Clinical outcomes of LeFort colpocleisis: a single-center experience from Turkey

  • Bekir Sitki Isenlik Antalya Training and Research Hospital, Department of Obstetrics and Gynecology, Antalya, Turkey
  • Bilgesu Cetinel Aygun Aydın Child and Women Hospital, Department of Obstetrics and Gynecology, Aydın, Turkey
  • Erinc Tekin Antalya Training and Research Hospital, Department of Obstetrics and Gynecology, Antalya, Turkey
  • Orkun Han Antalya Training and Research Hospital, Department of Obstetrics and Gynecology, Antalya, Turkey
  • Hasan Ali Inal Antalya Training and Research Hospital, Department of Obstetrics and Gynecology, Antalya, Turkey
Keywords: gynecologic surgical procedures;, pelvic organ prolapse;, quality of life;, surveys and questionnaires;, women

Abstract


Background/Aim. LeFort colpocleisis (LFC) is a procedure for treating pelvic organ prolapse (POP) in women. The aim of the study was to assess the sociodemographic characteristics, anatomical outcomes, satisfaction, and clinical outcomes of patients who underwent LFC for POP. Methods. The study retrospectively and consecutively included 103 patients who underwent LFC for stage III and stage IV POP between January 2010 and December 2022. The participants’ sociodemographic characteristics and clinical outcomes were documented. The Turkish version of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to determine quality of life. Results. The patients’ mean age was 73.1 ± 26.7 years, mean body mass index 27.4 ± 3.8 kg/m2, parity 4.8 ± 1.5, smoking rate 12.6%, POP quantification (POP-Q) stage III 30.1%, and POP-Q stage IV 69.9%. Their satisfaction rate results were 93.3%. Significant differences were observed in the preoperative period compared to the postoperative period in constipation (40.7% vs. 26.2%; p = 0.038), difficult defecation (22.3% vs. 8.7; = 0.012), fecal incontinence (18.4% vs. 7.7%; p = 0.039), stress urinary incontinence (25.2% vs. 4.8%; p < 0.001), urge incontinence (49.5% vs. 27.1%, p = 0.001), voiding dysfunction (37.8% vs. 23.3%; p = 0.002), and urinary retention (42.7% vs. 12.6%; p < 0.001). Postoperative PFDI-20 scores were also significantly lower compared to the preoperative period (57.19 ± 16.57 vs. 21.62 ± 6.96; p < 0.001). Conclusion. This study showed that LFC has been established as a surgical procedure with high anatomical success, high patient satisfaction rates, and minimal complications, especially in advanced POP with age-related comorbidities.

References

Wang X, Chen Y, Hua K. Pelvic Symptoms, Body Image, and Regret after LeFort Colpocleisis: A Long-Term Follow-Up. J Minim Invasive Gynecol 2017; 24(3): 415–9.

Inal HA, Kaplan PB, Usta U, Taştekin E, Aybatli A, Tokuc B. Neuromuscular morphometry of the vaginal wall in women with anterior vaginal wall prolapse. Neurourol Urodyn 2010; 29(3): 458–63.

Ng SC, Chen GD. Obliterative LeFort colpocleisis for pelvic organ prolapse in elderly women aged 70 years and over. Tai-wan J Obstet Gynecol 2016; 55(1): 68–71.

Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol 2006; 194(5): 1411–7.

Kaplan PB, Usta U, Inal HA, Tastekin E, Tokuc B. Neuromus-cular morphometry of the uterine ligaments and vaginal wall in women with pelvic organ prolapse. Neurourol Urodyn 2011; 30(1): 126–32. Erratum in: Neurourol Urodyn 2014; 33(8): 1281.

Blankenship L, Good MM, Smotherman C, Gautam S, Singh R. Risk factors predicting the loss of functional independence af-ter obliterative procedures for pelvic organ prolapse. Int Uro-gynecol J 2021; 32(2): 267–72.

Inal ZO, Inal HA. Comparison of abdominal, vaginal, and lap-aroscopic hysterectomies in a tertiary care hospital in Turkey. Ir J Med Sci 2018; 187(2): 485–91.

Abbasy S, Kenton K. Obliterative procedures for pelvic organ prolapse. Clin Obstet Gynecol 2010; 53(1): 86–98.

Catanzarite T, Rambachan A, Mueller MG, Pilecki MA, Kim JY, Kenton K. Risk factors for 30-day perioperative complications after Le Fort colpocleisis. J Urol 2014; 192(3): 788–92.

Reisenauer C, Oberlechner E, Schoenfisch B, Wallwiener D, Huebner M. Modified LeFort colpocleisis: clinical outcome and patient satisfaction. Arch Gynecol Obstet 2013; 288(6): 1349–53.

Haylen BT, Freeman RM, Lee J, Swift SE, Cosson M, Deprest J, et al. International Urogynecological Association (IU-GA)/International Continence Society (ICS) joint terminolo-gy and classification of the complications related to native tis-sue female pelvic floor surgery. Neurourol Urodyn 2012; 31(4): 406–14.

Wang X, Hu C, Chen Y, Hua K. LeFort colpocleisis for recur-rent pelvic organ prolapse. Int Urogynecol J 2020; 31(2): 381–4.

Ghezzi F, Uccella S, Cromi A, Bogani G, Candeloro I, Serati M, et al. Surgical treatment for pelvic floor disorders in women 75 years or older: a single-center experience. Menopause 2011; 18(3): 314–8.

Zebede S, Smith AL, Plowright LN, Hegde A, Aguilar VC, Davila GW. Obliterative LeFort colpocleisis in a large group of elder-ly women. Obstet Gynecol 2013; 121(2 Pt 1): 279–84.

Salvatore S, Siesto G, Rizk DE. Definition of recurrence of pel-vic organ prolapse: is it really important? Int Urogynecol J 2011; 22: 635–6.

Mettu JR, Colaco M, Badlani GH. Evidence-based outcomes for mesh-based surgery for pelvic organ prolapse. Curr Opin Urol 2014; 24(4): 370–4.

Dallas KB, Rogo-Gupta L, Elliott CS. What Impacts the All Cause Risk of Reoperation after Pelvic Organ Prolapse Re-pair? A Comparison of Mesh and Native Tissue Approaches in 110,329 Women. J Urol 2018; 200(2): 389–96.

Krissi H, Aviram A, Ram E, Eitan R, Wiznitzer A, Peled Y. Colpocleisis surgery in women over 80 years old with severe triple compartment pelvic organ prolapse. Eur J Obstet Gyne-col Reprod Biol 2015; 195: 206–9.

Wadsworth K, Lovatsis D. A qualitative study of women’s val-ues and decision-making surrounding LeFort colpocleisis. Int Urogynecol J 2020; 31(6): 1099–103.

Fitzgerald MP, Richter HE, Bradley CS, Ye W, Visco AC, Cundiff GW, et al. Pelvic support, pelvic symptoms, and patient satis-faction after colpocleisis. Int Urogynecol J Pelvic Floor Dys-funct 2008; 19(12): 1603–9.

Hullfish KL, Bovbjerg VE, Steers WD. Colpocleisis for pelvic organ prolapse patients goals, quality of life and satisfaction. Obstet Gynecol 2007; 110(2 Pt 1): 341–5.

Gutman RE, Bradley CS, Ye W, Markland AD, Whitehead WE, Fitzgerald MP. Effects of colpocleisis on bowel symptoms among women with severe pelvic organ prolapse. Int Uro-gynecol J 2010; 21(4): 461–6.

Published
2024/08/30
Section
Original Paper