Objectives This study aimed to analyze the incidence and risk factors of vault dehiscence after hysterectomy with respect to the mode of operation and the time to occurrence.

Methods We conducted a retrospective study including 6,530 patients who underwent hysterectomy at Severance Hospital between July 2013 and February 2019. We then analyzed the characteristics of 53 cases of vaginal vault dehiscence based on the mode of hysterectomy and the time to occurrence.

Results Among 6,530 hysterectomy cases, 53 cases of vault dehiscence (0.81%) were found, with 41 occurring after total abdominal hysterectomy (TAH) (0.46%) and 12 occurring after minimally invasive hysterectomy (MIH) (1.05%) (p=0.009). The incidence of dehiscence after MIH was statistically higher in benign diseases. In contrast, a malignant disease was associated with a higher risk of dehiscence after TAH (p=0.011). The time to occurrence, based on the 8-weeks cutoff, varied significantly based on the menopausal status; early-onset dehiscence occurred more frequently in premenopausal compared to postmenopausal women (93.1% vs. 33.3%, respectively; p=0.031). Surgical repair was more frequently required in cases of late-onset dehiscence than in early-onset dehiscence (95.8% vs. 51.7%, respectively; p<0.001).

Conclusions Our results were consistent with the concept that the occurrence of vaginal vault dehiscence may be correlated with the method of surgery. Patient-specific factors, such as menopausal status, uterine weight, and cause of operation, may influence the timing and severity. Thus, personalized counseling may help reduce vaginal vault dehiscence.