A brief discussion, trying to make a case for more frequent use of Colpocleisis

1. • An Obsolete past OR the Next big thing?

2. Making a case for Colpocleisis
Ajay Dhawle
12.09.2017

3. • “Simple, Effective & Underutilized”

4. History
• (Greek) Kolpos: folds; Cleisis: closure
• 1823 Gerardin described denuding the anterior and posterior
vaginal wall at the introitus and suturing them
• Current technique: A modification of that first described in
1877 by Leon LeFort.
• LeFort’s Repair: Partial colpocleisis technique that left the
uterus in situ, after which a perineorrhaphy was performed 8
days postoperatively.
• His technique was based on the premise that apposition of
the vaginal walls could prevent uterine prolapse and that a
widened genital hiatus may lead to unsuccessful outcomes.

5. What is colpocleisis?

7. Pre-requisites
• NOT sexually active
• Stage 3-4 prolapse
• ?Failed pessary/ not suitable

8. Advantages
• Fairly simple: LA/ regional
• Quick: shorter operating times
• Low morbidity, faster recovery
• Low recurrence rates
• Gentler learning curve (vs SSF/Sacro-
colpopexy)

9. Outcomes
• Zebede et al reported a 98.1% anatomic
success (310 women) with a 92.9% patient
satisfaction.
• The complication rate was low (15.2%) and
the mortality rate was 1.3%.

10. Concerns
• Regret
• Body image
• Access to cervix/ uterus
• Pyometra
• Pelvic abscess
• Worsening of UI

11. • Multicenter study by Crisp et al, colpocleisis as a definitive
surgical intervention resulted in a positive impact on bowel,
bladder, and prolapse symptoms. A high rate of satisfaction
and low levels of regret were reported.
• (Crisp CC, Book NM, Smith AL, Cunkelman JA, Mishan V, Treszezamsky AD, et al.
Body image, regret, and satisfaction following colpocleisis. Am J Obstet Gynecol.
2013 Nov. 209(5):473.e1-7.)
• Ninety five percent of those patients reported that they were
either “very satisfied” or “satisfied” with the outcome of their
surgery
• Fitzgerald MP, Richter HE, Bradley CS, Ye W, Visco AC, Cundiff GW, et al. Pelvic
support, pelvic symptoms, and patient satisfaction after colpocleisis. Int
Urogynecol J Pelvic Floor Dysfunct. 2008 Dec. 19(12):1603-9.

12. • De novo or worsening urinary incontinence is one of the
drawbacks of colpocleisis. However, the same risk is present in
approximately 40% of women who undergo surgical
reconstructive procedures for POP without a continence
operation
• Albo ME, Richter HE, Brubaker L, et al, for Urinary Incontinence Treatment Network. Burch
colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med.
2007;356:2143–2155.

13. Post Colpocleisis cancer
• Cervical smears/ biopsies
• PMB
R Elkattah, A Brooks, and R K Huffaker, “Gynecologic
Malignancies Post-LeFort Colpocleisis,” Case Reports
in Obstetrics and Gynecology, vol. 2014,

14. Alternatives
Anatomical repair
• Surgically complex
• Recurrence
• Steep learning curve
• Complications
Pessary
• Also not compatible
with sexual intercourse
• Need for follow up/
replacement
• PV discharge/ bleeding
• Erosion/ incarceration/
fistulae
• Palliative rather than
curative
• Economic viability esp
over long term?
Surgical Fitness?

15. Why Colpocleisis makes sense?
• Ageing population
• Increasing co-morbidities
• Obviates need for F/U
• Economically viable
• Low recurrence/ Good satisfaction rates

16. •Sexual activity: women ages 57 to 64 = 62%
women ages 75 to 85 =17%
•(Hullfish KL, Bovbjerg VE, Steers WD. Colpocleisis for pelvic organ prolapse:
patient goals, quality of life, and satisfaction. Obstet Gynecol. 2007 Aug. 110(2 Pt
1):341-5)

17. Unanswered Questions
• ? Concomittant incontinence procedures
• ? Safety as a day case
• ? Routine hysterectomy prior to Colpocleisis

18. • Eastern philosophy of ‘Karma’
• ‘What goes around, comes around’

19. Thank you