Evaluation of Perioperative Factors Influencing Vaginal Cuff Dehiscence After Minimally Invasive Hysterectomy [ID: 1372339

Abstract

INTRODUCTION: Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22). CONCLUSION: We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.