Page 40 - World Journal of Laparoscopic Surgery

Laparoscopic Management of Suspected Vault Recurrence

Fig. 2: Vaginal vault with the loop of omentum adhered (arrow) Fig. 3: Excised margin with remaining vaginal cuff ready for repair

nodularity at the tip of the vaginal stump, with focal M-shape folding. treatment is planned after the completion of a metastatic workup.
Its impression was postoperative change with superficial recurrence The standard treatment is radiotherapy (RT) which is effective for
cannot be completely excluded. Following this four-port laparoscopy local control and the effect has been documented in prospective
with 10 mm primary port at umbilicus was done. Intraoperatively, studies. Surgical treatment has also been advocated in isolated
adhesiolysis was done for the loop of omentum adhered to the vault recurrence.
vault (Fig. 2). The assistant inserted gauze on sponge forceps in the However, signs and symptoms of vault recurrence frequently
vagina to push it through the vagina to show margins of the vault. mimic extensive vault granulation. This is a common postoperative
Dissection was done all around the mass to excise the unhealthy complication after total hysterectomy for benign or malignant
cuff and get a good healthy cuff margin (Fig. 3) for better repair lesions but little reports have been published. Most of the time
and healing. Once excised, the specimen is retrieved vaginally and small granulation over the cuff is self-limiting and can be treated by
sent for a frozen section which revealed granulation tissue with chemical coagulation, such as, silver nitrate or thermal coagulation.
inflammation which was confirmed later. Closure of vaginal cuff with A large lesion as described in this case report needs excision.
1-0 suture (absorbable) in double-layer was done. Intraperitoneal The proper recognition and differentiation between granulation
drain was inserted to reduce the risk of infection and coverage with tissue and possible recurrent malignant tissue are most important
postoperative antibiotics for 1 week was given. She had an uneventful in patients who have been operated upon for malignant disease
postoperative period and was discharged on 3rd day. Her follow-up of the female pelvis. A biopsy of apparent granulation tissue in
till 6 months post-surgery was uneventful with healed vaginal cuff. such patients is, therefore, necessary before treatment is instituted.

discussion references
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World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020) 139