Laparoscopic hysterectomy: really so risky to a vaginal cuff dehiscence?

PURPOSE OF INVESTIGATION: The authors report their experience with vaginal vault suturing procedure in patients that underwent total laparoscopic hysterectomy (TLH) for benign diseases. Vaginal vault colpotomy and closure were only laparoscopically carried out.

MATERIALS AND METHODS: Longitudinal retrospective study was conducted in 550 patients, affected by gynaecological benign pathologies, that underwent TLH were enrolled. Information about age, body mass index, parity, corticosteroid therapy, previous pelvic surgery, smoking, diabetes, menopausal status, and procedure characteristics (operating time, blood loss, uterus weight, postoperative recovery time, and adverse outcomes) were collected. Postoperative complications and adverse outcomes were recorded.

RESULTS: Only one case (0.2%,) of vaginal cuff dehiscence (VCD) occurred four weeks after surgery, which was quickly laparoscopically repaired with interrupted intracorporeal knots. The trigger event was sexual intercourse in a patient affected by systemic lupus erythematosus (SLE). No cases of VCD presented in patients with other considered comorbidities.

CONCLUSION: A careful technique could further decrease the incidence of postoperative vaginal cuff dehiscence, regardless of laparoscopic or vaginal suture approach.