Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH

Water metabolism and postconcussional symptoms 5 weeks after mild head injury

Posttraumatic diabetes insipidus has been reported as a sequela to head injury. It is unknown whether subclinical types of diabetes insipidus, or other types of water metabolism disorders, occur after mild head injury (MHI) and, if so, whether they are related to the persistence of postconcussional symptoms. MHI patients (n = 38) were screened for disturbances of water metabolism by comparing plasma and urine osmolalities at about 5 weeks after the trauma. Eight patients had evidence of an increased plasma osmolality together with a relatively decreased urine osmolality after an overnight fast. The presence of this disturbance was significantly related to the persistence of postconcussional symptoms. The results suggest that subclinical disturbances of water metabolism may, among other factors, be related to the persistence of symptoms after MHI

Persistence of postconcussional symptoms in uncomplicated mildly head-injured patients: a prospective cohort study

We report the follow-up of 41 nonhospitalized subjects with uncomplicated mild head injury (MHI) and no premorbid compromising condition. At 3 months after the trauma 22 patients still complained of at least 1 postconcussional symptom (PCS) and 10 patients had 3 or more PCS. At 6 months 12 patients complained of at least 1 PCS, whereas 9 patients still had 3 symptoms or more. Patients with persistent PCS complained more of emotional symptoms. Results obtained with objective tests indicated that this group was characterized by a decreased performance on the Stroop Color Word Interference Test and a reduced tolerance to light and sound stimuli in comparison with patients with only few or no PCS. Persistent neurobehavioral deficits were correlated with scores on a postconcussive/cognitive rating scale, but not with scores on an emotional/vegetative scale. Although most patients may substantially recover after MHI, about 1 in 4 patients may persist with a residue of neurobehavioral deficits. Patients with persistent PCS should be evaluated in a multidiagnostic and objective way in order to gain a better understanding of the nature and origin of the subjective symptoms

Persistence of postconcussional symptoms in uncomplicated mildly head-injured patients: a prospective cohort study

We report the follow-up of 41 nonhospitalized subjects with uncomplicated mild head injury (MHI) and no premorbid compromising condition. At 3 months after the trauma 22 patients still complained of at least 1 postconcussional symptom (PCS) and 10 patients had 3 or more PCS. At 6 months 12 patients complained of at least 1 PCS, whereas 9 patients still had 3 symptoms or more. Patients with persistent PCS complained more of emotional symptoms. Results obtained with objective tests indicated that this group was characterized by a decreased performance on the Stroop Color Word Interference Test and a reduced tolerance to light and sound stimuli in comparison with patients with only few or no PCS. Persistent neurobehavioral deficits were correlated with scores on a postconcussive/cognitive rating scale, but not with scores on an emotional/vegetative scale. Although most patients may substantially recover after MHI, about 1 in 4 patients may persist with a residue of neurobehavioral deficits. Patients with persistent PCS should be evaluated in a multidiagnostic and objective way in order to gain a better understanding of the nature and origin of the subjective symptoms