Decreased Incidence of Vaginal Cuff Dehiscence after Laparoscopic Closure with Bidirectional Barbed Suture

Abstract

Study Objective To estimate whether a new surgical technique is associated with lower incidence of postoperative breakdown of the vaginal cuff after laparoscopic hysterectomy or trachelectomy, compared with previous methods of closure. Design Retrospective cohort study, Canadian Task Force Classification II-3. Setting Tertiary-care university-based teaching hospital. Patients Patients who underwent laparoscopic vaginal closure after removal of the uterus and/or cervix by members of a subspecialty gynecologic laparoscopy division from January 2007 to January 2010 (n = 387). Interventions Use of bidirectional barbed suture for laparoscopic vaginal cuff closure. Measurements and Main Results A total of 387 patient records were reviewed. The incidence of vaginal cuff dehiscence among those with other methods of closure was 4.2%, while there were no cases of dehiscence among those who had closure with bidirectional barbed suture (p = .008). Postoperative bleeding (OR 2.3, 95% C.I. 1.3–3.9), presence of granulation tissue (OR 1.9, 95% C.I. 0.92–3.9), and cellulitis (OR 4.6, 95% C.I. 1.0–21.1) all occurred more frequently in patients without barbed suture closure. Conclusion Dehiscence of the vaginal cuff after laparoscopic closure is a rare but important complication in gynecologic surgery. Use of bidirectional barbed suture eliminated the problem in our first year of experience with the technique. We also observed a decreased incidence of other common problems of the vaginal cuff. This method is easy to learn and inexpensive and does not require advanced skills such as laparoscopic knot-tying.