Vaginal Cuff Dehiscence After Different Modes of Hysterectomy

OBJECTIVE: To update the incidence of vaginal cuff dehiscence after different modes of hysterectomy and to describe surgical and patient characteristics of dehiscence complications. METHODS: This was an observational cohort study at a large academic hospital. All women who underwent hysterectomy and dehiscence repair between January 2006 and December 2009 were identified. Data from this study period were analyzed separately and in combination with our preliminary study (January 2000 to December 2005) for a 10-year analysis (January 2000 to December 2009). The primary outcome was incidence of vaginal cuff dehiscence after total laparoscopic hysterectomy compared with abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy (LAVH). RESULTS: Between 2006 and 2009, the overall incidence of dehiscence was 0.39% (95% confidence interval [CI] 0.21–0.56). The incidence after total laparoscopic hysterectomy was 0.75% (95% CI 0.09–1.4), which was the highest among all modes of hysterectomy (LAVH was 0.46% [95% CI 0.0–1.10]; total abdominal hysterectomy was 0.38% [95% CI 0.16–0.61]; and total vaginal hysterectomy was 0.11%, [95% CI 0.0–0.32]). This incidence was appreciably lower than previously reported (4.93% in 2007 publication, 2.76% readjusted calculation). The 10-year cumulative incidence of dehiscence after all modes of hysterectomy was 0.24% (95% CI 0.15–0.33) and 1.35% (95% CI 0.72–2.3) among total laparoscopic hysterectomies. During the 10-year study period, total laparoscopic hysterectomy-related dehiscence was significantly increased compared with other modes of hysterectomy, with a risk ratio of dehiscence after total laparoscopic hysterectomy of 9.1 (95% CI 4.1–20.3) compared with total abdominal hysterectomy, risk ratio of 17.2 (95% CI 3.9–75.9) compared with total vaginal hysterectomy, and risk ratio of 4.9 (95% CI 1.1–21.5) compared with LAVH. CONCLUSION: Our updated 1.35% incidence of dehiscence after total laparoscopic hysterectomy is much lower than previously reported. LEVEL OF EVIDENCE: II

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