Colpocleisis (Lefort Procedure)
Ambulatory vaginal procedure to treat complete prolapse
When patients have a uterine prolapse or vaginal vault prolapse such that the cervix or vagina apex descends past the introitus or vaginal opening there obviously has been a loss of support to this area. In a healthy, sexually active woman the vagina may be surgically attached to the sacrospinous ligament, sacrum or fascia support system, typically with the use of mesh. Although these reconstructive techniques are effective, they can be associated with occasional serious complications such as severe hemorrhage or major nerve injury or graft complications.
In those frail elderly women who do not wish to be sexually active in the future we have found that total colpocleisis is a simple, safe, and effective surgical procedure that reliably relieves these women of their symptoms without the potential hazards of vaginal suspension. The procedure is called a total colpocleisis for patients who do not have a uterus and have complete vaginal vault prolapse and a Lefort colpocleisis for patients who still have a uterus. Total colpocleisis procedure is often coupled with a sling procedure for urinary incontinence such as the TVT sling, TOT sling, or Mini-sling. Dr. Miklos and Dr. Moore were the first surgeons to report on coupling these two procedures in elderly patients utilizing local anesthesia. The colpocleisis procedure is done through the vagina and essentially closes the vaginal walls together on the inside. The patient can no longer engage in sexual intercourse due to the closing up of the vagina, however the vagina looks completely normal from the outside. Colpocleisis is an extremely effective operation which:
- Closes down the vaginal canal, thus preventing prolapse.
- Inhibits a patient from future sexual intercourse
- 90-95% cure rate
- Is performed using local anesthesia, epidural, spinal
- Has no need for General anesthesia
- Takes 30-45 minutes to perform
- Minimal pain or complications
- Rapid recovery with very little downtime
- Can be coupled with sling (incontinence) procedures
Colpocleisis is an excellent operation for the treatment of uterine prolapse or complete vaginal vault prolapse for patients that are:
- Not sexually active
- Have no future plans for sexual activity
- Medically fragile
Dr Miklos and Moore have found Colpocleisis to be an excellent option for elderly women that have large prolapse that are not sexually active and have no desire to be in the future. The alternative to this procedure is to use a pessary (rubber vaginal insert to hold prolapse in place)((link to pessary section here)) which in many cases is not tolerated by women or does not work versus a complete reconstructive procedure using mesh grafts which done vaginally or laparoscopically is a much larger surgery with higher rates of complications and longer recovery. Dr Moore and Miklos have successfully treated women with this procedure that have been up to 95 years of age with very low rates of complications. Of course any surgery has risks, however this procedure carries the lowest risks of complications than any other for prolapse.