Postoperative wound dehiscence and fistulas after short-interval hysterectomy following bariatric surgery

The effect of bariatric procedures on outcomes of gynecologic surgery is poorly defined. A 47-year-old underwent a laparoscopic Roux-en-Y gastric bypass, followed seven weeks later by elective abdominal hysterectomy. An appendectomy was performed for appendiceal adhesions to the uterus and intraoperative cystoscopy was normal. The immediate postoperative course was unremarkable. Ten days later, she presented with a large pelvic abscess, dehiscence at the appendectomy site, vaginal cuff dehiscence, and bladder injury. Management included vaginal cuff repair, ileostomy, and cystorrhaphy. She then developed vesicovaginal fistula and superficial wound dehiscence, requiring prolonged hospitalization, antibiotics, total parenteral nutrition, and conservative management until resolution. Dehiscence and complex fistula formation are potential complications of gynecologic surgery performed during the rapid weight loss phase following bariatric surgery.