title: Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture.
abstract: OBJECTIVE
  To estimate whether a new surgical technique is associated with lower incidence of postoperative breakdown of the vaginal cuff after laparoscopic hysterectomy or trachelectomy, compared with previous methods of closure.
  
  
  METHODS
  Retrospective cohort study, Canadian Task Force Classification II-3.
  
  
  METHODS
  Tertiary-care university-based teaching hospital.
  
  
  METHODS
  Patients who underwent laparoscopic vaginal closure after removal of the uterus and/or cervix by members of a subspecialty gynecologic laparoscopy division from January 2007 to January 2010 (n = 387).
  
  
  METHODS
  Use of bidirectional barbed suture for laparoscopic vaginal cuff closure.
  
  
  RESULTS
  A total of 387 patient records were reviewed. The incidence of vaginal cuff dehiscence among those with other methods of closure was 4.2%, while there were no cases of dehiscence among those who had closure with bidirectional barbed suture (p = .008). Postoperative bleeding (OR 2.3, 95% C.I. 1.3-3.9), presence of granulation tissue (OR 1.9, 95% C.I. 0.92-3.9), and cellulitis (OR 4.6, 95% C.I. 1.0-21.1) all occurred more frequently in patients without barbed suture closure.
  
  
  CONCLUSIONS
  Dehiscence of the vaginal cuff after laparoscopic closure is a rare but important complication in gynecologic surgery. Use of bidirectional barbed suture eliminated the problem in our first year of experience with the technique. We also observed a decreased incidence of other common problems of the vaginal cuff. This method is easy to learn and inexpensive and does not require advanced skills such as laparoscopic knot-tying.
authors.affiliation: Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, NC 27599-7570, USA. matthew_siedhoff@med.unc.edu
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Siedhoff
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Yunker
authors.forename: John F
authors.initials: JF
authors.lastname: Steege
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures; D014621:Vagina / Q000601:surgery*