Histologic characteristics of vaginal cuff tissue from patients with vaginal cuff dehiscence.

J Minim Invasive Gynecol
Publication Year: 
Jennifer Klauschie
Yan Wen
Bertha Chen
Lu Zhou
Raphael Nunez-Nateras
Idris T Ocal
Dora Lam-Himlin
Rosanne Kho
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Public Summary: 
Scientific 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 SM22alpha (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 SM22alpha (1.85 vs 1.27; p = .09). Interobserver variability was low (kappa = 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.