LAS VEGAS – The risk of vaginal cuff complications was not influenced by the type of hysterectomy performed, although suture technique was a factor, in a retrospective analysis of 604 patients.
"In our study, the intracorporeal cuff suture was superior to the vaginal suture to prevent the vaginal cuff complications of evisceration and dehiscence in total laparoscopic hysterectomy," Dr. Yoon Byoung Kim said at the 41st AAGL Global Congress.
Although vaginal cuff dehiscence is a rare complication of hysterectomy, concerns have been raised that total laparoscopic hysterectomies may be associated with an increased risk of this potentially morbid complication.
Researchers at Beth Israel Deaconess Medical Center recently reported an updated incidence of vaginal cuff dehiscence of 1.35% after total laparoscopic hysterectomy, the highest rate among all hysterectomy modes evaluated (Obstet. Gynecol. 2011;118:794-801). This was dramatically lower, however, than the 4.93% incidence the group reported in a previous study (J. Minim. Invasive Gynecol. 2007;14:311-7).
Dr. Kim and her associates looked at the risk factors for vaginal cuff complications for six types of hysterectomies performed in 604 women between June 2007 and June 2011 at Korea University Anam Hospital, Seoul, Korea. The approach was robotic hysterectomy in 7, robotic radical hysterectomy and node dissection (RRHND) in 9, total laparoscopic hysterectomy (TLH) in 276, laparoscopically assisted vaginal hysterectomy (LAVH) in 238, laparoscopic radical hysterectomy and node dissection (LRHND) in 11, and abdominal radical hysterectomy in 63.
The suture technique was intracorporeal continuous for robotic hysterectomy, RRHND, and LRHND; intracorporeal or vaginal continuous locking for total laparoscopic hysterectomy; vaginal continuous locking for LAVH; and a 5-point suture with figure-8 vaginal suture for abdominal radical hysterectomy. Two TLH patients closed with a 3-point intracorporeal suture and figure-8 vaginal suture were excluded from the TLH analysis.
Among the remaining 274 TLH women, there were 1 case of evisceration and 4 cases of dehiscence with the intracorporeal continuous suture, compared with 0 cases of evisceration and 11 cases of dehiscence with the vaginal continuous locking suture (2.63% vs. 10.47%; P = .02).
In addition, the duration between surgery and the vaginal cuff complication was significantly longer with the intracorporeal suture than the vaginal suture (72.8 days vs. 23.6 days; P = .01), Dr. Kim said.
"The possible reasons for this result can be infection or delicate layering of the submucosal layer," she said.
Among all 604 women, there were 3 eviscerations (0.49%) and 21 cases of dehiscence (3.43%).
The incidence of evisceration was 0% for robotic hysterectomy, 11.1% for RRHND, 0.36% for total laparoscopic hysterectomy, 0% for LAVH, 0% for LRHND, and 1.5% for abdominal radical hysterectomy. The incidence of vaginal dehiscence was 0% for radical hysterectomy, 0% for RRHND, 5.43% for total laparoscopic hysterectomy, 1.68% for LAVH, 0% for LRHND, and 3.17% for abdominal radical hysterectomy.
Although total laparoscopic hysterectomy was associated with a higher incidence of cuff complications, the finding was not statistically significant, Dr. Kim said. Overall, there was no significant correlation between the incidence of cuff complications and the type of operation or suture technique.
The investigators then performed a subgroup analysis that included age, body mass index, operation time, estimated blood loss, postoperative fever, and antibiotic use. None of these risk factors correlated with dehiscence or evisceration (P = 0.99, 0.32, 0.46, 0.32, .06, and 0.42, respectively), Dr. Kim reported.
The limitations of the study were its small sample size, significant heterogeneity, and variation in sample size between groups, she said.
Dr. Kim reported no relevant financial disclosures.