- LeFort partial colpocleisis
- Colpectomy and colpocleisis
- Colpectomy and colpocleisis after two previously failed obliterative procedures
These videos were selected by Mickey Karram, MD, and are presented courtesy of the International Academy of Pelvic Surgery (IAPS)
This article, with accompanying video footage, is presented with the support of the International Academy of Pelvic Surgery.
As women live longer, on average, pelvic floor disorders are, as a whole, becoming more prevalent and a greater health and social problem. Many women entering the eighth and ninth decades of life display symptomatic pelvic organ prolapse (POP)—often after an unsuccessful trial of a pessary or even surgery.
These elderly patients often have other concomitant medical issues and are not sexually active, making extensive surgery for them less than an ideal solution. Instead, surgical procedures that obliterate the vaginal canal can alleviate their symptoms of POP.
In this article, we provide a step-by-step description of:
- LeFort partial colpocleisis in a woman who still has her uterus in place
- partial or complete colpectomy and colpocleisis in a woman who has post-hysterectomy prolapse
- levator plication and perineorrhaphy, as essential concluding steps in these procedures.
LeFort partial colpocleisis
An obliterative procedure in the form of a LeFort partial colpocleisis is an option when a patient 1) has her uterus and 2) is no longer sexually active. Because the uterus is retained in this procedure, however, keep in mind that it will be difficult to evaluate any uterine bleeding or cervical pathology in the future. Endovaginal ultrasonography or an endometrial biopsy, and a Pap smear, must be done before LeFort surgery.
The ideal candidate for LeFort partial colpocleisis is a woman who has complete uterine prolapse, or procidentia (FIGURE 1), which is characterized by symmetric eversion of the anterior and posterior vaginal walls.
FIGURE 1 Pelvic organ prolapse, preoperatively
Top: Uterine procidentia. A patient who has this condition is an ideal candidate for LeFort partial colpocleisis. Bottom: Asymmetric anterior vaginal prolapse.
LeFort partial colpocleisis: Key step by key step
FIGURE 2 shows key steps in performing LeFort partial colpocleisis. See Video #1 at www.obgmanagement.com for demonstrations of how to perform LeFort partial colpocleisis.
FIGURE 2 Steps: LeFort partial colpocleisis
A. Denude the anterior vaginal epithelium. B. Plicate the neck of the bladder. C. Next, denude the posterior vaginal epithelium. D. Approximate most proximal surfaces. E. Place lateral sutures to allow for drainage canals. F. The uterus has been replaced and most of the distal incisions closed.