Published in:
01-06-2020 | Enterocele | IUJ Video
Colpocleisis with a skin flap
Published in: International Urogynecology Journal | Issue 6/2020
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Introduction and hypothesis
Pelvic organ prolapse is a common problem affecting up to 50% of women over the age of 50. The various methods of reconstructive pelvic organ prolapse surgery have been reported to be associated with long-term recurrence rates of up to 50%.
Methods
Management of patients with repeated failure of different surgical procedures is often challenging. Obliterative surgery can be an option for women with a POP-Q stage 2 or larger genital prolapse who are not sexually active. The video of the procedure shows how to address enterocele with frail and puffy vaginal epithelium of the posterior vaginal wall after unsuccessful surgery procedures by employing a perineal skin flap. The repeated enterocele was treated by using a skin flap during a LeFort colpocleisis, and Labhard perineoplasty was added.
Results
In some patients obliterative surgery may fail, especially those with recurrent POP. The use of a perineal skin flap in reoperation of POP is a possible solution for surgical treatment of recurrent enterocele with poor quality of the posterior vaginal wall. This patient’s postoperative course was uneventful. At her follow-up visit 2 months later an examination revealed excellent healing.
Conclusion
Obliterative surgery can be an option for women with large prolapses who are not sexually active and do not plan to be so in the future. Le Fort with perineal skin flap and Labhard high perineoplasty is one possible surgical technique which can treat recurrent pelvic organ prolapse in older patients where previous procedures have failed.