The le fort colpocleisis: An analysis of 43 operations

Colpocleisis: a review

“…In one of the three cases, failure was attributed to the omission of concomitant perineorrhaphy. Subsequent case reports of the LeFort technique included modifications such as making the lateral channels smaller to allow greater apposition of the anterior and posterior vagina and to prevent recurrent prolapse [10], use of different suture material [7], plication of the levator ani muscle and fascia in the midline along with perineorrhaphy [6], cervical amputation [15], and attention to vaginal dissection toward the external urethral meatus [15,16].…”

“…Restriction of the genital hiatus was initially added to reduce the risk of prolapse recurrence and later advocated to purportedly reduce the risk of iatrogenic stress urinary incontinence symptoms [15]. Concurrent levator myorrhaphy, pubococcygeus plication, and/or high perineorrhaphy [22,[26][27][28][29]36] have been described as a means of reducing the genital hiatus and reinforcing posterior support (Fig.…”

“…Urinary incontinence has been reported as a common complication after colpectomy [15,16,30,33,35,37] but there are few reports that quantify this. Hoffman [35] reported that mixed incontinence was a new symptom in three of 27 (11%) patients, who had either no urinary symptoms or who had urinary retention before colpocleisis.…”

“…Early authors focused on modifying the LeFort colpocleisis to reduce the rate of de novo stress incontinence. These modifications included moving the anterior edge of the colpectomy at least 1.5 cm away from the urethral meatus [15,16] and increasing urethral support through posterior reinforcement by levator myorrhaphy and high perineorrhaphy [8,16,28,38]. More recent series describe the combination of colpocleisis with procedures for treatment of stress incontinence.…”