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Granulation Tissue Formation at the Vaginal Cuff after Total Laparoscopic Hysterectomy or Davinci Assisted Total Hysterectomy with Uterosacral Ligament Colpopexy for Surgical Correction of Pelvic Organ Prolapse

2011; Elsevier BV; Volume: 18; Issue: 6 Linguagem: Inglês

10.1016/j.jmig.2011.08.563

1553-4669

Ali Azadi, Lioudmila Lipetskaia, Taraneh Yeganeh, Sylvina Tate, Sergio Diaz,

Uterine Myomas and Treatments

The aim of this study was to look at the prevalence of vaginal cuff granulation tissue formation after total laparoscopic hysterectomy or Davinci assisted total hysterectomy with laparoscopic uterosacral ligament colpopexy. This is a retrospective chart review of cohort of patients who underwent surgery for pelvic organ prolapse by one surgeon in a tertiary care center from January 2005 to December 2010. Patients' demographics as well as intra-operative information such as estimated blood loss, uterine weight, patient's age, BMI, smoking, any concomitant surgeries, complications, any significant past medical history was obtained by reviewing the medical records. 110 patients were found to have total laparoscopic hysterectomy or Davinci Assisted Total Hysterectomy with Uterosacral ligament colpopexy. Absorbable, braided suture (Vicryl)®was used for vaginal cuff closure and non-absorbable braided suture (Ethibond)® was used for colpopexy. Seven patients noted to form vaginal cuff suture granuloma (6.4%). Three patients were asymptomatic and one patient complained of vaginal bleeding. Three other patients complained of both vaginal bleeding and discharge. Only one patient required treatment in the operating room for excision of the lesion as well as thermal coagulation and all the other patients were treated at the office by chemical coagulation by application of silver nitrate. Three out of seven patients who developed granulation tissue had diabetes mellitus (42%) compared to 17% in patients who did not form granulation tissue (p value 0.126). Vaginal cuff granulation tissue is a common finding after laparoscopic hysterectomies and laparoscopic uterosacral ligament colpopexy using permanent sutures (Ethibond)®. The lower incidence of forming granulation tissue compare to historical data may be secondary to the placement of suture knot, which will be placed intraperitoneally and therefore causes less exposure of vaginal epithelium to the suture material. Diabetes Mellitus may be a risk factor for forming granulation tissue.