title: Totally laparoscopic treatment of vaginal cuff dehiscence: A case report and systematic literature review.
abstract: BACKGROUND
  To highlight the laparoscopic management as a feasible treatment option for vaginal cuff dehiscence with intestinal evisceration after hysterectomy.
  
  
  METHODS
  We report a rare case of a 49-year-old postmenopausal woman who was admitted to the emergency department with vaginal herniation of approximately 40cm of small bowel 3 months after total laparoscopic hysterectomy, treated laparoscopically exclusively.
  
  
  CONCLUSIONS
  The patient underwent a laparoscopic reduction of the protruded mass, inspection of the entire small bowel and closure of the vaginal dehiscence. She was discharged home in a good health and the postoperative course remains uneventful 6 months later. Our systematic review of the literature found 116 cases of vaginal evisceration, which were described as early as 1864. There is no consensus on the ideal method of surgical repair. To our knowledge, only 2% (3 cases) were treated totally laparoscopically and 10% by a combined approach (laparoscopic and vaginal). Although the current evidence does not suggest that one approach is preferred to the others, the laparoscopic approach seems to be the new trend for the management of this surgical emergency.
  
  
  CONCLUSIONS
  Totally laparoscopic repair in experience hands seems to be a safe approach to cure vaginal evisceration after pelvic surgery.
authors.affiliation: Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium. Electronic address: teothomopoulos@yahoo.com.
authors.forename: T
authors.initials: T
authors.lastname: Thomopoulos
authors.affiliation: Department of General Surgery, Hospital of Nyon (GHOL), Nyon, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Zufferey
keywords: Case report; Laparoscopic treatment; Pelvic surgery; Vaginal cuff dehiscence; Vaginal herniation