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A higher rate of vaginal cuff dehiscence is observed after total laparoscopic hysterectomy.

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eMediNexus    15 September 2018

A new article published in the Acta Obstetricia et Gynecologica Scandinavica evaluated the incidence of vaginal cuff dehiscence (VCD) after different types of hysterectomies. The present study evaluated a total of 13,645 hysterectomies from 1992-2015 in Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomies. Overall, 22 cases of VCD were included. It was noted that most cases occurred after total laparoscopic hysterectomy (TLH), and resulted in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure, vaginal, and abdominal hysterectomies, the incidence rates were 0.11%, 0.05% and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio of 71.1. In the sub-analysis of possible underlying factors, differences between TLH and conventional hysterectomies lied in the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD. The results suggested that compared to other types of hysterectomies, vaginal dehiscence has higher incidence after TLH.

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