The purpose of our study was to evaluate factors predisposing vault dehiscence after
hysterectomy and its manifestation.
Case series and review of the literature (Canadian Task Force classification II-3).
Retrospective analysis of 16 unpublished cases of vaginal vault dehiscence after total
laparoscopic hysterectomy from physicians who participated in the exchange on the
topic of vaginal vault dehiscence at the American Association of Gynecologic Laparoscopists
Endo Exchange List (group A) and review of 38 reported cases in the literature (group
The participating physicians were asked to complete a detailed questionnaire related
to vault dehiscence. In addition, we performed literature search using the keywords
"vault dehiscence," "vaginal vault dehiscence," "vault prolapse," and "hysterectomy,"
and conducted the search in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews.
We estimated risk factors and characteristic features for vaginal vault dehiscence.
The incidence of vault dehiscence was higher after laparoscopic hysterectomy (1.14%)
than after abdominal hysterectomy (0.10%, p <.0001, OR 11.5) and after vaginal hysterectomy
(0.14%, p <.001, OR 8.3). The time interval between hysterectomy and occurrence of
vault dehiscence in the laparoscopic group (8.4 +/- 1.2 weeks) was significantly shorter
than in the abdominal hysterectomy (112.7 +/- 75.1 weeks, p = .01) and in vaginal
hysterectomy (136.5 +/- 32.2 weeks, p <.0001) groups, respectively. It appears that
sexual intercourse was the main triggering event for vault dehiscence (58.8%). Vaginal
bleeding (50%) and vaginal evisceration (48.1%) were the main symptoms.
Our data suggest that vaginal vault dehiscence is rare but may occur more often after
laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is
related to the technique of laparoscopic suturing is unclear. Other risk factors such
as early resumption of regular activities and sexual intercourse may play a role.