Vaginal cuff: Difference between revisions
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'''The vaginal cuff''' is the upper portion of the vagina that opens up into the peritoneum and sutured shut after the removal of the cervix and uterus during a [[hysterectomy]].<ref name="Hoffman_2012" /><ref>{{cite web | url = http://www.medilexicon.com/dictionary/21790 | title = Vaginal Cuff - Medical Definition from MediLexicon | website = www.medilexicon.com | access-date = 2018-01-13 }}</ref> The vaginal cuff is created by suturing together the edges of the surgical site where the cervix was attached to the vagina. This is accomplished by bringing the edges of the vagina together and suturing them together and to the [[Uterosacral ligament|uterosacral ligaments]] to prevent prolapse. The peritoneum is also sewn into the newly created vaginal cuff.<ref name="Hoffman_2012">{{cite book | first1 = Barbara L. | last1 = Hoffman | first2 = J. Whitridge | last2 = Williams | name-list-format = vanc | title = Williams gynecology | date=2012 | publisher = McGraw-Hill Medical | isbn = 978-0-07-171672-7 | edition = 2nd | location = New York | pages = 1054 and 1050 | oclc = 779244257 }}</ref> There may be an advantage to using one method of closure over another.<ref name="Cronin_2012" /> The vaginal cuff has a tendency to partially or completely [[Wound dehiscence|dehisce]] or open up.<ref>{{cite journal | vauthors = Jelovsek JE, Maher C, Barber MD | title = Pelvic organ prolapse | journal = Lancet | volume = 369 | issue = 9566 | pages = 1027–38 | date = March 2007 | pmid = 17382829 | doi = 10.1016/s0140-6736(07)60462-0 }}</ref><ref>{{cite web | first = Michael L. | last = Sprague | name-list-format = vanc | date = January 2016| url = http://www.clevelandclinicmeded.com/live/courses/MIGS/presentations/0131_0730_Closure%20of%20the%20Vaginal%20Cuff_Sprague.pdf | title = Closure of the Vaginal Cuff Following Hysterectomy: Prevention and Management of Dehiscence | website = The Cleveland Clinic }}</ref> A further complication that can accompany the dehiscence of the vaginal cuff is evisceration or the movement of intestines into the vagina.<ref name="Cronin_2012">{{cite journal | vauthors = Cronin B, Sung VW, Matteson KA | title = Vaginal cuff dehiscence: risk factors and management | journal = American Journal of Obstetrics and Gynecology | volume = 206 | issue = 4 | pages = 284–8 | date = April 2012 | pmid = 21974989 | pmc = 3319233 | doi = 10.1016/j.ajog.2011.08.026 }}</ref> Some or all of the vaginal cuff can reopen.<ref name="Hur_2016">{{cite journal | vauthors = Hur HC, Lightfoot M, McMillin MG, Kho KA | title = Vaginal cuff dehiscence and evisceration: a review of the literature | journal = Current Opinion in Obstetrics and Gynecology | volume = 28 | issue = 4 | pages = 297–303 | date = August 2016 | pmid = 27310715 | doi = 10.1097/gco.0000000000000294 }}</ref> |
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The risk of vaginal cuff complications is related to the approach to hysterectomy: robotic-assisted total laparoscopic hysterectomy, total [[laparoscopic hysterectomy]], laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy, and total vaginal hysterectomy.<ref name="Hur_2016" /> |
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The vaginal cuff can be stressed by sexual intercourse, chronic constipation, asthma, [[Chronic obstructive pulmonary disease|COPD]], and other actions that increase intraabdominal pressure. This structure is prone to infection, hematoma and other postoperative complications. Factors that are thought to affect wound healing are radiation treatments, age, pelvic organ prolapse, the use of corticosteroids, concurrent malignancy.<ref name="Hur_2016" /> |
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Though rare, estimates of the prevalence of vaginal cuff dehiscence are difficult to assess due to the presence of only case studies and anecdotal reports.<ref name="Cronin_2012" /> If the vaginal cuff is compromised, vaginal evisceration can occur with the small intestine protruding out through the vagina.<ref name="Cronin_2012" /> |
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== References == |
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Revision as of 03:15, 6 May 2018
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