LeFort Partial Colpocleisis Research Articles

Le Fort Partial Colpocleisis: An Early and Feasible Option in Pelvic Organ Prolapse

To evaluate the safety and effectiveness of Le Fort Partial Colpocleisis (LFPC) in the surgical treatment of pelvic organ prolapse (POP) and to determine the incidence of pop recurrence in postoperative follow-up. Cross-sectional study. Ordu University Medical Faculty Training and Research Hospital, Ordu, Turkey, from June 2013 to November 2020. Sixty-four women (82.8% had uterine prolapsed) who had been operated as LFPC operations were included in the study. Patient's characteristics, medical comorbidities, postoperative outcomes, and operation complications were analysed. POP recurrence was evaluated during the postoperative follow-up period reaching 80 months. Eight patients (12.5%) had anti-incontinence surgery. Concomitant vaginal hysterectomy was performed in six patients (9.4%) and concomitant anti-incontinence surgery was performed in eight patients (12.5%). There were no serious intraoperative complications such as hematoma formation, and bladder / bowel injury. Postoperative complications were seen in a quarter of the patients (16/64) and most of them resolved spontaneously. Three of sixty-four patients (4.7%) were complicated with de novo urinary incontinence and all cases were healed without the need for treatment. In the current study, none of the patients reported POP recurrence on average over three years of follow-up. There was a low frequency of intraoperative and postoperative complications in LFPC surgery. In addition, no POP recurrence was observed in any patient during long-term follow-up. Therefore, the LFPC procedure was described as a good surgical option in the selected elderly population with POP. Colpocleisis, Le fort partial colpocleisis, Pelvic organ prolapse.

A Stepwise Approach to Lefort Colpocleisis

Study Objective The objective of this educational video is to describe the technique and required equipment for performing a LeFort partial colpocleisis using surgical footage as well as a low-cost surgical model. Design Educational surgical video. Setting Canadian academic medical centre. Patients or Participants This educational video was created using surgical footage as well as a low cost, reproducible surgical model. Interventions Using surgical footage and low-cost surgical model, we demonstrate a LeFort partial colpocleisis in six steps. (1) Proper patient positioning, (2) mark rectangular resection area, (3) dissect and resect vaginal epithelium, (4) place red rubber catheter to allow for lateral channels, (5) reduce prolapse using sequential pursestring sutures, (6) perineorrhaphy. Measurements and Main Results N/A. Conclusion Conclusion: Pelvic organ prolapse affects the quality of life of many patients, and one in nine will require corrective surgery by the age of 80. LeFort partial colpocleisis is a highly successful, minimally invasive surgical approach that is indicated in patients with pelvic organ prolapse who are no longer having vaginal intercourse and/or have comorbidities that prohibit a more extensive procedure. This video provides a stepwise approach to performing a LeFort partial colpocleisis. The objective of this educational video is to describe the technique and required equipment for performing a LeFort partial colpocleisis using surgical footage as well as a low-cost surgical model. Educational surgical video. Canadian academic medical centre. This educational video was created using surgical footage as well as a low cost, reproducible surgical model. Using surgical footage and low-cost surgical model, we demonstrate a LeFort partial colpocleisis in six steps. (1) Proper patient positioning, (2) mark rectangular resection area, (3) dissect and resect vaginal epithelium, (4) place red rubber catheter to allow for lateral channels, (5) reduce prolapse using sequential pursestring sutures, (6) perineorrhaphy. N/A. Conclusion: Pelvic organ prolapse affects the quality of life of many patients, and one in nine will require corrective surgery by the age of 80. LeFort partial colpocleisis is a highly successful, minimally invasive surgical approach that is indicated in patients with pelvic organ prolapse who are no longer having vaginal intercourse and/or have comorbidities that prohibit a more extensive procedure. This video provides a stepwise approach to performing a LeFort partial colpocleisis.

Le Fort partial colpocleisis as an effective treatment option for advanced apical prolapse in elderly women

ObjectiveThe aim of this study was to evaluate the outcomes of women with advanced apical prolapse who were treated with the obliterative LeFort partial colpocleisis (LFC) procedure. Materials and methodsWe reviewed the medical records of patients who underwent LFC for advanced apical prolapse. We collected data for baseline patient characteristics, co-morbidities, severity of prolapse, operating time, intraoperative injuries, and postoperative complications. Subjective postoperative outcomes and patient satisfaction levels were also assessed. ResultsNinety-five patients underwent LFC during the study period. Median age of patients at operation was 76.0years. Mean operation time was 121.5 ± 31.9 min. Mean postoperative hospital stay was 3.5 ± 1.6 days. Postoperative complications, which were virtually all urinary symptoms, were present in 29.8% of patients, and 89.3% of patients have been in spontaneous remission. There was one case with perineal wound infection, one case of prolapse recurrence, and one case of de novo rectal prolapse after LFC. The objective success rate of the LFC procedure for all patients was 98.9% (94/95). Most (96%) patients were satisfied with the LFC results and pleased with the improvement in body image. ConclusionThe obliterative LFC procedure had a high success rate and was associated with minimal adverse events for the elderly patients with advanced apical prolapse. This procedure should be considered as a treatment option for the advanced apical prolapse in selected elderly women who do not want to conserve vaginal intercourse, as it offers improvement in quality of life and is associated with a low regret rate.

Le Fort Partial Colpocleisis: A Low-Cost Model.

Objective:The aim of this study is to develop a simulation model for the Le Fort partial colpocleisis.Introduction:One in 9 women will undergo surgery for incontinence or prolapse by age 80 with 30% of these requiring an additional prolapse surgery. With a success rate of over 90% and recurrence rate of 4.2%, obliterative procedures hold a significant place in the management of pelvic organ prolapse in elderly women who are no longer sexually active. For new trainees, the Le Fort colpocleisis may be difficult to conceptually visualize, requiring the need to develop models as teaching tools.Method:A low-cost model was developed using easily available craft supplies to simulate the Le Fort partial colpocleisis with the uterus in situ to treat procidentia. The cost of each model was under US $14 and time to make was approximately 1 hour. The video presents the construction and use of this model.Conclusions:The Le Fort partial colpocleisis technique has been in use for over a century. The aging population as well as the high risk of recurrence after prolapse repairs makes colpocleisis an important technique for trainees to master. Simulation models have proven their efficacy as a training tool. This simple model will allow trainees to fully comprehend the steps of this procedure. Using this video, educators can construct a model and use it to orient trainees to the Le Fort partial colpocleisis procedure.

Perineal hernia extruding into the labium majus after multiple surgeries for pelvic organ prolapse

A 78-year-old woman presented with a large bulge in the right labium majus. She had a previous history of two anterior and posterior vaginal wall prolapse repairs, a vaginal hysterectomy for uterovaginal prolapse, a sacrospinous ligament fixation for vaginal vault prolapse, and a LeFort partial colpocleisis for recurrent vault prolapse. Magnetic resonance imaging (MRI) revealed an anterior perineal hernia containing small bowel. Surgery was performed to close the pelvic floor defect through a perineal approach, and polypropylene mesh was used as a bolster. The hernial sac contained small bowel with very thin adhesions. Over 6 months of follow-up, there was no recurrence of the hernia or mesh complications. Perineal hernias after gynecological surgeries for benign diseases are rare. The indications for repair and the optimal surgical approach are not well described.

Primary invasive carcinoma of the vagina after Le Fort partial colpocleisis for stage IV pelvic organ prolapse: a case report

We present here the case report of a postmenopausal woman who complained of recurrent pus-like vaginal discharge and perianal pain 1year after Le Fort colpocleisis, which was subsequently identified as a primary invasive carcinoma of the vagina. Biopsy confirmed a squamous cell carcinoma in the vagina, and the disease was classified as stage III according to FIGO staging. The patient received pelvic radiotherapy. This case emphasizes that differential diagnosis of recurrent vaginal discharge that presents remote from obliterative procedure for pelvic organ prolapse should consider not only pyometra, but also other causes.

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Transvaginal needle suspension with lefort colpocleisis for stress incontinence and advanced uterovaginal prolapse in a high-risk patient

Surgical therapy in high-risk patients with advanced symptomatic pelvic floor defects sometimes mandates a compromise in the extent of proposed and desired repairs in favor of procedures that can be performed more rapidly. An 80-year-old woman with disabling genuine stress urinary incontinence and stage IV uterovaginal prolapse who was unable to retain a pessary was at high surgical risk due to ischemic heart disease. Uterovaginal prolapse was treated by LeFort partial colpocleisis, and stress urinary incontinence by transvaginal needle suspension with symptomatic cure and without significant perioperative morbidity. Operating time was 29 minutes and estimated blood loss was 50 ml. The patient was discharged on the second postoperative day with adequate spontaneous voiding and without urinary retention. A combination of partial colpocleisis with transvaginal needle suspension worked well in this case and may represent an effective and rapid surgical option for similar women.

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty: Denehy T.R.; Choe J.Y.; Gregori C.A.; Breen J.L.; Elkins T. USA Am. J. Obstet. Gynecol. 1995 173/6 (1697–1702)

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty: Denehy T.R.; Choe J.Y.; Gregori C.A.; Breen J.L.; Elkins T. USA Am. J. Obstet. Gynecol. 1995 173/6 (1697–1702)

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty

OBJECTIVE: Our purpose was to evaluate and compare the Le Fort partial colpocleisis and posterior colpoperineoplasty with conventional surgical repair in the medically compromised elderly population. STUDY DESIGN: A retrospective sequential series of 21 elderly women with complete uterovaginal prolapse and severe medical illnesses, having failure of conservative management, underwent a modification of the Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty. The patients' ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications, and follow-up were assessed and compared with those of a retrospective group of 42 women with complete uterovaginal prolapse who had a vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty performed by the same surgical team during the same period. RESULTS: The median age of Le Fort partial colpocleisis was 82 years (range 65 to 91 years), whereas median age in the vaginal hysterectomy group was 66 years (range 39 to 80 years) ( p < 0.00). The median time under anesthesia of Le Fort partial colpocleisis was 75 minutes (range 35 to 120 minutes) compared with the vaginal hysterectomy median time of 150 minutes (range 90 to 210 minutes) ( p < 0.00). The median hospital stay for both Le Fort partial colpocleisis and vaginal hysterectomy was 5 days (range. Le Fort partial colpocleisis 4 to 42 days, vaginal hysterectomy 4 to 14 days). The median decrease in hemoglobin in the Le Fort partial colpocleisis group was 2.2 gm/dl (range 0.2 to 3.6 gm/dl) and 2.8 gm/dl (range 0.9 to 4.5 gm/dl) ( p = 0.51). The complications were comparable with the exception of one postoperative death in the Le Fort partial colpocleisis group. A total of 95% ( 19 20 ) of Le Fort partial colpocleisis patients had excellent results with a median follow-up of 25 months (range 4 to 40 months). CONCLUSION: In this preliminary assessment the modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty offers significant advantages in a select population of elderly, medically compromised patients in whom conservative management is not feasible.