Vaginal obliteration procedure without mucosal denudation: Simple colpocleisis

Abstract

For the patients with pelvic organ prolapse (POP) who are not sexually active, vaginal obliterative procedure (colpocleisis) is an excellent surgical technique with less recurrence without using a mesh—it can be performed under local anesthesia even in cases with high risk of complications. There are two types of vaginal closure: complete vaginal closure and partial vaginal closure (LeFort surgery); both procedures require vaginal mucosa dissection. We report a novel vaginal obliteration procedure without removing the vaginal mucosa for the POP patient with unstoppable anticoagulants. We named the procedure Simple Colpocleisis. Local anesthesia was implemented in both the anterior and the posterior vaginal wall, and transverse incisions were made in both sides. First, the proximal side (uterine side) of the anterior wall and the posterior wall’s incisions were sutured. Next, the distal side (perineal side) of the anterior wall and the posterior wall’s incisions were sutured to close the vaginal canal without removing the vaginal mucosa. Because of local anesthesia, the patient was able to walk immediately after surgery and was discharged the day after surgery. Colpocleisis is an effective procedure for POP patients who do not anticipate sexual intercourse but (both complete and partial) colpocleisis requires removal of the vaginal mucosa. We performed a simple vaginal closure by simple incision and suturing of the anterior and the posterior vaginal walls without removing the vaginal mucosa. This procedure is simpler than a conventional vaginal closure and has less risk of bleeding and postoperative hematoma. Although the long-term prognosis is unknown, we presume that our simple colpoclesis procedure can be an effective procedure for POP patients with multiple complications.