V-GYN-MD-136| Volume 44, ISSUE 5, P602, May 2022

Management of Vaginal Vault Dehiscence After Laparoscopic Hysterectomy

      Vaginal vault dehiscence is a rare but serious complication of laparoscopic hysterectomy. Here we review the epidemiology, diagnosis, and management of vaginal vault dehiscence, and illustrate a 5-step surgical approach to laparoscopic vault repair. At a tertiary care centre, surgical footage was obtained from a 34-year-old female presenting 8 weeks after total laparoscopic hysterectomy with complete vault dehiscence following intercourse. Vaginal vault dehiscence complicates 0.64%–1.35% of laparoscopic hysterectomies, and can be categorized as complete cuff dehiscence, partial cuff dehiscence, or partial thickness cuff dehiscence. Protective factors include use of barbed sutures compared to non-barbed sutures and laparoscopic closure compared to vaginal closure. Smoking and low BMI have been associated with increased risk of dehiscence. The surgical approach to a laparoscopic repair of cuff dehiscence can be standardized in 5 reproducible steps: abdominal survey, bladder and/or rectal dissection, vault debridement, vault closure, and cystoscopy. Vaginal vault dehiscence is an infrequently encountered complication of laparoscopic hysterectomy. This video reviews the clinical management and reproducible surgical repair of vaginal vault dehiscence.
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