LeFort Colpocleisis

As a result of the aging of our population, there has been a reported increase in the number of obliterative vaginal procedures being performed for vaginal vault prolapse. Many women of advanced age are not, and will not be, sexually active, and therefore, the simplicity, effectiveness, and low associated morbidity of the LeFort colpocleisis offers a very attractive treatment option. We perform this procedure under spinal or local anesthesia, thus reducing morbidity rates. Preoperative surgical clearance is of great important in these elderly patients.6 Preparation with local estrogen cream is also important.

Our surgical technique entails denuding a rectangular segment of the anterior and posterior vaginal walls. The rectangles are then approximated to each other such that when the prolapse is reinserted into the vaginal canal, the rectangles are sutured to each other (Figure 8-2.6). If an anti-incontinence procedure is necessary, it is performed before completion of closure of the vaginal defect. A peri-neoplasty is a very important part of the surgical procedure in order to decrease the strain on the superior sutures. We perform a tight perineoplasty with resultant exposure limited to the urethral meatus.

In a multicenter series of 224 patients with a mean age of 78.3 years (range, 61-92), the success rate for vaginal prolapse was 96.4%, with four wound breakdowns and four recurrent rectoceles.7 There was no perioperative mortality. This surgery seems to carry the highest degree of satisfaction for patients who undergo the procedure. However, preoperative counseling is of critical importance because of the postoperative inability to have sexual activity.

Figure 8-2.6. LeForte colpocleisis entails suturing the posterior and anterior vaginal walls to each other in order to obliterate the vaginal canal.

Figure 8-2.6. LeForte colpocleisis entails suturing the posterior and anterior vaginal walls to each other in order to obliterate the vaginal canal.

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