LeFort Colpocleisis Research Articles

LeFort Colpocleisis: Unmet Expectations about Correction of Urinary Symptoms Are Related to Disappointment and Regret

ABSTRACT Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student’s t-test, Fisher’s Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates.

Clinical outcomes of LeFort colpocleisis: A single-center experience from Turkey

Background/Aim. LeFort colpocleisis (LFC) is a procedure for treating pelvic organ prolapse (POP) in women. The aim of the study was to assess the sociodemographic characteristics, anatomical outcomes, satisfaction, and clinical outcomes of patients who underwent LFC for POP. Methods. The study retrospectively and consecutively included 103 patients who underwent LFC for stage III and stage IV POP between January 2010 and December 2022. The participants? sociodemographic characteristics and clinical outcomes were documented. The Turkish version of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to determine quality of life. Results. The patients? mean age was 73.1 ? 26.7 years, mean body mass index 27.4 ? 3.8 kg/m2, parity 4.8 ? 1.5, smoking rate 12.6%, POP quantification (POP-Q) stage III 30.1%, and POP-Q stage IV 69.9%. Their satisfaction rate results were 93.3%. Significant differences were observed in the preoperative period compared to the postoperative period in constipation (40.7% vs. 26.2%; p = 0.038), difficult defecation (22.3% vs. 8.7; p = 0.012), fecal incontinence (18.4% vs. 7.7%; p = 0.039), stress urinary incontinence (25.2% vs. 4.8%; p < 0.001), urge incontinence (49.5% vs. 27.1%, p = 0.001), voiding dysfunction (37.8% vs. 23.3%; p = 0.002), and urinary retention (42.7% vs. 12.6%; p < 0.001). Postoperative PFDI-20 scores were also significantly lower compared to the preoperative period (57.19 ? 16.57 vs. 21.62 ? 6.96; p < 0.001). Conclusion. This study showed that LFC has been established as a surgical procedure with high anatomical success, high patient satisfaction rates, and minimal complications, especially in advanced POP with age-related comorbidities.

Comparison of Clinical Results of Lefort and Total Colpocleisis Operations Performed in Patients with Uterovaginal Pelvic Prolapse

Purpose: The aim of this study is to compare the clinical results and operation success of Lefort and Total Colpocleisis surgeries performed in patients with stage 2 and above pelvic organ prolapse (POP).
 Materials and Methods: This retrospective cohort study included 40 patients who underwent Lefort and Total Colpocleisis surgeries in our clinic between 2015-2022. Demographic and clinical results were obtained from the hospital database. Data on the presence of relapse and de novo incontinence symptoms, postoperative complications, and their management were obtained from individual postoperative examinations of the patients.
 Results: The mean age at operation was 75.7±6.7. The mean parity of the patients was four, and all had a normal vaginal delivery. It was observed that 67.5% of the subjects had at least one comorbidity. The anatomic success rate of Total colpocleisis at one-year follow-up was 95.4%, and Lefort colpocleisis was 94.4%. The incidence of de novo stress urinary incontinence at one-year follow-up was 10%. The subjects were treated with mini-sling operations.
 Conclusion: Colpoclesis can be safely applied in the elderly and sexually inactive population due to its low perioperative complications and recurrence rates compared to reconstructive surgeries. It should be kept in mind that de novo incontinence may occur after colpoclesis surgery.

Management of Abscess Following Le Fort Colpocleisis

Management of Abscess Following Le Fort Colpocleisis

Management of pyometra after Lefort colpocleisis

LeFort colpocleisis is a highly effective surgical treatment for pelvic organ prolapse. Postoperative pyometra is a rare, but serious complication

Robotic-assisted total laparoscopic hysterectomy in a patient with a history of a lefort colpocleisis: tips and tricks for performing a hysterectomy without a manipulator

Robotic-assisted total laparoscopic hysterectomy in a patient with a history of a lefort colpocleisis: tips and tricks for performing a hysterectomy without a manipulator

Anatomical and symptomatic outcomes in patients with Le Fort colpocleisis with or without hysterectomy

BackgroundWe aimed to evaluate the short-term anatomical and clinical outcomes of elderly patients who underwent the Le Fort colpocleisis operation due to pelvic organ prolapse (POP) in our clinic.MethodsThe medical records of fifty-nine sexually inactive females, with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operations were prospectively analysed. Preoperative and 12th month postoperative data were recorded. Lower urinary tract symptoms (LUTS) was also evaluated preoperatively and 12 months postoperatively in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above vaginal introitus.ResultsA total of 59 patients were included in this study. The average age of the patients was 71.67 ± 7.01 (years). The mean BMI was 27.1 ± 9.52 kg/m2. POP-Q point, C (6.70 ± 2.44 vs. − 2.66 ± 1.21) measurements were significantly deeper, as well as Gh (4.83 ± 0.94 vs. 4.26 ± 0.94) and TVL (3.51 ± 1.24 vs. 8.93 ± 1.73) measurements were significantly higher after surgery than during the preoperative period (p < 0.01, p < 0.01, p < 0.01, respectively). There were no cases of recurrence. The evaluation of LUTS at the 12-months postoperative follow-up revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms (p = 0.007, p < 0.001, p = 0.01, p < 0.001, respectively).ConclusionsLe Fort colpocleisis is a simple and effective procedure that provides successful anatomical and clinical outcomes in sexually inactive and elderly women with POP. However, the long-term results of this procedure need further investigation.

Role of Hysteropexy in the Management of Pelvic Organ Prolapse.

To discuss considerations for hysteropexy for apical pelvic organ prolapse (POP) and summarize available literature comparing various hysteropexy techniques to analogous procedures involving hysterectomy. Hysteropexy for apical POP has increased in popularity in recent years, although anatomic factors and gynecologic cancer risk must be taken into account. Native tissue hysteropexy options include the LeFort colpocleisis, sacrospinous hysteropexy, and uterosacral hysteropexy. Although vaginal mesh was banned by the Food and Drug Administration in 2019, abdominal mesh sacrohysteropexy done either open or laparoscopically remains an option in the USA. Overall, short-term prolapse outcomes appear to be comparable between uterus-sparing approaches and hysterectomy, with less blood loss and shorter operating room time observed with the uterine-sparing approaches, although long-term outcome data remains variable and limited. Uterine-sparing apical POP repair may be offered to appropriate patients without certain risk factors, although longer-term data will be required to evaluate durability.

Colpocleisis techniques: an open-and-shut case for advanced pelvic organ prolapse

The purpose of this video is to demonstrate several advanced surgical techniques to improve efficiency and optimize the clinical success of the colpocleisis procedure. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population. For women with advanced pelvic organ prolapse, multiple medical comorbidities, and who no longer desire penetrative vaginal intercourse, an obliterative approach is preferred due to decreased anesthetic needs and operative time, and 95% long-term efficacy. The umbrella term of “colpocleisis” encompasses LeFort Colpocleisis, a uterine sparing procedure, colpocleisis with hysterectomy, and post-hysterectomy vaginal vault colpocleisis. Typically levator myorrhaphy and perineorrhaphy are also included to reinforce the repair. This video demonstrates several advanced surgical techniques to streamline the colpocleisis procedure. These methods include using electrosurgery to mark out the epithelium, the push-spread technique for superficial dissection, and demonstrating methods to create the lateral tunnels during LeFort colpocleisis with and without the use of a urinary catheter. Retraction with Allis clamps and rubber bands on hemostat clamps are utilized to improve visualization. Approximation of the anterior and posterior vaginal muscularis is also performed to obliterate the vaginal canal. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. An anatomic model is used to demonstrate the suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles. Ultimately the goal of colpocleisis is a vaginal opening that is one centimeter in width and three centimeters in depth. These skills enable the surgeon to maximize efficiency and surgical outcomes of obliterative procedures for advanced stage pelvic organ prolapse.

Clinical outcomes in patients with advanced pelvic prolapse who underwent LeFort surgery or pessary placement- A prospective cohort study.

Background:The aim of the present study was to compare the six-month results in terms of prolapse symptoms in postmenopausal patients with advanced pelvic prolapse (POP) who underwent LeFort colpocleisis surgery or with pessary placement.Methods:In this prospective cohort study, 110 older women were enrolled from April 2016 to January 2018. The women were diagnosed with stage III or higher genital prolapse according to the POP quantification (POP-Q) system. The patients were divided into two groups: surgical (LeFort colpocleisis surgery; n=55) and non-surgical (pessary placement, n=55). The study population underwent LeFort colpocleisis surgery or pessary placement in two university clinics (Beheshti or Alzahra Hospitals). All patients completed the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20). The main short-term outcome measurement (six months) was the manifestation of a pelvic prolapse in the groups.Results:The patients had a mean age of 68.98±8.79 years in the non-surgical group and 64.76±7.04 years in the surgical group. The analytic results showed a significant difference between the two groups (P=0.006). After treatment, the prolapse symptoms improved in both groups (p<0.001). However, the total PFDI-20 score did not show any significant differences at the end of the six-month follow- up (P=0.19).Conclusion:Both strategies (pessary placement or LeFort colpocleisis surgery) provide a short-term option for the treatment of older women with stage III or higher POP. The findings of this study could assist with treatment options and allow better guidance for older patients with symptomatic POP in the treatment decision process.

Le Fort Colpocleisis

<h3>Study Objective</h3> To highlight a safe and effective technique of the Lefort Colpocleisis for treating pelvic organ prolapse in an elderly patient. <h3>Design</h3> Educational Video. <h3>Setting</h3> OR. <h3>Patients or Participants</h3> The index patient is an 82-yo G2P1011 patient with symptomatic stage III pelvic organ prolapse; the anterior compartment was the leading edge. Due to the prolapse the patient was unable to exercise and walk as much as she desired. She failed an initial trial of ring pessary. After appropriate counseling, the patient opted for surgical intervention via a Lefort Colpocleisis with the understanding that this would preclude vaginal intercourse in the future. Preoperative evaluation with cystoscopy, urodynamic studies and a pelvic ultrasound were all within normal limits. We started the procedure by marking rectangular areas on the anterior and posterior vagina. The marked areas are then removed by careful sharp and blunt dissection. The edges of the rectangle and the denuded vaginal mucosa were then closed; leaving laterally created tunnels for drainage of cervical mucus. As successive sutures were placed; it was ensured that the knots were within the epithelial lined tunnels. This carefully maneuvered technique allowed the uterus and vaginal apex to be gradually turned inward. A bladder neck plication suture was then placed due to the high risk of stress incontinence accompanying these cases. A perineorrhaphy was completed to narrow the vaginal introitus. A cystoscopy was then performed confirming ureteral patency and excluding lower urinary tract injury. At her postoperative visit the patient had resolution of her symptoms and was pleased with the outcome of her surgery. <h3>Interventions</h3> LeFort Colpocleisis. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> This technique is a good approach for the management of pelvic organ prolapse in elderly patients or those who are not candidates for major reconstructive surgery.

Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review.

In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries. Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary. Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries. Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.

Risk Factors for Urinary Retention After Colpocleisis.

Transient urinary retention occurs frequently after pelvic organ prolapse surgery. While the prevalence of postoperative urinary retention has been reported for reconstructive procedures, a paucity of data exists for colpocleisis. The objectives of this retrospective cohort study were to identify risk factors for transient urinary retention after colpocleisis and to determine the rate of its occurrence. A retrospective chart review was performed for patients undergoing colpocleisis from January 2015 to December 2019 in a high-volume urogynecology practice. Patients were excluded if they required prolonged catheterization postoperatively because of a surgical complication or used a catheter before surgery, or if a suprapubic catheter was placed during surgery. Potential patient and procedural risk factors were analyzed. Transient urinary retention was diagnosed if patients failed their postoperative voiding trial and went home with a catheter. A total of 172 patients met the inclusion criteria. The incidence of transient postoperative urinary retention was 55%, with rates of 36.7% with LeFort colpocleisis, 51.5% with posthysterectomy colpocleisis, and 64.9% with colpocleisis with concomitant hysterectomy. Logistic regression revealed an increased risk of postoperative urinary retention if hysterectomy was performed at the time of colpocleisis (odds ratio, 2.9; confidence interval, 1.23-6.84; P = 0.015). Patient age, prolapse severity, preoperative postvoid residual volume, and concomitant anti-incontinence procedure were not associated with transient postoperative urinary retention. Transient urinary retention occurs in more than half of patients after colpocleisis. Patients undergoing concomitant hysterectomy have the highest risk of postoperative urinary retention. Surgeons can use this information both for counseling and management decisions for individual patients.

Teaching the art of LeFort colpocleisis: a moderate-fidelity, low-cost simulation model.

The objective was to demonstrate the build and use of a low-cost, moderate-fidelity simulation model for LeFort colpocleisis. We a present a video demonstrating the creation of a LeFort colpocleisis model, the mounting of this model to a pre-existing vaginal hysterectomy simulator (SimVaHT), and the use of the model to teach the steps of the LeFort colpocleisis procedure. This LeFort colpocleisis model is easy to make, from readily available materials, and is inexpensive. It can help trainees to enhance their intraoperative learning.

Follow-up of patients after colpectomy or Le Fort colpocleisis: Single center experience

ObjectiveAs the population ages, obliterative procedures (OP) are expected to become an increasingly important treatment option. The primary aim of this study was to evaluate vaginal and urinary symptoms 3 months after OP and peri- and postoperative complications. The secondary aim was to investigate long-term outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA. Study designRetrospective study of 43 women who underwent OP during a 10-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 3 months postoperatively and at long-term follow-up. Records were reviewed for complications, use of anesthetics, recurrences, patient satisfaction and regret. ResultsA Le Fort colpocleisis was performed in 31 (72 %) and a colpectomy in 12 (28 %) patients. At 3 months` follow-up, patients had a statistically significant improvement in vaginal symptoms. Twelve patients (46 %) became continent, compared with 14 (54 %) with remaining urinary incontinence (UI). There were no patients with de novo UI 3 months’ after surgery. Total complication rate was 4,6% (2/43). A symptomatic recurrent prolapse occurred in 4 patients (9.3 %). The satisfaction rate was 86 %. No patients reported regret choosing to have vaginal closure surgery. Twenty one (49 %) of the procedures were performed under local anesthesia with intravenous sedation. ConclusionObliterative procedures are good surgical options for elderly women with a positive impact on vaginal and urinary symptoms, low complication and recurrence rate. Patients report high satisfaction and no regret over loss of sexual ability at longterm follow-up. OP under LA with intravenous sedation is a feasible and safe option.

Le Fort colpocleisis: An evaluation of results and quality of life at intermediate-term follow-up

ObjectivesTo assess postoperative complications, intermediate-term anatomic and subjective success rates, and quality of life following obliterative Le Fort colpocleisis (LFC) for advanced pelvic organ prolapse (POP). Study DesignWe conducted a retrospective cohort study with 53 subjects who underwent LFC surgery between January 2012 and April 2019. Demographic and treatment data were retrieved from a hospital database. Data on postoperative anatomic results were gathered from individual examinations of study subjects. The Clavien-Dindo classification was used to evaluate the complications. The Prolapse-Quality of Life (P-QoL) questionnaire was administered in person or over the telephone before and after the operation. Low scores on the P-QoL reflect a high quality of life. ResultsThe mean age at operation was 73 ± 7.1 years. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12–82). Ninety-two percent of subjects had at least one comorbidity. When subjects were classified using the Pelvic Organ Prolapse (POP) Quantification System, seven (13.2 %) had Stage 3 POP and 46 (86.8 %) had Stage 4 POP. The overall rate of minor peri-operative complications rate was 11.3 % (six subjects). The objective success rate of LFC at intermediate-term follow-up was 98.1 %, and the subjective success rate was 96.2 %. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12–82). There was a statistically significant decrease in the postoperative P-QoL score (p < 0.001). ConclusionsBased on positive intermediate-term anatomic and subjective outcomes, including a significant decrease in P-QoL questionnaire scores and a lack of regret, obliterative LFC should be considered a first-choice procedure for elderly and sexually inactive women with advanced POP.

Surgical and quality of life outcomes after pelvic organ prolapse surgery in older postmenopausal women.

IntroductionTo evaluate the surgical outcome, and quality of life (QoL) 12-months after Le Fort colpocleisis (LFC), and sacrospinous fixation (SSF) in older postmenopausal women.Material and methodsEighty-six (86) post-menopausal women were included in this study (38 in the LFC group and 48 in the SSF group). Pelvic organ prolapse quantification (POP-Q) was used to evaluate the participants’ pelvic organ prolapse (POP) pre-operatively and post-operatively (PO). The Arabic version of the WHOQoL-BREF Inventory was used to evaluate the participants’ QoL preoperatively and post-operatively. The surgical outcome and QoL 12-months after LFC and SSF were analysed to evaluate the surgical outcome, as well as QoL 12 months after LFC and SSF.ResultsThe pre-operative Aa, Ba, D, Ap, and Bp values of POP-Q significantly improved 12 months PO in the LFC group (p1 = 0.004, 0.0006, 0.02, 0.004, and 0.0001; respectively), and in the SSF group (p1 = 0.003, 0.0003, 0.003, 0.0005, and 0.01, respectively). Eighty (93.02%) of the studied women had no prolapse at 12-month PO follow-up. The 12-month PO psychological and social health domains were significantly higher in the SSF group compared to the LFC group (p2 = 0.04, and 0.02, respectively). In addition, the 12-month PO general health satisfaction and total QoL scores were significantly higher in the SSF group compared to the LFC group (p2 = 0.03 and 0.01, respectively).ConclusionsLFC can be considered a good surgical procedure with minimal or neglectable complications for POP in older postmenopausal women with multiple co-morbidities. The psychological and social health domains, general health satisfaction, and total QoL score were significantly higher in the SSF group compared to LFC group 12 months PO.

Endometrial Cancer Evaluation After Le Fort Colpocleisis

Background: Le Fort colpocleisis is a highly effective surgery for pelvic organ prolapse. One consequence of the surgery is difficulty accessing the endometrial cavity. Endometrial cancer risk incr...

Risk factors predicting the loss of functional independence after obliterative procedures for pelvic organ prolapse.

To determine the risk factors associated with loss of functional independence after obliterative procedures for pelvic organ prolapse (POP). The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was used to collect data on women who underwent obliterative vaginal procedures from 2011 to 2016, using current procedural terminology (CPT) codes for LeFort colpocleisis (57120) and vaginectomy (57110). The criterion for loss of functional independence was a transition from a functionally independent status to a dependent status (discharge to a post-care facility) or death within the 30-day postoperative period. Multivariate regression analysis was utilized to determine factors associated with loss of functional independence. A total of 1847 women were included in the analysis. A loss of functional independence was noted in 50 of the 1847 women (2.6%). The women who suffered loss of functional independence were older than those who were independent postoperatively (mean age 79.3years, SD 7.47 vs. 76.7years, SD 8.1, respectively). On multiple logistic regression analysis, age ≥ 80years (OR 2.8, 95% CI 1.4-5.5), American Society of Anesthesiologists (ASA) classification ≥ 3 (OR 2.3, CI 1.1-4.7) and length of stay ≥ 5days (OR 15.2, 95% CI 6.2-37.1) remained significantly associated with an increased risk of loss of functional independence. Age ≥ 80years, ASA classification ≥ 3 and longer length of stay are associated with an increased risk of loss of functional independence after an obliterative procedure for pelvic organ prolapse. Consideration of these factors during the preoperative decision-making process may help improve outcomes in this cohort.

Transperineal Repair of Enterocele within Perineal Hernia Secondary to Le Fort Colpocleisis

An 80-year-old female patient with advanced pelvic organ prolapse underwent vaginal hysterectomy with unilateral sacrospinous fixation and anterior/posterior correction through repair of the paravaginal defect and perineorrhaphy. Within less than a year after the first procedure, the patient presented with stage 4 uterovaginal prolapse, and a Le Fort colpocleisis with perineorrhaphy was performed.