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Total colpocleisis for vaginal eversion

J O DeLancey1, G W Morley

  • 1Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, USA.

American Journal of Obstetrics and Gynecology
|June 1, 1997
PubMed
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Total colpocleisis effectively treats posthysterectomy vaginal eversion. This surgical technique offers a high success rate for vaginal vault prolapse, even in complex cases, with minimal incontinence issues when urethral support is addressed.

Area of Science:

  • Gynecology
  • Pelvic Reconstructive Surgery

Background:

  • Vaginal eversion, or vaginal vault prolapse, is a common complication after hysterectomy.
  • Many patients present with recurrent prolapse, extensive scarring, and ulceration, complicating treatment.
  • Associated pelvic floor dysfunction, including stress incontinence and poor urethral support, requires concurrent management.

Purpose of the Study:

  • To describe the technique of total colpocleisis for managing posthysterectomy vaginal eversion.
  • To present the surgical outcomes and complication rates associated with this procedure.
  • To evaluate the efficacy of total colpocleisis in resolving vaginal eversion and associated incontinence.

Main Methods:

  • A cohort of 33 women (aged 51-94 years) with posthysterectomy vaginal eversion underwent total colpocleisis.

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  • Many patients had a history of multiple prior prolapse surgeries.
  • Concurrent procedures included suburethral plication, needle suspension, pubovaginal sling, and perineorrhaphy to address urethral support and perineal defects.

    • Main Results:

    • The surgical procedure duration ranged from 30 to 205 minutes with an average blood loss of 206 ml.
    • No intraoperative complications were reported.
    • Postoperative follow-up averaged 35 months, with an initial cure rate of 100% for vaginal eversion. One recurrence was successfully re-treated. Four of five women with preoperative stress incontinence were cured.

    Conclusions:

    • Total colpocleisis is a safe and effective surgical option for selected patients with posthysterectomy vaginal eversion.
    • Addressing defective urethral support concurrently with colpocleisis minimizes the risk of postoperative incontinence.
    • This technique provides a durable solution for complex vaginal vault prolapse cases.