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Vaginal Cuff Dehiscence After Endometriosis Surgery
Zoë Boersen1, Catharina Ida Maria Aalders1, Eleonore Rosalinde Klinkert2
1Department of Obstetrics and Gynecology, Rijnstate Hospital, the Netherlands.
Summary
Women undergoing laparoscopic hysterectomy for endometriosis may face a higher risk of vaginal cuff dehiscence. This complication, often triggered by sexual activity, may be linked to factors associated with endometriosis and its treatment.
Area of Science:
- Gynecologic surgery
- Reproductive medicine
- Surgical complications
Background:
- Laparoscopic hysterectomy is a treatment for endometriosis.
- Vaginal cuff dehiscence is a rare complication (0.03%-0.30%).
- Sexual intercourse is a potential trigger for dehiscence.
Observation:
- Case series of women aged 35-46 undergoing laparoscopic endometriosis surgery.
- Vaginal cuff opened with a high-energy device and closed with absorbable suture.
- Symptoms of dehiscence (abdominal pain, fever) occurred 60-194 days post-surgery, often during or after intercourse.
Findings:
- Endometriosis patients may have impaired vaginal cuff wound healing, potentially due to pre-surgery gonadotrophin-releasing hormone analogue use.
- Use of high-energy devices for cuff opening may contribute to poor healing.
- Resuming sexual activity before complete healing increases dehiscence risk.
Implications:
- Women with endometriosis may be predisposed to vaginal cuff dehiscence due to patient-specific factors, not solely the condition.
- Surgeons should consider these factors when managing patients with endometriosis undergoing hysterectomy.
- Awareness and careful post-operative management are crucial to prevent this complication.
