Laparoscopic Vaginal Vault Excision for Treatment of Post-Hysterectomy Pain

There is no need for some women to continue suffering with post-hysterectomy pelvic pain and dyspareunia (painful intercourse). Laparoscopic Vaginal Vault Excision, a technique Mr. Trehan innovated allows for women to overcome this.

Following a hysterectomy for chronic pelvic pain, some patients will still suffer with pain, whilst other patients who had a hysterectomy but no pain beforehand may experience chronic pelvic pain after the hysterectomy.

The cause of this pain after a hysterectomy may be caused by pathologies at the top of the vagina (vaginal vault(cuff)) which was stitched at the time of the removal of the uterus.

The pelvic anatomy following a hysterectomy is shown below:

At this vaginal vault(cuff), a variety of pathologies may develop:

  • Neuroma (abnormal nerve aggregate)
  • Endometriosis
  • Endometriotic cyst
  • Epidermal cyst
  • Fibrosis and scarring
  • Inflammation

One means by which this post-hysterectomy pain can be treated is via excision (cutting out) of the vaginal vault (cuff). During excision of the vaginal vault, the vaginal vault is opened up and the post-hysterectomy vaginal vault scar is then excised (removed). The vaginal vault is then closed up again using stitches. A video of Mr. Trehan performing this technique can be viewed below:

Mr. Trehan published the first peer-reviewed journal paper discussing a technique laparoscopic excision of the vaginal apex for the treatment of post-hysterectomy pain. In this paper, over 90% of the women who responded felt that the operation improved their pelvic pain. This paper can be read by clicking here.

Laparoscopic excision of the vaginal vault is an extremely technically demanding procedure given the close proximity of the bladder, ureters and rectum and there are very few specialists in the world who are able to carry this procedure out.

Mr. Trehan performs all benign gynaecological procedures, including excision of the vaginal vault via laparoscopic (keyhole) surgery as it is associated with less post-operative pain and complications, a quicker recovery and a far superior cosmetic appearance when compared to laparotomy (open surgery). Mr. Trehan’s patients can be confident that their operation will be completed by keyhole means as Mr. Trehan’s conversion to laparotomy rate is amongst the lowest in the medical literature, as are his major complication rates, reoperation rates and readmission rates. Further, over 90% of Mr Trehan’s patients are able to leave the hospital after just an overnight stay in hospital.