Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener).
Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener).
J Minim Invasive Gynecol. 2021 May;28(5):991-999.e1. doi: 10.1016/j.jmig.2020.09.005. Epub 2020 Sep 11.
The primary objective was to assess the effect of the route of closure of the vaginal cuff on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy (LH). The secondary objective was to assess patient- and surgical-risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications.
Retrospective chart review with case-control component.
Tertiary care center (main hospital and regional hospitals).
A total of 1278 women underwent LH or robot-assisted hysterectomy in 2016, and met the inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016.
A retrospective comparison of patients with vaginal cuff closure and laparoscopic cuff closure (LCC) undergoing LH or robot-assisted hysterectomy in 2016. Patients with VCD from 2009 through 2016 (n = 26) were matched by route of cuff closure to the next 7 patients who underwent hysterectomies (n = 182), who became controls.
In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC (8/989; 0.81%) and vaginal cuff closure (1/289; 0.35%; p = .41). Seven VCD cases were performed by high-volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in the rates of perioperative complications or surgeon volume between routes of cuff closure. The case-control patients differed in smoking status (p = .010) and history of prior laparotomy (p = .017). Logistic regression showed that increasing age (odds ratio 0.95; 95% confidence interval, 0.91-0.99) and increasing body mass index (odds ratio 0.98; 95% confidence interval, 0.83-0.97) were protective for VCD.
VCD is a rare but serious complication of LH. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend that, to optimize patient outcomes, surgeons employ the closure technique that they are best accustomed to.
本研究的主要目的是评估阴道残端闭合路径对腹腔镜子宫切除术（LH）中阴道残端裂开（VCD）发生率的影响。次要目的是评估与 VCD 相关的患者和手术风险因素、闭合路径的围手术期并发症发生率以及外科医生手术量对并发症的影响。
回顾性图表审查与病例对照部分。
三级保健中心（主要医院和区域医院）。
共有 1278 名女性于 2016 年接受 LH 或机器人辅助子宫切除术，符合纳入标准。独立地，从 2009 年至 2016 年期间确定了 26 例 VCD。
2016 年对接受 LH 或机器人辅助子宫切除术的阴道残端闭合和腹腔镜残端闭合（LCC）患者进行回顾性比较。2009 年至 2016 年期间发生 VCD 的患者（n=26）根据袖口闭合路径与下 7 例接受子宫切除术的患者（n=182）相匹配，成为对照组。
2016 年，有 9 例 VCD（0.70%）。LCC（8/989；0.81%）和阴道残端闭合（1/289；0.35%；p=0.41）之间 VCD 无显著差异。7 例 VCD 患者由高容量外科医生（每年进行>30 例子宫切除术）进行手术，他们更可能进行 LCC 并使用带刺缝线。袖口闭合路径之间的围手术期并发症或外科医生手术量无显著差异。病例对照患者的吸烟状况（p=0.010）和既往剖腹手术史（p=0.017）存在差异。逻辑回归显示，年龄增加（优势比 0.95；95%置信区间，0.91-0.99）和体重指数增加（优势比 0.98；95%置信区间，0.83-0.97）是 VCD 的保护因素。
VCD 是 LH 的一种罕见但严重的并发症。尽管有先前的研究，但我们没有发现 VCD 或围手术期并发症的发生率因袖口闭合路径或外科医生手术量的不同而有显著差异。鉴于没有证据支持一种袖口闭合路径，我们建议外科医生为了优化患者结局，采用他们最熟悉的闭合技术。
