Notes
Comprehensive Gynecology (4th ed.). Stenchever-Droegermueller. pp. 580–581.
Tests and procedures involving the female reproductive system | |||||||||||
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| Ovaries | |||||||||||
| Fallopian tubes | |||||||||||
| Uterus |
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| Vagina | |||||||||||
| Vulva | |||||||||||
| Medical imaging | |||||||||||
| Colpocleisis | |
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| Specialty | Gynaecology |
Colpocleisis (Ancient Greek: kolpos, meaning "hollow" + cleisis, meaning "closure") is a surgical procedure involving closure of the anterior and posterior vaginal walls. It is indicated in women with recurrent or severe pelvic organ prolapse who no longer desire penetrative vaginal sexual intercourse. [1]
In 1867, Neugebauer of Warsaw performed the first colpocleisis, which was introduced as a treatment for pelvic organ prolapse. Ten years later, LeFort of Paris performed the next colpocleisis and published his findings. The original procedure did not involve a hysterectomy. [2] LeFort described a partial colpocleisis, which involves the removal of the epithelial layer 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 in order to create drainage tunnels if the uterus is preserved. [2]
The most common indication for colpocleisis is pelvic organ prolapse. There are both reconstructive and obliterative surgical options for pelvic organ prolapse. Reconstructive surgery options include mesh-augmented procedures and native tissue repairs, whereas obliterative surgery such as colpocleisis is often considered in elderly patients with no desire for sexual activity. [2]
Indications for colpocleisis include: severe pelvic organ prolapse not relieved by conservative methods, patients who cannot tolerate reconstructive surgery, patients who no longer plan to have vaginal intercourse [3]
For patients with complete uterine prolapse who still have their uterus and are not interested in continued sexual function, partial colpocleisis is indicated. For patients with pelvic organ prolapse who have already had their uterus removed (post-hysterectomy) and are not interested in continued sexual function, complete colpocleisis is indicated. If the vagina is completely everted, then total colpectomy and complete colpocleisis is the first-line procedure indicated. [4]
Before surgery, a pap smear, transvaginal ultrasound, and endometrial biopsy are usually obtained. Gynecologic surgeries lasting greater than 30 minutes should also include venous thromboembolism prophylaxis with low molecular weight heparin or unfractionated heparin to help prevent clot formation. [5] Preoperative bowel preparation with antibiotics may lower infection rates for colorectal surgery, but this has not been effectively proven for use in gynecologic surgery and is therefore not indicated. [5] Preoperative assessment for urinary stress incontinence is also performed.
For a partial colpocleisis, the cervix is pulled outward on traction and the vagina is everted. The vagina is then injected with local anesthetic and a Foley catheter is placed into the urethra. With a marking pen, a rectangle is drawn on both the anterior and posterior vaginal walls to identify the areas to be removed. Using sharp dissection, the anterior and posterior vaginal wall epithelial layers are then removed. The cut edges of the anterior and posterior vaginal walls are sewn together and the vagina is then inverted back to normal anatomical position. Once the vagina is inverted, the top and bottom margins are sewn together. [4]
For a complete colpocleisis, the most prominent portion of the prolapse is clamped and injected with local anesthetic. An incision is made around the base of the prolapse. With a marking pen, the segments of vagina that will be removed are marked out. The vaginal epithelium is then removed sharply, while keeping the majority of the muscularis layer of the vaginal wall intact. Sutures are then placed in a purse-string fashion and the vagina is inverted back to normal anatomical position. [4]
After surgery, the patient is typically kept overnight in the hospital. The patient should be encouraged to walk and move around early, to help prevent the formation of blood clots. The patient should also avoid heavy lifting for at least 6 weeks post-operatively to help prevent pelvic organ prolapse from recurring. [5]
Comprehensive Gynecology (4th ed.). Stenchever-Droegermueller. pp. 580–581.
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