Vaginal Vault Dehiscence After Hysterectomy
Notice bibliographique
Résumé
Vaginal vault dehiscence, a surgical emergency, is a rare complication of hysterectomy that can occur a few weeks, several months, or years after the operation. Its incidence in several studies ranged from 0.03% to 0.3%. There is relatively little detailed information on predisposing factors for vault dehiscence and its manifestation after hysterectomy. This retrospective case series and literature review evaluated factors predisposing to vault dehiscence after hysterectomy and its manifestation. A total of 54 cases of vault dehiscence were identified: 16 were unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy obtained from 5 physicians participating in the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and 38 cases were found in an English-language literature search (group B). Participating physicians completed a detailed questionnaire containing demographic data, indications and type of hysterectomy, operative procedure, predisposing factors, and potential triggering factors for dehiscence. The literature search was conducted in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews using the keywords ‘‘vault dehiscence,” ‘‘vaginal vault dehiscence,” ‘‘vault prolapse,” and ‘‘hysterectomy.” The data for groups A and B were analyzed separately and combined. All but one of the vaginal vault dehiscence in group A occurred after laparoscopic hysterectomy. In group B from the literature, 44.7% occurred after abdominal hysterectomy, 34.2% after laparoscopic hysterectomy, and 21.1% after vaginal hysterectomy. In group A, vault dehiscence was diagnosed an average of 3 weeks (3–6.5) after hysterectomy; and, in group B, dehiscence occurred an average of 10.5 weeks (8–16) (P = 0.0007, confidence interval = −9.5 to −4). The majority of vaginal vault dehiscence occurred after sexual intercourse (58.8%), but defecation preceded dehiscence in 8.8% of patients, regular housework in 8.8%, and 14.7% was reported to be spontaneous. The time interval between hysterectomy and vaginal vault dehiscence was significantly shorter after laparoscopic hysterectomy (7 [3–11] weeks) compared with abdominal (13 [8–24] weeks) or vaginal (116 [108–156] weeks) (P = <0.0001, confidence interval = −153.5 to −88). The type of vaginal vault closure after hysterectomy or vault fraction was not significant. The most common symptoms among the 54 combined cases were bleeding (50% and bowel prolapse [48.1%]). These findings suggest that vaginal vault dehiscence occurs more frequently after the laparoscopic procedure than after other hysterectomy techniques. Other predisposing risk factors include early resumption of sexual intercourse and regular activities before healing is complete.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».