Treatment of Vaginal Cuff Evisceration

  title={Treatment of Vaginal Cuff Evisceration},
  author={Catherine Ann Matthews and Kimberly S. Kenton},
  journal={Obstetrical \& Gynecological Survey},
BACKGROUND: Laparoscopic and robotic-assisted hysterectomies are associated with higher rates of vaginal cuff dehiscence and evisceration than are open and vaginal hysterectomies. With the rising prevalence of minimally invasive hysterectomy, gynecologists should know how to manage this rare but potentially serious condition. Urgent laparotomy historically was recommended for management of vaginal cuff evisceration to allow for complete bowel evaluation. More recently, successful outcomes using… 
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A 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence is presented, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy.
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Treatment of vaginal cuff evisceration.
If transvaginal closure proves to be curative when a complication such as evisceration is to be treated, it is questioned by the scientific community as to why it should not be regarded as a safe and effective option at the end of laparoscopic hysterectomy.
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The initial physical examination showed some redness to the bowel serosa that was concerning for possible bowel compromise, and Natural orifice transluminal endoscopic surgery through the vaginal orifice can further optimize the approach to surgery by also examining the abdominal contents directly and safely.


Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?
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Robotic total laparoscopic hysterectomy may be associated with increased risk of vaginal cuff dehiscence and small bowel evisceration, because of thermal spread and cuff tissue damage from electrosurgery used for colpotomy.
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Vaginal cuff dehiscence should be considered in patients with vaginal bleeding and sudden watery discharge after robotic cuff closure, similar as previously reported for laparoscopic procedures.
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