A case of vaginal cuff dehiscence after radical laparoscopic hysterectomy.
Rossetti A°, Sizzi O°. Loddo A*
°Nuova Villa Claudia Hospital, Rome, Italy
*University of Cagliari, Italy. Obstetrics and Gyneological Department

CASE REPORT: A 42 year old patient was admitted in the emergency unit of out Hospital 10 days after having undergone a radical laparoscopic hysterectomy in another hospital for cervical cancer stage I. She complained of lack of feeling of bladder fullness and need to strain to empty the bladder. She reported of an acute pelvic pain after voiding the bladder. At the pelvic examination, several loops of the small bowel were protruding out of the vagina. An immediate laparoscopy was planned. It was impossible to simply reposition the bowel loops inside the abdominal cavity. We had to cut the previous vaginal closure and reposition the bowel inside the abdomen. A general surgeon was called to give his judgment on the soundness of movements and vascularization of the bowel and correctness of avoiding a bowel resection. Later a double layer, one vaginal and one laparoscopic suture was applied.

DISCUSSION: Vaginal cuff dehiscence is a severe adverse event that occurs more frequently after total laparoscopic hysterectomy compared with abdominal and vaginal hysterectomy. (1) It varies between 0.3 and 3.1 % . Some authors propose that electrosurgical colpotomy used in TLH could be responsible for suboptimal vaginal cuff healing, due to tissue necrosis and prolonged devascularisation. (2). Uccella et al. reported an increased incidence associated with laparoscopic single-layer interrupted suture compared to transvaginal closure (0.18 and 0.64 %, respectively). (3)

In this case we had a wider vaginal cuff as result of a radical procedure and only three single stitches were applied. Enough space to allow the bowel to go through and narrow enough not to permit to reacsend.

1. Hur HC, Donnellan N, Mansuria S, et al. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118:794–801.
2. Hur HC, Guido RS, Mansuria SM, et al. Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol. 2007;14:311–317.
3. Uccella S, Ghezzi F, Mariani A, et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. 2011;205:119.