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 a less-invasive vaginal or combined vaginal and laparoscopic approach have been reported.
Technique: Patients are selected for transvaginal repair of vaginal cuff evisceration if there is no clinical evidence of peritonitis or ischemic injury to the prolapsed bowel segment. Under general anesthesia and after administration of intravenous antibiotics, the bowel is copiously irrigated and replaced into the abdomen. The vaginal cuff is sharply debrided of any necrotic tissue, and a full-thickness closure is performed using a delayed absorbable monofilament suture.
Experience: We have successfully managed four cases of vaginal cuff evisceration through a transvaginal approach without intraoperative or postoperative complications.
Conclusion: Vaginal cuff dehiscence and evisceration can be treated by transvaginal bowel reduction and cuff closure when the bowel appears uninjured and there are no signs of peritonitis.