1
|
Murray B, Smith CE, Alsina J, Howard M, Landen C, Gehrig PA. Application of a Malecot drain in the management of a vaginal cuff dehiscence: A case report and review of the literature. Gynecol Oncol Rep 2024; 54:101416. [PMID: 38799231 PMCID: PMC11126945 DOI: 10.1016/j.gore.2024.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Background Vaginal cuff dehiscence (VCD) in the setting of acute infection is an uncommon but serious complication of total hysterectomy without clear guidelines for management. There is a need for further documentation of best practices around treatment, particularly when it comes to surgical drain utilization and placement. Case description We present a case of a 68-year-old with primary peritoneal carcinoma who underwent a robot-assisted total laparoscopic hysterectomy as part of an interval debulking surgery and had a VCD. The cuff was repaired vaginally in the operating room with placement of a Malecot catheter for pelvic abscess drainage. Discussion The literature is sparse in regard to clear guidelines for management of VCD. Surgical and expectant management approaches are dependent on patient stability, surgical experience, local practice norms, and evidence of intra-abdominal injury. Interventional radiology has become a primary source of drain placement in management of VCD and vaginal cuff abscess. Malecot drains are a low cost, and effective intervention for such management and an important resource for the gynecologic surgeon.
Collapse
Affiliation(s)
- Bria Murray
- University of Virginia, Department of Obstetrics and Gynecology, United States
| | | | - Jorge Alsina
- University of Virginia, Department of Obstetrics and Gynecology, United States
| | - Megan Howard
- University of Pittsburgh Medical Center, United States
| | - Charles Landen
- University of Virginia, Department of Obstetrics and Gynecology, United States
| | - Paola A Gehrig
- University of Virginia, Department of Obstetrics and Gynecology, United States
| |
Collapse
|
2
|
Jaime Moens B, Buonomo A, De Sutter P. Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature. J Clin Med 2023; 12:4187. [PMID: 37445221 DOI: 10.3390/jcm12134187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described.
Collapse
Affiliation(s)
- Babette Jaime Moens
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Antonino Buonomo
- Department of Gynaecology, Centre Hospitalier Universitaire Tivoli, Avenue Max Buset 34, 7100 La Louviere, Belgium
| | - Philippe De Sutter
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| |
Collapse
|
3
|
Eoh KJ, Lee YJ, Nam EJ, Jung HI, Kim YT. Clinical Relevance of Vaginal Cuff Dehiscence after Minimally Invasive versus Open Hysterectomy. J Clin Med 2023; 12:3001. [PMID: 37109333 PMCID: PMC10142584 DOI: 10.3390/jcm12083001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7-1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51-4.98 and OR: 2.20; 95% CI, 1.09-4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence.
Collapse
Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea;
| | - Young Joo Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Hye In Jung
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| |
Collapse
|
4
|
Fermin O, Delgado A, Sarkar P, Chern JY, Wenham R, Hoffman MS. Vaginal Evisceration Subsequent to Hysterectomy at a Major Cancer Center. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Oriana Fermin
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Papri Sarkar
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
| | - Jing-Yi Chern
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Robert Wenham
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mitchel S. Hoffman
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
- Department of Gynecology/Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| |
Collapse
|
5
|
Prevention and management of vaginal cuff dehiscence: an updated review. Curr Opin Obstet Gynecol 2022; 34:250-255. [PMID: 35895968 DOI: 10.1097/gco.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy. RECENT FINDINGS Recent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence. SUMMARY The focus of this review is to help surgeons identify patient risk factors and address them preoperatively and to review surgical techniques that can minimize the risk of vaginal cuff dehiscence.
Collapse
|
6
|
Lee DH, Kim ET, Jo HB, Hwang SY, Lee NK, Suh DS, Kim KH. Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer: A case report. Medicine (Baltimore) 2022; 101:e29225. [PMID: 35512082 PMCID: PMC9276405 DOI: 10.1097/md.0000000000029225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality. PATIENT CONCERNS A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation. DIAGNOSIS Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel. INTERVENTIONS Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally. OUTCOMES The patient experienced no postoperative complications and remained disease-free for 9months postoperatively. LESSONS Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.
Collapse
Affiliation(s)
- Dong Hyung Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun Taeg Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hyun Been Jo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea
| | - Seo Yoon Hwang
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea
| | - Nam Kyung Lee
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea
- Department of Radiology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea
| |
Collapse
|
7
|
Boersen Z, Aalders CIM, Klinkert ER, Maas JWM, Nap AW. Vaginal Cuff Dehiscence After Endometriosis Surgery. JSLS 2019; 23:JSLS.2019.00018. [PMID: 31341379 PMCID: PMC6639167 DOI: 10.4293/jsls.2019.00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Laparoscopic hysterectomy is one of the surgical treatment options for endometriosis. A rare complication of this surgical procedure is vaginal cuff dehiscence, with an incidence of 0.03% to 0.30%. Sexual intercourse may be the main triggering event. It is unclear if patients with endometriosis are more prone to develop vaginal cuff dehiscence than other women undergoing laparoscopic hysterectomy. Methods We present the cases of women aged 35 to 46 years who underwent laparoscopic endometriosis surgery. In all patients the vaginal cuff was opened with a high-energy surgical device and closed with an absorbable suture. After 60 to 194 d, the patients developed symptoms including acute abdominal pain and fever shortly after or during coitus and were diagnosed with vaginal cuff dehiscence. Results Patients undergoing surgical treatment for endometriosis may experience poor wound healing of the vaginal cuff due to the frequent use of gonadotrophin-releasing hormone analogues before surgery. Contributing to this may be the use of a high-energy surgical device when opening the vaginal cuff. Resuming sexual activities before proper healing of the wound has occurred may then trigger vaginal cuff dehiscence. Conclusion Women with endometriosis might be prone to develop vaginal cuff dehiscence, not because of the endometriosis itself but because of a combination of patient-specific factors present in women with endometriosis. Surgeons treating women with endometriosis should be aware of this.
Collapse
Affiliation(s)
- Zoë Boersen
- Department of Obstetrics and Gynecology, Rijnstate Hospital, the Netherlands
| | | | | | | | - Anna Willemina Nap
- Department of Obstetrics and Gynecology, Rijnstate Hospital, the Netherlands
| |
Collapse
|
8
|
Taşkın S, Şükür YE, Turgay B, Altin D, Ortaç F. Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2019; 234:38-42. [DOI: 10.1016/j.ejogrb.2018.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/17/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
|
9
|
Ala‐Nissilä S, Laurikainen E, Mäkinen J, Jokimaa V. Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy. Acta Obstet Gynecol Scand 2018; 98:44-50. [DOI: 10.1111/aogs.13459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Seija Ala‐Nissilä
- Department of Obstetrics and Gynecology Turku University Hospital Turku Finland
| | - Eija Laurikainen
- Department of Obstetrics and Gynecology Turku University Hospital Turku Finland
| | - Juha Mäkinen
- Department of Obstetrics and Gynecology Turku University Hospital Turku Finland
| | - Varpu Jokimaa
- Department of Obstetrics and Gynecology Turku University Hospital Turku Finland
| |
Collapse
|
10
|
|
11
|
Uccella S, Malzoni M, Cromi A, Seracchioli R, Ciravolo G, Fanfani F, Shakir F, Gueli Alletti S, Legge F, Berretta R, Corrado G, Casarella L, Donarini P, Zanello M, Perrone E, Gisone B, Vizza E, Scambia G, Ghezzi F. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018; 218:500.e1-500.e13. [PMID: 29410107 DOI: 10.1016/j.ajog.2018.01.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vaginal cuff dehiscence following hysterectomy is considered an infrequent but potentially devastating complication. Different possible techniques for cuff closure have been proposed to reduce this threatening adverse event. OBJECTIVE The aim of the present randomized study was to compare laparoscopic and transvaginal suture of the vaginal vault at the end of a total laparoscopic hysterectomy, in terms of incidence of vaginal dehiscence and vaginal cuff complications. Factors associated with vaginal dehiscence were also analyzed. This article presents the results of the interim analysis of the trial. STUDY DESIGN Patients undergoing total laparoscopic hysterectomy for benign indications were randomized at the time of colpotomy to receive vaginal closure through transvaginal vs laparoscopic approach using a 1:1 ratio. Allocation concealment was obtained using a password-protected randomization database. Monopolar energy for colpotomy was set at 60W. Vaginal closure was performed with a single-layer running braided and coated 0-polyglactin suture. In all cases an attempt was performed to include the posterior peritoneum in the suture. Laparoscopic knots were tied intracorporeally. All patients were scheduled for a postoperative follow-up visit 3 months after surgery, to detect possible vaginal cuff complications. Univariate and multivariable analyses were performed to identify independent predictors of vaginal cuff dehiscence after total laparoscopic hysterectomy. RESULTS After enrollment of 1408 patients, a prespecified interim analysis was conducted. Thirteen (0.9%) women did not undergo the postoperative assessment and were excluded. Baseline characteristics of the 1395 patients included (695 in the transvaginal group and 700 in the laparoscopic group) were similar between groups. Patients in the transvaginal group had a significantly higher incidence of vaginal dehiscence (2.7% vs 1%; odds ratio, 2.78; 95% confidence interval, 1.16-6.63; P = .01) and of any cuff complication (9.8% vs 4.7%; odds ratio, 2.19; 95% confidence interval, 1.43-3.37; P = .0003). Based on these findings, the data monitoring committee recommended that the trial be terminated early. After multivariable analysis, transvaginal closure of the vault was independently associated with a higher incidence of vaginal dehiscence and any vaginal complication; premenopausal status and smoking habit were independently associated with a higher risk of dehiscence. CONCLUSION Laparoscopic closure of the vaginal cuff at the end of total laparoscopic hysterectomy is associated with a significant reduction of vaginal dehiscence, any cuff complication, vaginal bleeding, vaginal cuff hematoma, postoperative infection, need for vaginal resuture, and reintervention.
Collapse
Affiliation(s)
- Stefano Uccella
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy; Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
| | - Mario Malzoni
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Renato Seracchioli
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Ciravolo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Fevzi Shakir
- Department of Obstetrics and Gynecology, Royal Free Hospital, London, United Kingdom
| | - Salvatore Gueli Alletti
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Francesco Legge
- Division of Gynecology, Department of Obstetrics and Gynecology, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Lucia Casarella
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Paolo Donarini
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Margherita Zanello
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuele Perrone
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| |
Collapse
|
12
|
Karacan T, Ozyurek E, Usta T, Odacilar E, Hanli U, Kovalak E, Dayan H. Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. J OBSTET GYNAECOL 2018; 38:842-847. [PMID: 29577776 DOI: 10.1080/01443615.2017.1416597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p < .05). V-Loc™ 180 unidirectional barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed suture is the second largest series after the study of Cong et al. What the implications are of these findings for clinical practice and/or further research: We believe that the barbed suture, the surgery results of which are openly discussed in our study, will be more prominent in clinical practice owing to the shortened operating time, and that the use of these sutures does not cause a significant increase in vaginal cuff complications.
Collapse
Affiliation(s)
- Tolga Karacan
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Eser Ozyurek
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Taner Usta
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Eylem Odacilar
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Ulviye Hanli
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Ebru Kovalak
- a Department of Obstetrics and Gynaecology , University of Health Sciences, Bagcilar Research and Education Hospital , Istanbul , Turkey
| | - Huseyin Dayan
- b Department of Obstetrics and Gynaecology , Arnavutkoy Government Hospital , Istanbul , Turkey
| |
Collapse
|
13
|
Smith K, Caceres A. Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials. Cureus 2017; 9:e1766. [PMID: 29234570 PMCID: PMC5724812 DOI: 10.7759/cureus.1766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions. The development of minimally invasive surgery has transformed this procedure, resulting in improved outcomes, superior cosmesis, and quicker return to normal function. Vaginal cuff closure is a critical component of hysterectomy, with many variations in surgical technique and materials. This review provides an overview of intracorporeal suturing and knot-tying techniques at the level of a junior resident in obstetrics and gynecology and describes several validated models that have been developed to test resident skill level in vaginal cuff closure. We also provide a review of the literature regarding vaginal cuff closure techniques and suture materials, including knotless barbed sutures. Finally, a brief discussion of single-site surgery, the latest development in minimally invasive hysterectomy, will be provided. We hope to provide a better understanding of vaginal cuff closure for residents in the field of obstetrics and gynecology.
Collapse
|
14
|
Makai GE, Schaeffer KD, Sloan NL. Independent Learning of Electrosurgery in Gynecology: A Randomized Controlled Trial. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gretchen E. Makai
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| | | | - Nancy L. Sloan
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| |
Collapse
|
15
|
Kusunoki S, Huang KG, Magno A. Spontaneous Healing of Vaginal Cuff Dehiscence in a Uterine Cervical Cancer Following Laparoscopic Radical Hysterectomy and Chemoradiation. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University Tokyo, Japan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Angelito Magno
- Department of Obstetrics and Gynecology, University of Perpetual Help Las Pinas and De La Salle University Medical Center, Cavite, Philippines
| |
Collapse
|
16
|
|
17
|
Stahl JM, Park HS, Silasi DA, Azodi M, Damast S. Influence of robotic-assisted laparoscopic hysterectomy on vaginal cuff healing and brachytherapy initiation in endometrial carcinoma patients. Pract Radiat Oncol 2016; 6:226-232. [DOI: 10.1016/j.prro.2015.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/11/2015] [Accepted: 09/28/2015] [Indexed: 10/21/2022]
|
18
|
Brown DN, Gobern JM. Unidirectional Barbed Suture for Vaginal-Cuff Closure in Laparoscopic and Robotic Hysterectomy. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Douglas N. Brown
- Division of Minimally Invasive Gynecologic Surgery, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Joseph M. Gobern
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
| |
Collapse
|
19
|
Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology. Eur J Obstet Gynecol Reprod Biol 2016; 202:83-91. [PMID: 27196085 DOI: 10.1016/j.ejogrb.2016.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. METHODS Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). RESULTS Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B). CONCLUSION The application of these recommendations should minimize risks associated with hysterectomy.
Collapse
|
20
|
Gauthier T, Huet S, Marcelli M, Lamblin G, Chêne G. Hystérectomie pour pathologie bénigne : choix de la voie d’abord, technique de suture vaginale et morcellement : recommandations. ACTA ACUST UNITED AC 2015; 44:1168-82. [DOI: 10.1016/j.jgyn.2015.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
|
21
|
Uccella S, Ghezzi F. Re: JSLS. 2013;17:414-417. Effects of electrosurgery and vaginal closure technique on postoperative vaginal cuff dehiscence. JSLS 2015; 19:JSLS-D-13-00359. [PMID: 25722630 PMCID: PMC4333829 DOI: 10.4293/jsls.2015.003594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Stefano Uccella
- Obstetrics and Gynecology Department University of Insubria Varese, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department University of Insubria Varese, Italy E-mail
| |
Collapse
|
22
|
Abstract
BACKGROUND Laparoscopic and robotic-assisted hysterectomies are associated with higher rates of vaginal cuff dehiscence and evisceration than are open and vaginal hysterectomies. With the rising prevalence of minimally invasive hysterectomy, gynecologists should know how to manage this rare but potentially serious condition. Urgent laparotomy historically was recommended for management of vaginal cuff evisceration to allow for complete bowel evaluation. More recently, successful outcomes using a less-invasive vaginal or combined vaginal and laparoscopic approach have been reported. TECHNIQUE Patients are selected for transvaginal repair of vaginal cuff evisceration if there is no clinical evidence of peritonitis or ischemic injury to the prolapsed bowel segment. Under general anesthesia and after administration of intravenous antibiotics, the bowel is copiously irrigated and replaced into the abdomen. The vaginal cuff is sharply debrided of any necrotic tissue, and a full-thickness closure is performed using a delayed absorbable monofilament suture. EXPERIENCE We have successfully managed four cases of vaginal cuff evisceration through a transvaginal approach without intraoperative or postoperative complications. CONCLUSION Vaginal cuff dehiscence and evisceration can be treated by transvaginal bowel reduction and cuff closure when the bowel appears uninjured and there are no signs of peritonitis.
Collapse
|