Trends and Risk Factors for Vaginal Cuff Dehiscence After Laparoscopic Hysterectomy

Abstract

Study Objective Primary objective: Assess the effect of the route of vaginal cuff closure on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy. Secondary objectives: Assess patient and surgical risk factors associated with VCD, the rate of intra- and perioperative complications by route of closure, and the impact of surgeon volume on complications. Design Retrospective chart review with case-control component. Setting Tertiary care referral center. Patients or Participants 1277 women underwent laparoscopic (LH) or robotic-assisted (RAH) hysterectomy in 2016 and met inclusion criteria. 26 cases of VCD were identified from 2009 through 2016. Interventions A retrospective comparison of patients with vaginal (VCC) and laparoscopic (LCC) cuff closure undergoing LH and RAH in 2016. Patients with VCD (n=26) were matched by route of cuff closure to the next seven hysterectomies (n=182) which became controls. Measurements and Main Results In 2016, there were 8 cases of VCD (0.63%). There was no difference between LCC=7/988 (0.71%) and VCC 1/289 (0.35%, p=0.49). 7 VCD cases were performed by high volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture (p<0.001). However, there were no significant differences in rates of perioperative complications or surgeon volume between routes of cuff closure. Case-control patients differed in smoking status (p=0.010) and history of prior laparotomy (p=0.017). Logistic regression showed increasing age (OR 0.95, CI 0.91-0.99) and increasing BMI (OR 0.98, CI 0.83-0.97) were protective for VCD. Conclusion VCD is a rare but serious complication of laparoscopic hysterectomy. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend surgeons employ the closure technique they are best accustomed with to optimize patient outcomes. Primary objective: Assess the effect of the route of vaginal cuff closure on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy. Secondary objectives: Assess patient and surgical risk factors associated with VCD, the rate of intra- and perioperative complications by route of closure, and the impact of surgeon volume on complications. Retrospective chart review with case-control component. Tertiary care referral center. 1277 women underwent laparoscopic (LH) or robotic-assisted (RAH) hysterectomy in 2016 and met inclusion criteria. 26 cases of VCD were identified from 2009 through 2016. A retrospective comparison of patients with vaginal (VCC) and laparoscopic (LCC) cuff closure undergoing LH and RAH in 2016. Patients with VCD (n=26) were matched by route of cuff closure to the next seven hysterectomies (n=182) which became controls. In 2016, there were 8 cases of VCD (0.63%). There was no difference between LCC=7/988 (0.71%) and VCC 1/289 (0.35%, p=0.49). 7 VCD cases were performed by high volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture (p<0.001). However, there were no significant differences in rates of perioperative complications or surgeon volume between routes of cuff closure. Case-control patients differed in smoking status (p=0.010) and history of prior laparotomy (p=0.017). Logistic regression showed increasing age (OR 0.95, CI 0.91-0.99) and increasing BMI (OR 0.98, CI 0.83-0.97) were protective for VCD. VCD is a rare but serious complication of laparoscopic hysterectomy. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend surgeons employ the closure technique they are best accustomed with to optimize patient outcomes.