Vaginal vault dehiscence after hysterectomy.
OBJECTIVE
The purpose of our study was to evaluate factors predisposing vault dehiscence after hysterectomy and its manifestation.


METHODS
Case series and review of the literature (Canadian Task Force classification II-3).


METHODS
Multicenter study.


METHODS
Retrospective analysis of 16 unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy from physicians who participated in the exchange on the topic of vaginal vault dehiscence at the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and review of 38 reported cases in the literature (group B).


METHODS
The participating physicians were asked to complete a detailed questionnaire related to vault dehiscence. In addition, we performed literature search using the keywords "vault dehiscence," "vaginal vault dehiscence," "vault prolapse," and "hysterectomy," and conducted the search in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews.


RESULTS
We estimated risk factors and characteristic features for vaginal vault dehiscence. The incidence of vault dehiscence was higher after laparoscopic hysterectomy (1.14%) than after abdominal hysterectomy (0.10%, p <.0001, OR 11.5) and after vaginal hysterectomy (0.14%, p <.001, OR 8.3). The time interval between hysterectomy and occurrence of vault dehiscence in the laparoscopic group (8.4 +/- 1.2 weeks) was significantly shorter than in the abdominal hysterectomy (112.7 +/- 75.1 weeks, p = .01) and in vaginal hysterectomy (136.5 +/- 32.2 weeks, p <.0001) groups, respectively. It appears that sexual intercourse was the main triggering event for vault dehiscence (58.8%). Vaginal bleeding (50%) and vaginal evisceration (48.1%) were the main symptoms.


CONCLUSIONS
Our data suggest that vaginal vault dehiscence is rare but may occur more often after laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the technique of laparoscopic suturing is unclear. Other risk factors such as early resumption of regular activities and sexual intercourse may play a role.
Agdi
Mohammed
M
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Al-Ghafri
Wadha
W
Antolin
Rommel
R
Arrington
Jeff
J
O'Kelley
Kenneth
K
Thomson
Angus J M
AJ
Tulandi
Togas
T
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D014782:Visceral Prolapse / Q000209:etiology