Telek Savci Bekir, St Martin Brad, Harmanli Oz
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT, USA.
Int Urogynecol J. 2025 Jan 28. doi: 10.1007/s00192-025-06041-0.
Perineorrhaphy with levator myorrhaphy is considered a standard part of colpocleisis. Typically, this is done through a separate incision after colpocleisis is completed. We present a video to demonstrate a modified approach to LeFort colpocleisis incorporating perineorrhaphy into the procedure.
A rectangular piece of anterior vaginal mucosa is dissected off the underlying fibromuscular tissue starting from 2-3 cm distal to the cervix and ending proximal to the urethrovesical junction. Similarly, a symmetrical posterior vaginal mucosa is dissected starting from the introitus and ending 2-3 cm distal to the cervix. The lateral edges of the rectangles between the anterior and posterior vaginal walls are sutured to create channels. The raw surfaces, including the fibromuscular tissue on the anterior and posterior vagina, are sutured to each other in three rows. Vaginal epithelium is closed continuously starting from the anterior wall and ending with posterior epithelium at the introitus.
Dissection of the anterior and posterior vaginal epithelium mimics standard colporrhaphy. The number of incisions and suturing is decreased by incorporating perineorrhaphy into colpocleisis. Sagittal closure with this technique restores the Aa point to a more anatomical position.
These modifications may decrease operative time and de novo stress incontinence and allow less experienced surgeons to consider colpocleisis. Our surgical approach, which incorporates perineorrhaphy into colpocleisis, enables easier adaptation to the procedure and may decrease de novo stress incontinence.
会阴修补术联合提肌修补术被认为是阴道封闭术的标准组成部分。通常情况下，这是在阴道封闭术完成后通过单独切口进行的。我们展示一段视频，以演示一种改良的LeFort阴道封闭术方法，即将会阴修补术纳入该手术过程。
从宫颈远端2 - 3厘米处开始，向尿道膀胱交界处近端方向，将一块矩形的阴道前壁黏膜从其下方的纤维肌肉组织上剥离。同样，从阴道口开始，向宫颈远端2 - 3厘米处方向，对称地剥离阴道后壁黏膜。将阴道前后壁之间矩形区域的侧边缝合以形成通道。包括阴道前壁和后壁的纤维肌肉组织在内的创面，分三排相互缝合。从阴道前壁开始连续缝合阴道上皮，在阴道口以阴道后壁上皮结束缝合。
阴道前后壁上皮的剥离类似于标准的阴道修补术。将会阴修补术纳入阴道封闭术可减少切口和缝合的数量。采用该技术进行矢状位缝合可使Aa点恢复到更符合解剖学的位置。
这些改良可能会减少手术时间和新发压力性尿失禁的发生，并使经验较少的外科医生也能考虑实施阴道封闭术。我们将会阴修补术纳入阴道封闭术的手术方法，使手术更容易实施，并且可能会减少新发压力性尿失禁的发生。
