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Circumferential vault excision and reconstruction: technical description of management of intractable secondary vault hemorrhage following hysterectomy in resource limited settings.

Hemorrhage following gynecological surgery is an infrequent complication. It can be divided based on time of onset into primary and secondary. Secondary hemorrhage is a life threatening complication with a reported incidence of 0.17-0.45%. When the etiology cannot be ascertained and when the hemorrhage does not respond to conservative management it is aptly labeled as intractable hemorrhage. Numerous techniques have been employed in order to manage secondary hemorrhage including vaginal exploration and securing of the bleeding vessels, laparotomy and ligation of uterine and internal iliac arteries and transarterial embolisation of uterine or internal iliac vessels using interventional radiologic modalities. Circumferential vault excision and reconstruction is a methodical technique to effectively control this condition with a total laparoscopic route with systematic and easily replicable steps.

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