Colpocleisis - Procedure, Indications, Contraindications, and Complications

Introduction-

Colpocleisis, or vaginal closure surgery, is a surgical procedure to treat uterine or vaginal vault prolapse in women. In prolapse, pelvic floor muscles that support the uterus and other pelvic organs weaken, causing the uterus to drop down into the vagina, creating a bulge. Pelvic prolapse can generate a feeling of pressure or discomfort in the lower belly. In addition, they make urination and sexual intercourse painful.

What Is the Type of Surgery for Vaginal Vault Prolapse?

Surgery to treat prolapse is preferred when invasive treatments do not work well.

There are two main types of surgeries to treat uterine or vaginal vault prolapse:

• Obliterative or Occlusive Surgery: During this surgery, narrowing, shortening, or closure of the vagina is done to support the pelvic organs.

• Reconstructive Surgery: During this surgery, the uterus is removed by detaching it from the vagina, ovaries, fallopian tubes, surrounding blood vessels, and connective tissues. Most of the time, the cervix may be removed as well. All the other organs are repositioned into the pelvis, including the vagina.

Colpocleisis is a type of obliterative surgery that involves shortening the vaginal canal by stitching the front and back walls of the vagina, thereby providing support. The recovery after colpocleisis is faster because colpocleisis is less invasive and done through the vagina, but reconstructive surgery is done through an abdomen incision. It also has a high success rate, but it is usually reserved for older women because the vagina is too narrow to be able to have vaginal sex.

Is Colpocleisis a Major Surgical Procedure?

Yes. Colpocleisis, however, does not require as much time or invasion as reconstructive surgery. Colpocleisis takes approximately an hour. Surgery for reconstruction may require a maximum of five hours.

Is Colpocleisis Common?

According to research, people who are assigned female at birth and recognize themselves as women will require surgery for either POP (pelvic organ prolapse) or incontinence by the age of 80. POP is successfully treated with colpocleisis, frequently with no side effects.

How Is Colpocleisis Performed?

During Surgery

• Colpocleisis is performed under general anesthesia or spinal anesthesia.

• After the patient numbs, a catheter is placed in the bladder.

• During the surgery, the vaginal lining and the internal vaginal walls are sewn together, thus preventing the vagina from bulging out.

• The walls (front and back) of the vagina are sewn together, which pushes back the prolapsed organs and prevents them from falling back.

• Few sutures are made to narrow the vaginal opening, which prevents the recurrence of vaginal vault prolapse.

• During this surgery, no mesh is used.

• Any other surgery required to correct the pelvic floor prolapse is done along with colpocleisis, such as a hysterectomy or surgery to correct urinary incontinence.

• Then, using a small camera, the inside of the urinary bladder is checked for any damage made during surgery.

• If the uterus is still present, it is pulled above the stitches placed over the vagina.

• A small drainage tunnel is made for the drainage of blood and mucus.

After Surgery

• After the surgery, the patient is moved to the recovery room.

• The catheter will be removed, and the bladder will be tested for any issues with emptying it before the patient leaves the hospital.

• About 50 percent of women have issues emptying the bladder immediately after the surgery, but it is just a temporary issue. So, a catheter is placed before leaving the hospital, and the catheter is later removed.

• Antibiotics and painkillers would be prescribed.

• Bloody vaginal discharge may be experienced for a few days to weeks after the surgery. Wearing sanitary pads will be helpful.

• Patients can continue their daily activities a few days to a few weeks after the surgery after consulting their surgeon.

• Rigorous exercises or lifting heavy objects should be avoided for six weeks.

• It takes about six to eight weeks for complete recovery.

• Patients can urinate and pass stools generally after surgery, but vaginal intercourse would not be possible.

What Distinguishes a Total Colpocleisis from a Partial One (Le Fort)?

When individuals have colpocleisis, their pelvic organs protrude outside of the body and are stitched together by their healthcare provider. The surgery course will vary depending on whether the physician suggests a total or partial colpocleisis.

In total colpocleisis (complete colpocleisis), the walls of the vagina are stitched together from front to back. The pelvic organs that are drooping are pushed back into position by shortening the vaginal canal.

Similar to a total colpocleisis, a partial colpocleisis (Le Fort colpocleisis) results in a shorter vaginal canal. However, it forms two tiny tunnels in the vaginal canal that let bodily fluids escape the uterus through the vagina. Le Fort colpocleisis is the most suitable option for those still with uteruses.

To Whom Is the Colpocleisis Surgery Recommended?

• Colpocleisis is recommended when there is no improvement in prolapse symptoms with non-invasive treatments.

• Colpocleisis surgery is less invasive than reconstructive surgery and, therefore, is recommended in older women with a medical condition.

In Whom Is Colpocleisis Not Recommended?

Colpoclesis is not recommended for sexually active women because, after the surgery, the vagina will be just one inch long with a very narrow opening. This makes vaginal sex impossible. However, the labia and vulva, the outer side of the vagina, look the same. The changes are seen only in the inner side of the vagina. So external sexual stimulations such as primary organ arousal and stimulation of the clitoris are still possible after the surgery. A Pap test and examination of the cervix and uterus for yearly screenings are not possible after the surgery.

How Does the Recovery Happen?

Colpocleisis recuperation time is comparable to that of other vaginal procedures. The gynecologist can perform these procedures with minimally invasive techniques, so patients will probably be able to return home on the day of surgery.

What Are the Complications Related to Colpocleisis?

After the surgery, the patient can face a few complications, such as:

• Hematoma - It is the collection of blood formed under the vaginal tissues due to bleeding from the surfaces that have been sewn together. This can cause discomfort and pain, and can also become infected. Most hematomas will resolve after some time without any treatment. Rarely do the stitches need to be opened to allow a hematoma to drain.

• Constipation - It is a common short-term problem after surgery. The doctor may prescribe laxatives or stool softeners and suggest you follow a high-fiber diet and drink plenty of water.

• Bladder and Bowel Injury - These are rare complications of colpocleisis surgery. The risk of damage to the bladder is less than 1 in every 100 individuals. If damage occurs, it will be repaired while the patient is in surgery.

• Worsening or Persisting Problems With the Bladder or Bowels - Many women with pelvic floor prolapse also have issues with their bowel or bladder. Treatment for the prolapse bulge does not solve the problem. They may have issues like bladder leakage, coughing, sneezing, and laughing, which might worsen.

• Bleeding - If excessive bleeding after the surgery, the patient may need a blood transfusion.

• Feeling Regret - During colpocleisis, the vagina is closed, after which sexual intercourse is not possible. Few women later regret having colpocleisis done. However, about 5 percent of women regret doing this surgery.

Conclusion

Colpocleisis is a minimally invasive surgery for internal vaginal canal closure to correct pelvic organ prolapse in sexually inactive older women. The success rate for this surgery is more than 95 percent. The main drawback of the surgery is that sexual intercourse and pelvic examinations are not possible after surgery.