From the Research
Vaginal cuff dehiscence typically does not close on its own and usually requires surgical repair. This condition, which involves the separation of the surgically created closure at the top of the vagina after hysterectomy, is considered a medical emergency that needs prompt intervention. Small, superficial separations with no tissue protrusion might occasionally heal with conservative management including pelvic rest, antibiotics if infection is present, and close monitoring 1. However, most cases, especially those with evisceration (protrusion of abdominal contents into the vagina), require immediate surgical intervention to close the defect and prevent serious complications such as infection, tissue necrosis, or damage to protruding organs. The surgical repair typically involves removing any devitalized tissue and reclosing the vaginal cuff, sometimes reinforcing it with additional sutures or tissue. Following repair, patients need to avoid activities that increase intra-abdominal pressure (heavy lifting, straining, sexual intercourse) for 8-12 weeks to allow proper healing and prevent recurrence.
Key Points to Consider
- The use of barbed sutures and laparoscopic approach to close the vaginal cuff have been identified as effective strategies in reducing the risk of vaginal cuff dehiscence 1.
- Transvaginal suture of the vault at the end of an endoscopic hysterectomy may increase the risk of dehiscence compared to laparoscopic closure 1.
- Poor wound healing, often resulting from factors like infection, radiation, steroid use, or premature resumption of sexual activity after hysterectomy, is a common underlying cause of dehiscence 2, 3, 4, 5.
Management and Prevention
- Prompt recognition and management are critical to achieve best outcomes in cases of vaginal cuff dehiscence 3, 4.
- Good surgical technique, optimization of vaginal cuff healing, and minimization of postoperative cuff infection are important in preventing dehiscence 2, 3.
- Patients should be advised to avoid activities that increase intra-abdominal pressure for 8-12 weeks after hysterectomy to prevent recurrence of dehiscence.