Issues around vaginal vault closure

Abstract

Key content Vaginal cuff dehiscence (VCD), vault prolapse, vaginal cuff granulation and infected vault haematoma are adverse events following hysterectomy. There are several approaches to closing the vaginal cuff, each using different techniques and sutures. Dehiscence of the vaginal cuff is more common with laparoscopic hysterectomy. Techniques that minimise excessive use of diathermy may reduce the risk of vault dehiscence. The incidence of post‐hysterectomy vault prolapse is estimated to be between 1.8% and 11.6%. McCall culdoplasty seems to be effective in supporting the vaginal vault. Different techniques are used to minimise the development of vault haematoma and granulation tissue. Learning objectives To understand the different techniques used for vault closure during hysterectomy. To understand the different surgical approaches used to reduce the risk of vault dehiscence, vault prolapse and haematoma after hysterectomy. To understand the post‐operative care procedure that should be followed after hysterectomy to minimise the risk of vaginal vault complications. Ethical issues Patients should be aware of the risk of vaginal vault dehiscence, vault prolapse, haematoma and granulation tissue formation after hysterectomy. Trainees should be well trained using simulators, be supervised when performing laparoscopic vaginal vault closure and be made aware that vaginal closure is another safe treatment option.