Recent reviews describe a disproportionate number of vaginal cuff dehiscences occurring after total laparoscopic hysterectomy TLH , suggesting that vaginal cuff dehiscence may be a more common complication of laparoscopic hysterectomy than TAH or TVH. Sacral colpopexy for vaginal vault prolapse. Until the date, no method appears to be preferable in absolute terms with respect to another. Since its approval by the Food and Drug Administration in , robotic surgery has increased in popularity and volume for both benign and malignant gynecological procedures. Initially, leakage from the vagina may be confused from peritoneal fluid that leaks from the vaginal cuff. The main difference between these sutures is the lack of knot-tying required with use of barbed suture as, theoretically, tension is controlled across tissue when the barbs are locked into place.
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Pelvic Organ or Vaginal Prolapse

Although cuff dehiscence can occur after defecation or sexual intercourse, most cases appear spontaneously. Beginning at the 12 o'clock position, a full-length, long-acting absorbable or permanent suture is placed through the anterior peritoneum Fig. A vesicovaginal fistula is a hole between the bladder and vagina. In our case series, only one patient had an identifiable precipitating event: Knots were tied intracorporeally.
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Vaginal cuff | Radiology Reference Article |

At our hospitals and clinics, we help them move from difficult diagnoses toward brighter, healthier futures. If the intact uterosacral ligaments can be picked up in the Halban-type suture, this will add strength to the closure. She was discharged home after completing 24 hours of broad-spectrum IV antibiotics and advised to delay resumption of vaginal intercourse for 3 months. In some cases, the primary indication for hysterectomy is symptomatic pelvic relaxation. Hysterectomy permits the surgeon to visualize and use the supportive structures, attaching them to the vaginal membrane. Preoperative Considerations Any woman with vaginal prolapse that is bothering them usually high stage and who has either tried or considered a pessary, is a candidate for the above described procedures. Because one would expect dissolution of absorbable suture and complete wound reapproximation by this time, we suggest that patients with delayed VCD may have other predisposing risk factors.
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The available studies in literature recommend that none of the abdominal, vaginal or laparoscopic approach for VCD repair is superior to each other. Closing the cul-de-sac and peritoneal cavity during vaginal hysterectomy. At the time of increased intra-abdominal pressure, the levator plate and endopelvic fascia especially the cardinal-uterosacral complex hold the cervix and upper vagina in their proper positions. Two women underwent robotic total laparoscopic hysterectomy for menorrhagia and stage I endocervical adenocarcinoma, respectively. Vaginal cuff dehiscence with small bowel evisceration after hysterectomy is a rare event that may be occurring more frequently with the advent of robotic laparoscopic hysterectomies. She had no prior abdominal or pelvic surgeries. Several modifications to abdominal sacrocolpopexy have been proposed, but this discussion is limited to a single modification of two of them.
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