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Definition

A vaginal cuff is made when the upper part of the vagina is stitched shut. It is done after the cervix and uterus are removed. The cuff can reopen. A vaginal cuff repair is done to fix the cuff.

Reasons for Procedure

The cuff may be damaged or reopen because of:

  • Problems after surgery such as infection, injury, or a buildup of blood under the skin
  • Health problems that put strain on the belly such as constipation or coughing
  • Cancer
  • Pelvic organ prolapse
  • Having sex

An open cuff can lead to complications. The most serious one is when intestines push out through open cuff. A repair would prevent this.


Possible Complications

Problems are rare, but all procedures have some risk. Your doctor will go over some possible problems such as:

  • Bleeding
  • Infection
  • Damage to nearby organs
  • Blood clots

The risk of problems is higher if you:

  • Smoke
  • Drink
  • Have long term diseases such as diabetes or obesity

What to Expect

Prior to Procedure

Leading up to the procedure:

  • Talk to your doctor about the medicines you take. You may be asked to stop taking some medicines up to 1 week in advance.
  • Arrange for a ride home from the hospital.
  • Do not eat or drink anything after midnight before the procedure.

Anesthesia

General anesthesia will be used. You will be asleep.


Description of the Procedure

The procedure can be done 1 of 3 ways:


Open

A cut is made in the lower belly. The doctor will be able to see the cuff. The cuff will be closed with stitches. The belly will then be closed with stitches, staples, or glue. A bandage will be placed over the wound.


Laparoscopic

Small cuts are made in the belly. Special tools are placed into the cuts. One will send images to a screen in the room so the doctor can see the area. Other tools will be used to repair the cuff. The tubes will be removed. The holes are sealed and bandaged.


Vaginal

There are no cuts needed with this method. Special tools are passed through the vagina. One will send images to a screen in the room so the doctor can see the area. The cuff will be closed with stitches.


The doctor will also look for any damage to other tissue in the area. Intestines may need to be moved back in to place.


How Long Will It Take?

1 to 3 hours


How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. You will be sore for a few days. Medicine can help to manage pain.


Average Hospital Stay

You may need to stay in the hospital for up to 3 days. The length of stay will depend on the type of surgery you had. You may need to stay longer if you have problems.


Post-procedure Care

The care staff will help to manage pain and watch for problems.


Short walks will be encouraged.


During your stay, your care team will take steps to lower your chance of infection such as:

  • Wash their hands.
  • Wear gloves or masks.
  • Keep your incisions covered.

There are also steps you can take to lower your chance of infection such as:

  • Wash your hands often. Remind visitors and your care team to do the same.
  • Remind your care team to wear gloves or masks as needed.
  • Not allowing others to touch your incisions.

Recovery can take up to 6 weeks. Some movement and sexual activity will be limited.


Call Your Doctor

Call your doctor if you have:

  • Signs of infection such as fever or chills
  • Heavy bleeding
  • Pain that is not helped with medicine
  • Redness, swelling, or draining from the incisions
  • Swelling, redness, or pain in your legs

If you think you have an emergency, call for emergency medical services right away.


RESOURCES

CANADIAN RESOURCES

References

Bleull S, Smith, H, et al. Transvaginal management of vaginal cuff dehiscence with bowel evisceration following delayed diagnosis. Case Rep Obstet Gynecol. 2017;2017:4985382.

Cronin B, Sung VW, et al. Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol. 2012;206(4):284-288.

Hysterectomy. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T116102/Hysterectomy . Updated May 7, 2019. Accessed May 22, 2019.

Matthews CA, Kenton K. Treatment of vaginal cuff evisceration. Obstet Gynecol. 2014;124(4):705-708.

Narducci F, Sonoda Y, et al. Vaginal evisceration after hysterectomy: the repair by a laparoscopic and vaginal approach with a omental flap. Gynecol Oncol. 2003;89(3):549-551.

Suzuki Y, Imai Y, et al. Laparoscopic repair of the vaginal cuff dehiscence: dehiscence occurring after the first sexual intercourse after the laparoscopic modified radical hysterectomy. Clin Case Rep. 2018;6(12):2495-2497.