Site-Specific Colpocleisis Called Superior Approach


ST. LOUIS — A unique approach to colpocleisis has been developed that incorporates vaginal repair of paravaginal defects, apposition of the pubocervical and rectovaginal septa, and minimal anatomical distortion.

“There is a place for this in your practice, and it is not hopelessly complicated,” Carl W. Zimmerman, M.D., said at the 14th International Pelvic Reconstructive and Vaginal Surgery Conference.

“We're relying on native endopelvic connective tissue to close the urogenital hiatus, which is unique in colpocleisis techniques,” said Dr. Zimmerman, professor of obstetrics and gynecology at Vanderbilt University, Nashville, Tenn.

The use of colpocleisis to correct advanced prolapse is certainly not for every woman, he stressed, since it permanently closes the vagina and therefore prevents coitus.

“This operation is not an option for the 11% of women with primary pelvic floor defects, or even for the 30% of patients who need a second corrective surgery. This is for the small percentage of physically active and relatively healthy individuals who have multiple recurrences or massive prolapse profoundly eroding their quality of life,” he said at the conference, sponsored by the Society of Pelvic Reconstructive Surgeons and Emory University.

Traditional colpocleisis closes the urogenital hiatus without specifically identifying the perivaginal endopelvic fascial septa, while using some degree of vaginectomy. This class of operation historically has been associated with failure because of the advanced degree of prolapse in the patients selected and the nonspecific operative technique, he added.

But Dr. Zimmerman has had no failures during 3 years of follow-up in the 15 patients he's treated using his site-specific technique.

“The unique part of this operation is that in other colpocleisis techniques the anterior and posterior vaginal walls are sutured together in a variety of ways, but there's no specific attempt to identify the fascial breaks and use those as a closure mechanism for the colpocleisis procedure,” he told this newspaper. This traditional approach results in a significant degree of anatomical distortion, which weakens the closure, Dr. Zimmerman explained.

With his site-specific technique, he said, “DeLancey level II lateral attachment is restored in the same way that it would be for a reconstruction, and the edges of the pubocervical and rectovaginal septa are then sutured together with permanent sutures. This technique occludes the urogenital hiatus in a site-specific fashion and eliminates vaginal depth. However, in the process, there is minimal anatomical disruption and maximal strength in the repair.”

This photo shows a patient with advanced pelvic organ prolapse.

This image shows the same patient after undergoing site-specific colpocleisis. Photos courtesy Dr. Carl W. Zimmerman