH). We closed the vaginal cuff promptly via the vaginal. No complications occurred after the closure operation.
After these 4 cases of vaginal cuff dehiscence, we recognized the need to review these cases carefully in order to discover the cause and how to prevent this from occurring in other patients. Appropriate management of this complication by reducing the use of power source and attempting different suturing techniques are important steps towards preventing this potentially serious complication.
