title: Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?
abstract: 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.
authors.affiliation: Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, via Massarenti 13, 40138 Bologna, Italy.
authors.forename: Pierandrea De
authors.initials: PD
authors.lastname: Iaco
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceccaroni
authors.forename: Carlo
authors.initials: C
authors.lastname: Alboni
authors.forename: Brunilde
authors.initials: B
authors.lastname: Roset
authors.forename: Maddalena
authors.initials: M
authors.lastname: Sansovini
authors.forename: Luigi
authors.initials: L
authors.lastname: D'Alessandro
authors.forename: Elettra
authors.initials: E
authors.lastname: Pignotti
authors.forename: Domenico De
authors.initials: DD
authors.lastname: Aloysio
mesh_terms: 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*