technique for minimizing vaginal cuff dehiscence

7/23/2019 Technique for Minimizing Vaginal Cuff Dehiscence

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Techniques for Minimizing Vaginal CuDehiscence

Budi Iman SantosoIGES Makassar !" #o$em%er !&'(



DEFINISI

• Vaginal Cu Dehiscence )VCD* di%agimen+adi , – Partial VCD

• Ter-isahn.a $aginal cu secara -arsial saatfollo/ u- kedua )0 %ulan atau le%ih denganatau tan-a -resentasi klinis dari n.eri -el$ik-erdarahan $aginal atau duh .ang

memerlukan tera-i konser$atif

mal S et al2 Int 3 4e-rod Contrace-t 5%stet G.neol2 !&'( 6-r78)!*,889:



DEFINISI (2)

– Complete dehiscence ter-is ahn.a secara kom-lit$aginal cu diketahui saat follo/ u- -ertama )setelah0& hari* .ang mem%utuhkan -em%edahan

– Complete separation ter+adi ka-an sa+a dengan atautan-a -resentasi klinis mem%utuhkan inter$ensikonser$atif dan -em%edahan

•

Vaginal Cu E$isceration )VCE* – Ter-isahn.a secara kom-lit $aginal cu dengan

-rotrusi isi intra:a%dominal atau organ $iseral lainn.ake $agina

mal S et al2 Int 3 4e-rod Contrace-t 5%stet G.neol2 !&'( 6-r78)!*,889:



INSIDENS

Total 0,39%

Total ;a-arosco-ic1.sterectom. )T;1*

'0(<

;a- 6ssisted Vaginal1.sterectom. );6V1*

'!=<

6%dominal 1.sterectom. )61* '!=<

Vaginal 1.sterectom. )V1* &&=

<

Dr Smitharaga$han 6gnieszka Tul/in Mr 3im Clark2 Vaginal Va

ult

Dehiscence )VVD* >ollo/ing Total ;a-arosco-ic 1.sterectom.2 BSGE#or/ich !&'82



PRESENTASI TIPIKAL

? @ = %ulan -ost:o-

Muncul saat%erhu%ungan

#.eri A %erdarah

Da-at ter+adi E$iserasisus

Dr Smitharaga$han 6gnieszka Tul/in Mr 3im Clark2 Vaginal Vault Dehiscence )VVD*

>ollo/ing Total ;a-arosco-ic 1.sterectom.2 BSGE #or/ich !&'82

S-ekulum menu+ukan defek -ada vault suture line kemungkinan -rola-s usus atau omentum ke dalam $agina



ETIOLOGI

• Etiologi masih %elum +elas dan %elumada -ola dari ter+adin.a dehiscence

• >aktor risiko .ang umum se-erti triasatro -ostmeno-ause dan-em%edahan se%elumn.a

Gandhi 3ha S2 Vaginal Vault e$$isceration2 The 5$stetrician A

G.naecologist !&''7'0,!0':09



Postmenoa!se

De"s#ens#Esto$en

Pel#&s!o'tmen##s

anmelema

Pem*eaan

+a$#na a'#n$an

I-at

+as-!la'#

tas*e'-!'an

$

Post#ste'e-to

m#

A-s#sa$#na

*e'!*a

+a$#nasema-#n

memene-an

e't#-alGandhi 3ha S2 Vaginal Vault e$$isceration2 The 5$stetrician A G.naecologist!&''7'0,!0':09



FAKTOR RISIKO LAINN.A

Ted Teh Min ;ee 4osanna ho2 Vaginal Cu Dehiscence ,

Diagnosis Management and re$ention

Bahan en+ahitan

Indeks Massa Tu%uh

sia



/AAN AITAN

/aan a#tan De#s&en&eRate

ol.sor% !9? <

Dela.ed a%sor%a%leMonolament

&9( <

Braided suture 8! <

Fuill suture && <

Siedho et al Decreased incidence of $aginal cu dehiscence afterla-arosco-ic closure /ith Bidirectional Bar%ed Suture 3 Min In$ G.nSurg March !&'



INDEKS 1ASSA T/

1ur and ;ee et al Vaginal cu dehiscence after dierent modes ofh.sterectom., a follo/:u- stud. 5%stet G.n acce-ted -u%lication -ending

ho et al Cu Dehiscence 6fter 4o%otic rocedures 5%stet G.n 6ug !&&"

• !'" )'&'0 dengan IMT H !(*

Median IMT dehiscence -ada-asien T;1

• !0 )'(!' dengan IMT H !(*

Median IMT dehiscence -ada-asien 41



INDEKS 1ASSA T/

a'a&te'#st#&s

n na4!stemeans

Pal!e

/1I(e#s&en&e5no e#s&en&e)

0=9 !?= )=?* 0'8)==*

0,60

Siedho et al Decreased incidence of $aginal cu dehiscenceafter la-arosco-ic closure /ith Bidirectional Bar%ed Suture 3

Min In$ G.n Surg March !&''



SIA LANT1ENINGKATKAN RISIKO

DEISENEa'a&te'#st#&s

n na4!stemeans

Pal!e

A$e(e#s&en&e5noe#s&en&e)

0=9 0"? )(&* 808)?9*

0,09

Siedho et al Decreased incidence of $aginal cudehiscence after la-arosco-ic closure /ith Bidirectional

Bar%ed Suture 3 Min In$ G.n Surg March !&''



PENEGAAN

Meminimalisir luka termal saatcol-otom.

Teknik men+ahit .ang mum-uni

onseling untuk tidak%erhu%ungan seks

Ted ;ee2 Vaginal Cu Dehiscence , Diagnosis Management andre$ention2 Ma.o Clinic2 !&'!



M6#63EME# VCD

technique for minimizing vaginal cuff dehiscence

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