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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© 2022 Published by Elsevier Inc.
