Successful Management of Vaginal Cuff Dehiscence With Peritonitis by Elective Laparoscopic-Assisted Repair: A Case Report.

Abstract

Vaginal cuff dehiscence (VCD) is a rare complication of total laparoscopic hysterectomy (TLH); the incidence rate has been reported to be 1.27%. However, a definitive treatment strategy has not yet been established. To our knowledge, we report the first case of VCD that was successfully managed with elective laparoscopic-assisted vaginal repair following initial conservative antibiotic therapy. A 39-year-old woman presented with abdominal pain four months after TLH. She was diagnosed with a 2-cm VCD accompanied by abscess leakage and peritonitis. After confirming the absence of bowel evisceration, she was initially treated with intravenous antibiotics for seven days. After achieving infection control, a laparoscopic-assisted transvaginal repair was successfully carried out. The patient's postoperative course was uneventful, and no recurrence was observed at the 3-month follow-up. For VCD complicated by peritonitis but without bowel evisceration, performing elective repair after controlling the infection with antibiotics can be considered a safe and effective management strategy.