Colpoclisis
Colpoclisis (LaFort surgery)
What the surgery is for:
Treatment of severe pelvic organ prolapse by completely closing the vaginal cavity. The surgery can be performed with or without a hysterectomy. It is suitable for older, non-sexually active women who are not candidates for further reconstructive surgery.
Surgical method (LaFort):
The surgery is performed through a vaginal approach, without opening the abdomen. Parallel squares of vaginal mucosa are removed/cut from the front and back. The denuded areas are sutured together, creating a central "septum" that closes the vagina. Narrow lateral channels are left for drainage of secretions or future uterine bleeding. The entire vagina is shortened and closed, and the prolapse is resolved.
Success rates:
In most assessments, the objective/subjective success of colpoclisis is high (success rates Technically ~90% to 100% for symptomatic prolapse. The rate of recurrence of significant prolapse requiring repeat intervention is relatively low (0–5%).
Regret rates:
The regret rates reported in the literature vary widely. Many studies report low regret (0–5%), but several long-term studies have found higher regret rates, up to ~12–13% in some groups, with regret often stemming from unresolved bowel/urinary problems or effects on body image. Loss of ability to have vaginal intercourse is rare as a source of regret.
Other complications and outcomes:
Serious complications are rare, infections and UTIs are the most common complications. Bladder/bowel injury is rare, often related to other procedures performed at the same time (e.g. mid-urethral sling).
Pros and cons and the moral dilemma:
Advantages
Brief analysis and relatively safe.
Suitable for women at high surgical risk (light/local anesthesia).
High success rates and significant relief of symptoms.
Disadvantages
Final elimination of the possibility of vaginal penetration, therefore not suitable for sexually active women.
Future difficulty in clarifying and diagnosing gynecological malignancies.
The ethical dilemma: to do good to the woman or is it a mutilation of the body?
On the one hand, this is a simple, effective solution that improves the quality of life for elderly and disabled women. On the other hand, this is an irreversible surgery that eliminates vaginal function, so full informed consent and understanding of the consequences must be ensured.
Summary:
Colpocoliosis is an effective tool, but requires precise patient selection, an open conversation about sexuality and future function, and full informed consent (including a discussion of the implications of the procedure on future diagnosis of malignant diseases). The chance of symptomatic correction is high (≈90–100%), and the chance of recurrence of prolapse or need for repeat surgery is low. Careful selection of cases is important, the surgery is mainly suitable for older women who are not sexually active and do not intend to resume sexual activity, or those with a high surgical risk.
