全腹腔鏡下子宮全摘術後に腟断端離開を来した2症例

抄録

  Reportedly, total laparoscopic hysterectomy (TLH) is associated with a higher rate of postsurgical vaginal cuff dehiscence than abdominal surgery and laparoscopically assisted vaginal hysterectomy. We performed TLH in 322 patients. We report 2 cases of vaginal cuff dehiscence observed after TLH and discuss the preventive strategies in this context.

Case 1: A 48-year-old woman (2G1P) was diagnosed with cervical intraepithelial neoplasia stage III (CIN 3) and underwent TLH concomitant with bilateral salpingo-oophorectomy. We diagnosed her with vaginal cuff dehiscence 3 months postoperatively. We sutured the vaginal cuff via a vaginal approach and sutured the peritoneum laparoscopically. She reported no complications a year after this surgery.

Case 2: A 39-year-old woman (2G2P) was diagnosed with atypical endometrial hyperplasia and underwent TLH. We diagnosed her with vaginal cuff dehiscence 6 months postoperatively. Initially, we sutured the vaginal cuff via a vaginal approach and sutured the vaginal cuff and peritoneum laparoscopically. She reported no complications 18 months after this surgery.

  Following our observations in these 2 patients, we routinely suture the peritoneum following vaginal cuff closure in all our patients.

  Usually, it is observed that vaginal cuff dehiscence is associated with the use of powered devices during TLH. We emphasize that peritoneal suturing prevents vaginal cuff dehiscence.