Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?
OBJECTIVE
To evaluate the overall incidence of transvaginal evisceration following hysterectomy and to assess the risk associated with indication, route of surgery, age and vaginal cuff closure technique.


METHODS
A database was used to identify all patients undergoing hysterectomy from 1995 to 2001 at our institution and all the patients admitted for vaginal evisceration during the same period. Each vaginal evisceration was analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery.


RESULTS
Of the 3593 patients enrolled in the study, 63.5% underwent abdominal hysterectomy, 33.0% vaginal hysterectomy, and 3.5% laparoscopic hysterectomy. Ten patients (0.28%) presented to the emergency room with vaginal evisceration. No statistical differences in evisceration rates were seen according to the route of surgery. No differences were found between the 1440 patients who had closure of the vaginal cuff and the 2153 who had an unclosed cuff closure technique.


CONCLUSIONS
Our data suggest that, in young patients, sexual intercourse is to be considered the main trigger event before the complete healing of the vaginal cuff while, in elderly patients, the evisceration is a spontaneous event. Uterine prolapse was not associated with a higher rate and the route of surgery or vaginal cuff closure technique did not influence the dehiscence rate.
Iaco
Pierandrea De
PD
Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, via Massarenti 13, 40138 Bologna, Italy.
Ceccaroni
Marcello
M
Alboni
Carlo
C
Roset
Brunilde
B
Sansovini
Maddalena
M
D'Alessandro
Luigi
L
Pignotti
Elettra
E
Aloysio
Domenico De
DD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D014621:Vagina / Q000601:surgery; D014623:Vaginal Diseases / Q000209:etiology*