Vaginal Cuff Dehiscence After Endometriosis Surgery

BACKGROUND AND OBJECTIVES: Laparoscopic hysterectomy is one of the surgical treatment options for endometriosis. A rare complication of this surgical procedure is vaginal cuff dehiscence, with an incidence of 0.03% to 0.30%. Sexual intercourse may be the main triggering event. It is unclear if patients with endometriosis are more prone to develop vaginal cuff dehiscence than other women undergoing laparoscopic hysterectomy. METHODS: We present the cases of women aged 35 to 46 years who underwent laparoscopic endometriosis surgery. In all patients the vaginal cuff was opened with a high-energy surgical device and closed with an absorbable suture. After 60 to 194 d, the patients developed symptoms including acute abdominal pain and fever shortly after or during coitus and were diagnosed with vaginal cuff dehiscence. RESULTS: Patients undergoing surgical treatment for endometriosis may experience poor wound healing of the vaginal cuff due to the frequent use of gonadotrophin-releasing hormone analogues before surgery. Contributing to this may be the use of a high-energy surgical device when opening the vaginal cuff. Resuming sexual activities before proper healing of the wound has occurred may then trigger vaginal cuff dehiscence. CONCLUSION: Women with endometriosis might be prone to develop vaginal cuff dehiscence, not because of the endometriosis itself but because of a combination of patient-specific factors present in women with endometriosis. Surgeons treating women with endometriosis should be aware of this.