Vaginal Cuff Dehiscence Rates by Mode of Hysterectomy: An Update

Abstract

<h3>Study Objective</h3> To report vaginal cuff dehiscence rates by mode of hysterectomy as the surgical landscape has shifted towards minimally invasive approaches. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Large academic medical center and affiliated community hospital. <h3>Patients or Participants</h3> 4722 patients who underwent hysterectomy for benign and malignant indications between January 2010 and August 2021. <h3>Interventions</h3> Hysterectomy patients and vaginal cuff dehiscences were identified by ICD and CPT codes. <h3>Measurements and Main Results</h3> There were 663 supracervical hysterectomies and 4059 total hysterectomies identified (1360 robot-assisted total laparoscopic hysterectomies [RA-TLH, 28.8%], 1107 total abdominal hysterectomies [TAH, 23.4%], 938 total laparoscopic hysterectomies [TLH, 19.9%], 498 total vaginal hysterectomies [TVH, 10.5%], and 156 laparoscopic-assisted vaginal hysterectomies [LAVH, 3.3%]). Supracervical hysterectomies were excluded from analysis. Among 4059 total hysterectomies, there were 15 vaginal dehiscences (0.37%). The dehiscence rate was highest after RA-TLH at 0.66% (n=9), followed by TLH at 0.32% (n=3), and TAH at 0.27% (n=3), with no dehiscences after TVH or LAVH; these differences were not statistically significant (<i>p</i>=0.31). Compared to TAH, the relative risk for dehiscence after RA-TLH was 2.44 (95% CI 0.66 – 9.00), and after TLH was 1.18 (95% CI 0.24 – 5.83), which were also not statistically significant. Patient characteristics were reviewed including age, hysterectomy indication, colpotomy type, suture type, medical comorbidities, and presentation. The mean time to dehiscence was 39 days (range 8 – 145). The most common trigger event was coitus (41%). Most dehiscences followed benign hysterectomies (88%). <h3>Conclusion</h3> Our study offers the largest representation of robotic hysterectomies to date. Although dehiscence rates were higher after laparoscopic hysterectomy (RA-TLH 0.66%, TLH 0.32%) compared to abdominal hysterectomy (TAH 0.27%), the differences were not significant. Our 0.66% RA-TLH dehiscence rate is much lower than previously reported in large studies (1.6 – 4.1%). While broad conclusions are limited, dehiscences are overall rare (0.37%). More research is needed to evaluate factors responsible for increased risk.