The vaginal cuff is the upper portion of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

that opens up into the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesoth ...

and is sutured shut after the removal of the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

and

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

during a

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

. The vaginal cuff is created by

suturing A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of threa ...

together the edges of the surgical site where the cervix was attached to the vagina. This is accomplished by bringing the edges of the vagina together and suturing them together and to the

uterosacral ligaments The uterosacral ligaments (or rectouterine ligaments) belong to the major ligaments of uterus. Structure The rectouterine folds contain a considerable amount of fibrous tissue and non-striped muscular fibers which are attached to the front of the ...

to prevent prolapse. The peritoneum is also sewn into the newly created vaginal cuff. There may be an advantage to using one method of closure over another. The vaginal cuff has a tendency to partially or completely dehisce or open up. A further complication that can accompany the dehiscence of the vaginal cuff is evisceration or the movement of intestines into the vagina. Some or all of the vaginal cuff can reopen. The risk of vaginal cuff complications is related to the approach to hysterectomy: robotic-assisted total

laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...

hysterectomy, total

laparoscopic hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may ...

, laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy, and total vaginal hysterectomy. The vaginal cuff can be stressed by sexual intercourse,

chronic constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...

, COPD, and other actions that increase intra-abdominal pressure. This structure is prone to infection,

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

and other postoperative complications. Factors that are thought to affect wound healing are radiation treatments, age, pelvic organ prolapse, the use of

corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involve ...

, concurrent malignancy. Though rare, estimates of the prevalence of vaginal cuff dehiscence are difficult to assess due to the presence of only case studies and anecdotal reports. If the vaginal cuff is compromised, vaginal evisceration can occur with the

small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...

protruding out through the vagina.

References

{{reflist, 32em Vagina Gynaecology Women's health