Authors’ response

Abstract

We appreciated the interesting comments of Uccella et al. about our paper [ [1] Ceccaroni M. Berretta R. Malzoni M. et al. Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study. Eur J Obstet Gynecol Reprod Biol. 2011; 158: 308-313 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar ]. As previously stated, different aspects can play a role in the genesis of vaginal cuff dehiscence, such as vault infections, wound hematoma, resumption of sexual activity before complete healing, advanced age, previous radiation therapy, chronic steroid administration and trauma [ [2] Iaco P.D. Ceccaroni M. Alboni C. et al. Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?. Eur J Obstet Gynecol Reprod Biol. 2006; 125: 134-138 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar ]. Uccella et al. underlined that the route by which colporrhaphy is performed represents an important factor influencing the risk of dehiscence. In a retrospective review, the authors reported that laparoscopic and robotic vault sutures showed a higher risk of dehiscence when compared with the trans-vaginal approach [ [3] Uccella S. Ghezzi F. Mariani A. et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. 2011; (March) [Epub ahead of print] Google Scholar ]. Moreover, in this series, the vaginal route not only seemed to allow better results but also was shown to be an easier procedure compared with laparoscopic colporrhaphy. Deep rectal and parametrial infiltrating endometriosis with monolateral pudendal nerve involvement: case report and laparoscopic nerve-sparing approachEuropean Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 153Issue 2PreviewWe report a case of a 32-year-old woman, referred to our unit for pelvic pain syndrome with severe constipation, dyschezia, dysmenorrhea and ano-genital pain refractory to hormonal and opioid therapy. The patient reported catamenial irradiation of pelvic pain to the right ano-genital region and to her right leg, with impaired motility and sensitivity during pain peaks. Pain was evaluated using a visual analogue scale (VAS) [1], which showed unbearable dyschezia (VAS score = 10), severe dysmenorrhea (VAS score = 8) and right pudendal neuralgia (VAS score = 9). Full-Text PDF Vaginal cuff dehiscence after laparoscopic hysterectomyEuropean Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 161Issue 1PreviewWe read with much attention the very interesting paper by Ceccaroni et al. entitled “Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study” [1]. The article evaluates different important features of vaginal evisceration after hysterectomy (i.e. time of onset, trigger event, presenting symptoms). Among the other strengths, the article has the merit to present data from a large population (more than 8000 patients), and to stress the difference between the various approaches to hysterectomy, in terms of risk of vaginal cuff dehiscence. Full-Text PDF