The Risk of Vaginal Cuff Dehiscence with Different Suture Types Following Endoscopic Hysterectomy

Abstract

Study Objective To evaluate the rate of vaginal cuff dehiscence (VCD) after endoscopic hysterectomy using absorbable vs delayed absorbable suture. Design Retrospective cohort study. Setting Academic center, Mayo Clinic Phoenix, Arizona. Patients or Participants 586 consecutive patients undergoing endoscopic hysterectomy (499 robotic, 87 laparoscopic) with a specific cuff closure technique. Interventions Specific vaginal cuff closure technique with delayed absorbable (PDS and V-loc) or absorbable (Vicryl) suture. Measurements and Main Results The mean age was 50.8 years (SD 12.6) with a mean BMI of 30 kg/m2 (SD 8.4). Most patients were premenopausal (59%) and 4.6% were on or had previously received chemotherapy. Of the hysterectomies performed, 75% were for benign indications, 94.5% were simple hysterectomies and 5.5% were radical or modified radical hysterectomies. Mean estimated blood loss was 93.4 ml (SD 137.7ml). Vicryl was used in 152 patients, PDS in 161 patients and V loc in 273 patients. The 3 groups were similar in demographics except for uterine pathology (benign in 80.9% vs. 72.7% vs 73.2% respectively, p= 0.038), median blood loss (115.7 (SD 134.7) vs 87.9 (SD= 90.5) vs 96.9 (SD 161.2) ml respectively, p= 0.034). After a mean follow up period of 586.6 days (SD 725.7), vaginal cuff dehiscence occurred in 1.2% of patients (2.6% Vicryl, 0.6% PDS and 0.7% V loc, p= 0.165). VCD rate with delayed absorbable suture (PDS or V loc) vs absorbable suture (Vicryl), was 0.7% vs. 2.6%, p= 0.058. respectively. Logistic regression analysis revealed younger age and lower BMI are risk factors for VCD (OR: 0.91 95% CI 0.83-0.99 vs OR 0.76, 95% CI 0.61-0.94 respectively). Conclusion Delayed absorbable suture is preferable for vaginal cuff closure at endoscopic hysterectomy as compared to absorbable suture. Risk factors for vaginal cuff dehiscence are younger age and lower BMI.