Incorporating Perineorrhaphy into the LeFort Colpocleisis: A Modified Surgical Approach.

Abstract

Introduction and hypothesis: Perineorrhaphy with levator myorrhaphy is considered a standard part of colpocleisis. Typically, this is done through a separate incision after colpocleisis is completed. We present a video to demonstrate a modified approach to LeFort colpocleisis incorporating perineorrhaphy into the procedure.

Methods: A rectangular piece of anterior vaginal mucosa is dissected off the underlying fibromuscular tissue starting from 2-3 cm distal to the cervix and ending proximal to the urethrovesical junction. Similarly, a symmetrical posterior vaginal mucosa is dissected starting from the introitus and ending 2-3 cm distal to the cervix. The lateral edges of the rectangles between the anterior and posterior vaginal walls are sutured to create channels. The raw surfaces, including the fibromuscular tissue on the anterior and posterior vagina, are sutured to each other in three rows. Vaginal epithelium is closed continuously starting from the anterior wall and ending with posterior epithelium at the introitus.

Results: Dissection of the anterior and posterior vaginal epithelium mimics standard colporrhaphy. The number of incisions and suturing is decreased by incorporating perineorrhaphy into colpocleisis. Sagittal closure with this technique restores the Aa point to a more anatomical position.

Conclusion: These modifications may decrease operative time and de novo stress incontinence and allow less experienced surgeons to consider colpocleisis. Our surgical approach, which incorporates perineorrhaphy into colpocleisis, enables easier adaptation to the procedure and may decrease de novo stress incontinence.