Issues around vaginal vault closure TOG 2019

Question 1

Which type of hysterectomy has the highest risk of vaginal cuff dehiscence?

Answer 1

Laparoscopic 5%
abdo 0.3%
Vaginal 0.1%

Question 2

How can vaginal cuss dehiscence present?

Answer 2

Vaginal bleeding, discharge, pain and pressure

Question 3

How can reduce risk VCD laproscopicallty?

Answer 3

When incising the vaginal cuff, cut using monopoly current (less thermal spread)
Use sutures rather than electrocoagulation
Closs full thickness of the cuff with 2 layers of PDS 1cm from edge
Bidirectional barbered sutures/delayed absorbing

Question 4

How to manage vaginal cuff dehiscence.

Answer 4

Surgical emergency
Hydration and Abx
Trendelenbury to prevent exposed bowel to become exposed during transfer to theatre
Lavage, debridement and full thickness interrupted sutures

Question 5

What is and how common is vaginal vault prolapse?

Answer 5

<2cm less than TVL

36,000

Question 6

Surgical techniques to prevent vaginal vault prolapse?

Answer 6

Sacrospinout fixation (if vault descends)
McCall culdopolasty
Uterosacral ligament suspension

Question 7

Rate of ureteric injury with uterosacral ligament suspension

Answer 7

11%, especially vaginally

Question 8

How common is vaginal vault haeomatoma after vaginal hysterectomy?

Answer 8

25-59%

Question 9

What ia vaginal vault granulation? After which surgery is it most common?

Answer 9

Granulation tissue at vault

Following abdominal hysterectomy

Presents with copious vaignal discharge, bleeding sometime infection

Question 10

How to manage vaginal vault granulation

Answer 10

2-3 cauterisation, silver nitrate or cryotherapy

Consider rate prolapsed Fallopian tube. Can take Bx