ABSTRACT Vaginal vault dehiscence, a surgical emergency, is a rare complication of hysterectomy that can occur a few weeks, several months, or years after the operation. Its incidence in several studies ranged from 0.03% to 0.3%. There is relatively little detailed information on predisposing factors for vault dehiscence and its manifestation after hysterectomy. This retrospective case series and literature review evaluated factors predisposing to vault dehiscence after hysterectomy and its manifestation. A total of 54 cases of vault dehiscence were identified: 16 were unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy obtained from 5 physicians participating in the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and 38 cases were found in an English-language literature search (group B). Participating physicians completed a detailed questionnaire containing demographic data, indications and type of hysterectomy, operative procedure, predisposing factors, and potential triggering factors for dehiscence. The literature search was conducted in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews using the keywords ‘‘vault dehiscence,” ‘‘vaginal vault dehiscence,” ‘‘vault prolapse,” and ‘‘hysterectomy.” The data for groups A and B were analyzed separately and combined. All but one of the vaginal vault dehiscence in group A occurred after laparoscopic hysterectomy. In group B from the literature, 44.7% occurred after abdominal hysterectomy, 34.2% after laparoscopic hysterectomy, and 21.1% after vaginal hysterectomy. In group A, vault dehiscence was diagnosed an average of 3 weeks (3–6.5) after hysterectomy; and, in group B, dehiscence occurred an average of 10.5 weeks (8–16) (P = 0.0007, confidence interval = −9.5 to −4). The majority of vaginal vault dehiscence occurred after sexual intercourse (58.8%), but defecation preceded dehiscence in 8.8% of patients, regular housework in 8.8%, and 14.7% was reported to be spontaneous. The time interval between hysterectomy and vaginal vault dehiscence was significantly shorter after laparoscopic hysterectomy (7 [3–11] weeks) compared with abdominal (13 [8–24] weeks) or vaginal (116 [108–156] weeks) (P = <0.0001, confidence interval = −153.5 to −88). The type of vaginal vault closure after hysterectomy or vault fraction was not significant. The most common symptoms among the 54 combined cases were bleeding (50% and bowel prolapse [48.1%]). These findings suggest that vaginal vault dehiscence occurs more frequently after the laparoscopic procedure than after other hysterectomy techniques. Other predisposing risk factors include early resumption of sexual intercourse and regular activities before healing is complete.