title: Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study.
abstract: OBJECTIVE
  This study estimates the incidence of vaginal cuff dehiscence resulting from different approaches to hysterectomy.
  
  
  METHODS
  This multicentric study was carried out retrospectively. We retrospectively analyzed 8635 patients; 37% underwent abdominal hysterectomy, 31.2% vaginal hysterectomy, and 31.8% laparoscopic hysterectomy. All the hysterectomies were considered, vaginal evisceration was registered and analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. Continuous variables were compared using the one-way analysis of variance between groups as all data followed a Gaussian distribution, as confirmed by the Kolmogorov-Smirnov test. Differences among subgroups were assessed using the Tukey-Kramer multiple comparisons test. Categorical variables were compared with two tailed Chi-square tests with Yates correction or Fisher's exact test, as appropriate. Pearson's linear correlation was used to verify linear relationships between the dehiscence interval and patient's age at surgery.
  
  
  RESULTS
  Thirty-four patients (0.39%) experienced vaginal evisceration. The laparoscopic route was associated with a significantly higher incidence of dehiscence (p<0.05). No differences were found between the 6027 patients (69.8%) who had closure of the vaginal cuff and the 2608 (30.2%) who had an unclosed cuff closure technique.
  
  
  CONCLUSIONS
  Vaginal evisceration after hysterectomy is a rare gynecological surgical complication. Sexual intercourse before the complete healing of the vaginal cuff is the main trigger event in young patients, while evisceration presents as a spontaneous event in elderly patients. Surgical repair can be performed either vaginally or laparoscopically with similar outcomes.
authors: Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
authors: Marcello
authors: M
authors: Ceccaroni
authors: Roberto
authors: R
authors: Berretta
authors: Mario
authors: M
authors: Malzoni
authors: Marco
authors: M
authors: Scioscia
authors: Giovanni
authors: G
authors: Roviglione
authors: Emanuela
authors: E
authors: Spagnolo
authors: Martino
authors: M
authors: Rolla
authors: Antonio
authors: A
authors: Farina
authors: Carmine
authors: C
authors: Malzoni
authors: Pierandrea
authors: P
authors: De Iaco
authors: Luca
authors: L
authors: Minelli
authors: Luciano
authors: L
authors: Bovicelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D014621:Vagina / Q000601:surgery*