title: Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault.
abstract: Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH.
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Blikkendaal
authors.forename: A R H
authors.initials: AR
authors.lastname: Twijnstra
authors.forename: S C L
authors.initials: SC
authors.lastname: Pacquee
authors.forename: J P T
authors.initials: JP
authors.lastname: Rhemrev
authors.forename: M J G H
authors.initials: MJ
authors.lastname: Smeets
authors.forename: C D
authors.initials: CD
authors.lastname: de Kroon
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen