Management of Vaginal Vault Dehiscence after Laparoscopic Hysterectomy

Abstract

<h3>Study Objective</h3> To review the epidemiology, diagnosis and management of vaginal vault dehiscence, and to illustrate a 5-step surgical approach to laparoscopic vault repair. <h3>Design</h3> Surgical footage was obtained from an emergency case after appropriate consent from the patient. <h3>Setting</h3> A tertiary care centre. <h3>Patients or Participants</h3> A 34-year-old female who presented 8 weeks after a total laparoscopic hysterectomy with a complete vault dehiscence. <h3>Interventions</h3> Vaginal vault dehiscence complicates 0.64% to 1.35% of laparoscopic hysterectomies, and can be categorized as complete cuff dehiscence, partial cuff dehiscence or partial thickness. Protective factors include the use of barbed sutures as compared to non-barbed sutures and laparoscopic closure as compared as compared to vaginal closure. Smoking and low BMI have been associated with an increased risk of dehiscence. <h3>Measurements and Main Results</h3> The surgical approach to a laparoscopic repair of cuff dehiscence can be standardized in 5 reproducible steps: abdominal survey, bladder and/or rectal dissection, vault debridement, vault closure and cystoscopy. <h3>Conclusion</h3> Vaginal vault dehiscence being uncommon, residents may graduate without being exposed to a case. This video represents an educational tool that covers the clinical and surgical approaches to the reproducible management of vaginal vault dehiscence.