Modified Lefort partial colpocleisis
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IUJ VIDEO
Modified Lefort partial colpocleisis Hongtao Lv 1 & Fengnian Rong 1 Received: 17 July 2020 / Accepted: 21 September 2020 # The Author(s) 2020
Abstract Introduction and hypothesis We present a surgical video that describes the technical considerations for performing a modified LeFort partial colpocleisis. Methods Hydro-dissection with diluted pituitrin was performed before the creation of anterior and posterior mid-line incisions through which lateral flaps were created bilaterally to expose the bladder and rectum fascia. Several purse-string sutures were placed to push the bladder and rectum back to their normal positions and reinforce the fascia under the vaginal wall. After removing the excess part of the vaginal wall, the lateral margins were re-approximated to create lateral channels that were wide enough to fit one finger. Perineoplasty was then performed to reduce the length of the genital hiatus. Results The procedure was performed in a 76-year-old woman with stage III vaginal vault prolapse (POP-Q C + 2), stage IV anterior prolapse (POP-Q Ba+5), stage II posterior prolapse (POP-Q Bp-1), and mild occult stress urinary incontinence. The patient recovered well postoperatively, without recurrent prolapse and/or stress incontinence during 6 months of follow-up. Conclusions Our modified technique used traditional suture methods to strengthen the bladder and rectum fascia, keeping most of the vaginal wall to create a solid longitudinal septum in the center of the vagina that supported the vaginal vault. Keywords Pelvic organ prolapse . LeFort colpocleisis . Vaginal vault prolapse
Introduction Pelvic organ prolapse (POP) is very common. It is estimated that nearly 50% of women will develop some form of POP, and 10–20% of these women seek medical assistance [1]. Surgical treatment options for POP are classified as either reconstructive or obliterative techniques. For older women who do not seek to maintain coital function, the LeFort partial colpocleisis is a representative obliterative surgical technique used for frail, older women with advanced apical POP who are inappropriate candidates for vaginal reconstructive surgery Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04545-5) contains supplementary material. This video is also available to watch on http://link.springer. com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’. * Fengnian Rong [email protected] 1
Department of Gynecology and Obstetrics, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
[2]. The reported rate of POP recurrence after LeFort partial colpocleisis is 4.2% [3]. It has been speculated that the main risk factors for recurrence are an increased postoperative vaginal length and a wide vaginal hiatus [4]. Herein, we describe our modified LeFort partial colpocleisis technique for POP, which strengthens the pelvic floor on three levels [5].
Methods A 76-
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