Le Fort's procedure--an option for the aged

The changing demographics of the world's population will result in an increasing prevalence of pelvic organ prolapse and consequently a greater demand for healthcare services related to it. The objective of the study is to evaluate the efficacy of partial colpocleisis (Le Fort's operation) in a selected group of patients who are: (a) Not desirous of sexual function, (b) very elderly medically fragile, hence not fit for anaesthesia, (c) not fit for prolonged lithotomy position. After careful selection of cases 10 patients were included in the study from August 2005 to March 2006. USG(TVS) and cervical cytology were done to exclude any pathology. Partial colpocleisis was done under local anaesthesia with delayed absorbable sutures which closed the vagina from inside leaving drainage tracts on either side for egress of blood and cervicovaginal secretions postoperatively. A levator plication and high perineorrhaphy was also done. All patients(100%) had symptomatic relief. Only one patient (10%) had postoperative bleeding. Rest all had uneventful recovery. No recurrence of prolapse or SUI has developed till date. Operative time on average was 15 minutes. Hospital stay was 24 hours. Peroperative bleeding was negligible. Partial colpocleisis is an excellent operation for the treatment of pelvic organ prolapse (POP) for very selective group of patients. The advantage of the procedure lies in its simple technique, permanent cure, symptomatic relief and minimal surgical risk. Hence it can be done as a day care procedure at a very low cost.