Colpoclesis (Le Fort Technique)-Treat Vaginal Vault Prolapse

Colpocleisis (Le Fort Technique) is a surgery to correct Vaginal Vault Prolepses. This is when the pelvic organ has (“fallen womb, bladder”, etc.) for women who do not desire future vaginal intercourse and/or are in poor general health.

In older woman who are no longer sexually active a simple procedure for reducing prolapse is a partial colpocleisis. The procedure was described by ‘Le Fort’ Technique and involves the removal of strip of anterior and posterior vaginal wall, with closure of the margins of the anterior and posterior wall to each other. This procedure may be performed whether or not the uterus and cervix are present. When it is completed, a small vaginal canal exists on either side of the septum, produced by the suturing of the lateral margins of the excision.

 

Before the Procedure

If you have any medical problems, make sure that you are cleared for surgery (medicine or anesthesia). Make sure you have all the necessary lab work, EKG, or chest x-rays done at least 3 days before surgery.

Make sure your physician knows what medications, including herbal supplements, you are currently taking. Some Medications need to be stopped for some time before the procedure. Women seeking care for pelvic floor symptoms should undergo a thorough evaluation before having surgery. Those with pelvic organ prolapse may have coexisting pelvic floor disorders that may include defecatory dysfunction or urinary symptoms such as stress incontinence. Patients must therefore be questioned about any associated bothersome urinary or bowel symptoms because this may affect surgical planning.

In addition, a thorough physical examination should be conducted. Typically, a speculum and bimanual examination are performed.

 

Colpoclesis (Le Fort Technique) Surgical Procedure

The surgery is performed by making an opening in the vagina and the tissue layer under the vaginal skin is reinforced with strong sutures in order to “fix the bulging”. The vaginal opening is also narrowed. The stitches will dissolve over a period of a

Few months and will not need to be removed.

Recovery

Colpoclesis (Le Fort Technique) this procedure requires only an overnight stay in the hospital; Patients typically stay within the hospital for 23-hour observation and are discharged on postoperative day 1. Prior to discharge, a voiding trial is performed.

For patients with preoperative urinary retention, the authors use a suprapubic catheter. Those going home with a catheter are given antibiotics to prevent infection and are seen in the office within 5-6 days for catheter removal and subsequent bladder challenge. Pain control is usually accomplished with oral medications. Patients are discharged home with ibuprofen and acetaminophen with hydrocodone.

A follow-up postoperative visit is scheduled at 2 weeks. At this time, uterine pathology is reviewed if the patient had concomitant cervical dilation and curettage. A postvoid residual is also assessed to evaluate for urinary retention. Patients then have subsequent visits at 6 weeks, 3 months, and 1 year, and as needed thereafter.

Risks

As with any surgery there are risks, however this procedure carries the lowest risks of complications than any other for prolapse.

What are possible risks from this surgery:

• Bleeding
• Infection
• Damage to bowel
• Difficulty with bowel movements
• Failure of the surgery
• Rare risks include:

Blood clot in the legs or lungs

Complications from anesthesia