Abstract
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.
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References
Samuelsson EC, Arne Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180:299–305.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgical managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.
Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6.
Dällenbach P. To mesh or not to mesh: a review of pelvic organ reconstructive surgery. Int J Women's Health. 2015;7:331–43.
Ricci JV. Chapter 7, part 3: Gynaecological surgery and instruments of the renaissance period. In: The development of Gynaecological surgery and instruments. 1st ed. Philadelphia, PA: The Blakinson Company; 1949:417–441.
Dessie SG, Shapiro A, Haviland MJ, Hacker MR, Elkadry EA. Obliterative versus reconstructive prolapse repair for women over 70—is there an optimal approach? Female Pelvic Med Reconstr Surg. 2017;23(1):23–6.
Mikos T, Chatzipanteli M, Grimbizis GF, Tarlatzis BC. Enlightening the mechanism of POP recurrence after LeFort colpocleisis. Case report and review. Int Urogynecol J. 2017;28:971–8.
Zebede S, Smith AL, Plowringht LN, Hedge A, Aguilar VC, Davila GW. Obliterative LeFort colpocleisis in a large group of elderly women. Obstet Gynecol. 2013;121(2 Pt 1):279–84.
Buchsbaum GM, Lee TG. Vaginal Obliterative procedure for pelvic organ prolapse: a systematic review. Obstet Gynecol Survay. 2017;72:175–83.
Linder BJ, Gebhart JB, Occhino JA. Total colpocleisis: technical considerations. Int Urogynecol J. 2016;27:1767–9.
FitzGerald MP, Richter HE, Siddique S, Thompson P, Zyczynski H, Weber A. Colpocleisis: a review. Int Urogynecol J. 2006;17:261–71.
Jones K, Wang G, Romano R, St Marie P, Harmanli O. Colpocleisis: a survey of current practice patterns. Female Pelvic Med Reconstr Surg. 2017;23:276–80.
Knapstein PG, Friedberg V, Sevin BU. Reconstructive Surgery in Gynecology. Stuttgart: Georg Thieme Verlag, 1990, p.281. ISBN. 978-3137495017.
Van Huisseling JCM. A modification of Labhardt’s high perineoplasty for treatment of pelvic organ prolapse in the very old. Int Urogynecol J. 2009;20:185–91.
Pizarro-Berdichevsky J, Galleguillos G, Cuevas R, Blümel B, Pattillo A, Gonzales S, et al. Labhardt’s colpoperineocleisis: subjective results of an alternative treatment for genital prolapse in patients who are not sexually active: 2-year follow-up. Int Urogynecol J. 2014;25:417–24.
Pope RJ, Brown RH, Chipungu E, Hollier LH Jr, Wilkinson JP. The use of Singapore flaps for vaginal reconstruction in women with vaginal stenosis with obstetric fistula: a surgical technique. BJOG. 2018;125:751–6.
Martan A, Svabik K, Zamecnik L, Masata J. Surgical management of recurrent urethrovaginal fistula with a skin island flap. Int Urogynecol L. 2019;30:839–41.
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This work was supported by Charles University in Prague UNCE 204024.
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Martan, A., Svabik, K., Masata, J. et al. Colpocleisis with a skin flap. Int Urogynecol J 31, 1273–1276 (2020). https://doi.org/10.1007/s00192-019-04178-3
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DOI: https://doi.org/10.1007/s00192-019-04178-3