Themistoklis Mikos1, Mariliz Chatzipanteli2, Grigoris F Grimbizis2, Basil C Tarlatzis2. 1. Unit of Urogynecology, 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papagheorgiou General Hospital, Thessaloniki, Greece. themis.mikos@gmail.com. 2. Unit of Urogynecology, 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papagheorgiou General Hospital, Thessaloniki, Greece.
Abstract
INTRODUCTION AND HYPOTHESIS: Obliterative procedures for the treatment of pelvic organ prolapse have been reported to have a recurrence rate up to 10%. We present (1) a case report of a patient with prolapse after LeFort colpocleisis and how it was managed in our department, and (2) a review of the literature regarding the types of recurrence after LeFort colpocleisis, their rate and their treatment. METHODS: A 77-year-old woman was treated in our department for recurrence of prolapse through the right lateral channel 6 months after LeFort colpocleisis. A systematic review of the literature up to 2016 was performed through MEDLINE, Web of Science and the Cochrane Library. RESULTS: The patient underwent a modified repeat colpocleisis and 6 months later was doing well with no signs of recurrence. We found 28 eligible studies including 1,810 patients, and the rate of recurrence after LeFort colpocleisis was 4.2% (76/1,810) leaving the majority of patients very satisfied. Information about the management of recurrence of prolapse after LeFort colpocleisis was provided in 17 studies including 33 patients with a 60-month follow-up. It appears that there are three major categories of recurrent prolapse after LeFort partial colpocleisis: (1) patients with a total breakdown of colpocleisis (57.6%), (2) patients with "channel prolapse" (15.2%), and (3) patients with prolapse at sites not involved in the primary partial colpocleisis (27.3%). The most frequent treatments were total colpocleisis/colpectomy (27.3%), perineorrhaphy and posterior repair (9.1%) and hysterectomy (9.1%). Almost 50% of these patients opted not to have surgical treatment. CONCLUSIONS: The rate of prolapse recurrence after LeFort colpocleisis is estimated to be 4.2%. The management of recurrences after LeFort colpocleisis depends on the time and type of recurrence. The repeat modified LeFort colpocleisis is a viable option in patients with channel prolapse; if no uterus exists, colpectomy appears to be the best option.
INTRODUCTION AND HYPOTHESIS: Obliterative procedures for the treatment of pelvic organ prolapse have been reported to have a recurrence rate up to 10%. We present (1) a case report of a patient with prolapse after LeFort colpocleisis and how it was managed in our department, and (2) a review of the literature regarding the types of recurrence after LeFort colpocleisis, their rate and their treatment. METHODS: A 77-year-old woman was treated in our department for recurrence of prolapse through the right lateral channel 6 months after LeFort colpocleisis. A systematic review of the literature up to 2016 was performed through MEDLINE, Web of Science and the Cochrane Library. RESULTS: The patient underwent a modified repeat colpocleisis and 6 months later was doing well with no signs of recurrence. We found 28 eligible studies including 1,810 patients, and the rate of recurrence after LeFort colpocleisis was 4.2% (76/1,810) leaving the majority of patients very satisfied. Information about the management of recurrence of prolapse after LeFort colpocleisis was provided in 17 studies including 33 patients with a 60-month follow-up. It appears that there are three major categories of recurrent prolapse after LeFort partial colpocleisis: (1) patients with a total breakdown of colpocleisis (57.6%), (2) patients with "channel prolapse" (15.2%), and (3) patients with prolapse at sites not involved in the primary partial colpocleisis (27.3%). The most frequent treatments were total colpocleisis/colpectomy (27.3%), perineorrhaphy and posterior repair (9.1%) and hysterectomy (9.1%). Almost 50% of these patients opted not to have surgical treatment. CONCLUSIONS: The rate of prolapse recurrence after LeFort colpocleisis is estimated to be 4.2%. The management of recurrences after LeFort colpocleisis depends on the time and type of recurrence. The repeat modified LeFort colpocleisis is a viable option in patients with channel prolapse; if no uterus exists, colpectomy appears to be the best option.
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