Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty

OBJECTIVE: Our purpose was to evaluate and compare the Le Fort partial colpocleisis and posterior colpoperineoplasty with conventional surgical repair in the medically compromised elderly population. STUDY DESIGN: A retrospective sequential series of 21 elderly women with complete uterovaginal prolapse and severe medical illnesses, having failure of conservative management, underwent a modification of the Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty. The patients' ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications, and follow-up were assessed and compared with those of a retrospective group of 42 women with complete uterovaginal prolapse who had a vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty performed by the same surgical team during the same period. RESULTS: The median age of Le Fort partial colpocleisis was 82 years (range 65 to 91 years), whereas median age in the vaginal hysterectomy group was 66 years (range 39 to 80 years) (p < 0.00). The median time under anesthesia of Le Fort partial colpocleisis was 75 minutes (range 35 to 120 minutes) compared with the vaginal hysterectomy median time of 150 minutes (range 90 to 210 minutes) (p < 0.00). The median hospital stay for both Le Fort partial colpocleisis and vaginal hysterectomy was 5 days (range, Le Fort partial colpocleisis 4 to 42 days, vaginal hysterectomy 4 to 14 days). The median decrease in hemoglobin in the Le Fort partial colpocleisis group was 2.2 gm/dl (range 0.2 to 3.6 gm/dl) and 2.8 gm/dl (range 0.9 to 4.5 gm/dl) (p = 0.51). The complications were comparable with the exception of one postoperative death in the Le Fort partial colpocleisis group. A total of 95% (19/20) of Le Fort partial colpocleisis patients had excellent results with a median follow-up of 25 months (range 4 to 40 months). CONCLUSION: In this preliminary assessment the modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty offers significant advantages in a select population of elderly, medically compromised patients in whom conservative management is not feasible.