(Video Poster 36) Intraoperative Assessment During Reoperation for Lefort Colpocleisis Failure

Objectives: This video is a surgical case presentation that discusses patient assessment under anesthesia during reoperation for Lefort Colpocleisis failure. Specifically, it discusses tools that can be used to assess feasibility for vaginal hysterectomy, if desired by the patient or required due to patient pathology, and techniques when performing repeat Lefort Colpocleisis. Management options after Lefort Colpoclesis failure have been discussed, however intraoperative assessment after failure, including surgical tips and techniques have not been well-described.

Methods: Our patient is a 72-year-old female who presented to our office one year after LeFort Colpoclesis with pelvic pain and pressure. On exam she had near complete eversion of the vagina. She desired repeat surgery including hysterectomy, if possible. We first performed a vaginal exam under anesthesia, re-cannulating the lateral channels. We then performed cystoscopy and rectal exam to determine the relationship of the vaginal epithelium to the bladder and rectum. The bladder and rectum appeared to be in close proximity and a safe plane of entry to divide the vaginal epithelium was not easily discernible. Ultimately, given this assessment we did not feel that we could safely attempt hysterectomy. We decided instead to perform repeat Lefort Colpoclesis with high levatorplasty and perineorrhaphy. We were able to follow usual Lefort Colpoclesis technique and achieve a good anatomic outcome. The patient had an uncomplicated hospital course and was very pleased with the outcome of her surgery at her 6-week postoperative visit. Her pelvic pain had resolved.

Clinical Relevance: Vaginal hysterectomy may be feasible after Lefort Colpocleisis, however a thorough intraoperative assessment of the anatomy should be performed to ensure safety. This can be performed through vaginal and rectal exam under anesthesia with cystoscopy. If essential, one could consider using laparoscopic assistance to complete the hysterectomy. If hysterectomy is non-essential, repeat LeFort Colpocleisis with high levatorplasty with perineorrhaphy using usual technique is a preferred option to correct prolapse recurrence.