Original Article
Histologic Characteristics of Vaginal Cuff Tissue From Patients With Vaginal Cuff Dehiscence

Presented as an oral poster at the 39th Annual Meeting of the Society of Gynecologic Surgeons, Charleston, South Carolina, April 8, 2013.
https://doi.org/10.1016/j.jmig.2013.11.013Get rights and content

Abstract

Study Objective

To describe the histologic characteristics of vaginal tissue in patients with vaginal cuff dehiscence (VCD) after robotic hysterectomy and to compare this group with patients without dehiscence.

Design

Retrospective analysis (Canadian Task Force classification II-3).

Setting

Academic center.

Patients

Seven patients with VCD and 6 patients without VCD.

Interventions

Vaginal cuff tissue was obtained from all patients and was stained using hematoxylin-eosin and evaluated for acute and chronic inflammation markers including neutrophils, lymphocytes, and plasma cells. Immunohistochemical staining was performed and evaluated using the semiquantitative method for collagen types I and III, smooth muscle actin, and SM22α (myofibroblast) content. Grading was performed by 4 blinded investigators. The Mann-Whitney test was used to evaluate the 2 groups, and correlation coefficients for interobserver variability.

Measurements and Main Results

The VCD group, compared with the non-VCD group, demonstrated significantly greater numbers of neutrophils (1.71 vs 1.0; p = .04), lymphocytes (2.85 vs 1.33; p = .002), and plasma cells (2.2 vs 1.0; p = .001). There was no statistical difference between the groups in amounts of collagen I (1.71 vs 1.27; p = .09) and collagen III (1.66 vs 1.38; p = .37), smooth muscle actin (1.23 vs 1.33; p = .65), and SM22α (1.85 vs 1.27; p = .09). Interobserver variability was low (κ = 0.86; p = .76).

Conclusion

Compared with the control group, patients with VCD demonstrated significantly higher levels of acute and chronic inflammatory cells. This finding suggests that a prolonged inflammatory phase may be delaying normal progression to reparation in patients with dehiscence.

Section snippets

Materials and Methods

Twenty-one patients had VCD after robotic hysterectomy performed from 2006 to 2009 [2]. All of the original robotically assisted hysterectomies were performed using monopolar scissors or a spatula for colpotomy. Further, no adhesion barrier materials were used. During repair of dehiscence, distal portions of the anterior and posterior cuff were excised using a cold knife or scissors. Seven of these vaginal cuff tissue samples in paraffin-embedded blocks were identified from the Pathology

Results

Patients in the VCD and non-VCD groups were similar in age, body mass index, menopausal status, smoking status, and history of receiving hormone replacement therapy. All patients in the study group had vaginal cuff dehiscence after 6 weeks (range, 42–85 days) (Table 1). None of the patients in the VCD group had clinical evidence of hematoma, postoperative vaginal cuff cellulitis, or abscess.

Patients with VCD had significantly higher levels of acute and chronic inflammatory cells: neutrophils

Discussion

After injury, normal wound healing starts systematically with the process of hemostasis and immediate infiltration of neutrophils and macrophages. Lymphocytes migrate to the wound site within 24 hours to clear debris and produce cytokines, which attract fibroblasts and endothelial cells to initiate granulation tissue formation [6]. At 2 to 3 days after injury, the healing cycle changes from a predominantly inflammatory state to a reparative state. Timely progression of wound healing is highly

Acknowledgments

We thank Thomas Colby, MD, for reviewing the slides.

References (21)

There are more references available in the full text version of this article.

Supported by Mayo Clinic Arizona CR5 grant (Internal Grant Funding).

The authors declare no conflicts of interest.

Dr. Klauschie is currently affiliated with Academic Urology and Urogynecology of Arizona, Sun City West, Arizona.

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