technique for minimizing vaginal cuff dehiscence
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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 !&'(
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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:
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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 $agina
mal S et al2 Int 3 4e-rod Contrace-t 5%stet G.neol2 !&'( 6-r78)!*,889:
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INSIDENS
Total 0,39%
Total ;a-arosco-ic1.sterectom. )T;1*
'0(<
;a- 6ssisted Vaginal1.sterectom. );6V1*
'!=<
6%dominal 1.sterectom. )61* '!=<
Vaginal 1.sterectom. )V1* &&=
<
Dr Smitharaga$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
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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
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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$$isceration2 The 5$stetrician A
G.naecologist !&''7'0,!0':09
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Postmenoa!se
De"s#ens#Esto$en
Pel#&s!o'tmen##s
anmelema
Pem*eaan
+a$#na a'#n$an
I-at
+as-!la'#
tas*e'-!'an
$
Post#ste'e-to
m#
A-s#sa$#na
*e'!*a
+a$#nasema-#n
memene-an
e't#-alGandhi 3ha S2 Vaginal Vault e$$isceration2 The 5$stetrician A G.naecologist!&''7'0,!0':09
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FAKTOR RISIKO LAINN.A
Ted Teh Min ;ee 4osanna ho2 Vaginal Cu Dehiscence ,
Diagnosis Management and re$ention
Bahan en+ahitan
Indeks Massa Tu%uh
sia
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/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 !&'
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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
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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 !&''
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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 !&''
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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 !&'!
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M6#63EME# VCD
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