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| Name | repair of vaginal cuff dehiscence |
| Video Uploader | Video From Dr. Andreas Kavallaris |
| Upload Date | This Video Uploaded At 02-05-2022 16:46:27 |
| Video Discription | Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable and there is no consensus on how to manage this complication. The exact incidence of vaginal cuff dehiscence is difficult to determine because the definition and the incidence varies from study to study. Vaginal cuff dehiscence can occur at any time after a pelvic surgical procedure and has been reported as early as 3 days and as late as 30 years postoperatively. In retrospective cohort studies and larger case series the mean time to cuff dehiscence varied between 6.1 weeks up to 1.6 years (range 2 weeks to 5.4 years), though this may differ by mode of hysterectomy. Increased age, increased number of vaginal surgeries, vaginal atrophy, factors associated with poor wound healing (including malignancy, chronic steroid use, malnutrition, tissue radiation), increased valsalva (chronic cough), and postoperative vaginal cuff infection or hematoma may be risk factors for vaginal cuff dehiscence. Although intercourse, straining with defecation, or valsalva can precede postoperative dehiscence of the vaginal cuff, many women who experience vaginal cuff dehiscence have no identifiable precipitating event. In the cases of vaginal cuff dehiscence reported in the literature, 8%-48% reported intercourse and 16%-30% reported defecation or valsalva (cough or sneeze) as the precipitating event. However, spontaneous vaginal cuff dehiscence has been reported to represent up to 70% of cases. Therefore, a high index of suspicion should be maintained for patients presenting after hysterectomy with sudden onset pelvic or abdominal pain accompanied by vaginal bleeding or watery discharge. The current evidence available on approach (vaginal, abdominal, laparoscopic) to repair of a vaginal cuff dehiscence does not suggest that one approach is preferred over the others. Many factors affect choice of surgical repair including the clinical stability of the patient, surgeon experience, level of suspicion for damage to intra-abdominal organs, whether or not a bowel evisceration is present, ability to evaluate the bowel for ischemia or damage, ability to visualize and re-approximate vaginal mucosa adequately, and ability to perform additional necessary procedures. |
| Category | Science & Technology |
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