title: Vaginal cuff dehiscence: risk factors and associated morbidities.
abstract: OBJECTIVE
  To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence.
  
  
  METHODS
  We performed a retrospective analysis of total hysterectomy cases performed at Brigham and Woman's Hospital or Faulkner Hospital during 2009 through 2011.
  
  
  RESULTS
  During the study period, 2382 total hysterectomies were performed; 23 of these (0.96%) were diagnosed with cuff dehiscence, and 4 women had recurrent dehiscence. Both laparoscopic (odds ratio, 23.4; P = .007) and robotic (odds ratio, 73; P = .0006) hysterectomies were associated with increased odds of cuff dehiscence in a multivariate regression analysis. The type of energy used during colpotomy, mode of closure (hand sewn, laparoscopic suturing, or suturing assisted by a device), and suture material did not differ significantly between groups; however, continuous suturing of the cuff was a protective factor (odds ratio, 0.24; P = .03). Women with dehiscence had more extensive procedures, as well as an increased incidence of additional major postoperative complications (17.4% vs 3%, P = .004).
  
  
  CONCLUSIONS
  The rate of cuff dehiscence in our cohort correlates with the current literature. This study suggests that the risk of dehiscence is influenced mainly by the scope and complexity of the surgical procedure. It seems that different colpotomy techniques do not influence the rate of cuff dehiscence; however, continuous suturing of the cuff may be superior to interrupted suturing.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Noga
authors.initials: N
authors.lastname: Fuchs Weizman
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013536:Suture Techniques
keywords: Laparoscopy; Robotic surgery; Total hysterectomy; Vaginal cuff dehiscence