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Colpocleisis (Le Fort and Total)

Colpocleisis is an obliterative vaginal operation for advanced pelvic organ prolapse (POP), primarily in elderly women who no longer desire vaginal intercourse. It corrects prolapse by repositioning pelvic viscera and closing off the vaginal canal — partially (Le Fort, uterus retained) or totally (post-hysterectomy colpectomy). The operation is short, low-morbidity, and produces among the highest success rates of any POP repair.[1][2][3]

For the broader prolapse decision framework, see Prolapse Repair. For the McCall culdoplasty performed at concomitant hysterectomy in selected colpocleisis cases, see McCall Culdoplasty. Concurrent SUI procedures are covered in the Female Stress Incontinence Database.

Definitions​

The operation has several variants — same indication, same outcomes, different technical detail driven by whether the uterus is in situ.[1]

VariantUterusDescription
Le Fort (partial) colpocleisisIn situStrips of epithelium denuded from anterior and posterior vaginal walls, then sutured together; lateral channels preserved for drainage of cervical secretions[3]
Total colpocleisis (colpectomy)Absent (post-hysterectomy)Entire vaginal epithelium denuded; serial purse-string sutures invert the vagina[3]
Rouhier's colpocleisisRemoved at the same operationVaginal hysterectomy first, followed by total-style obliterative closure[1][8]

The intended endpoint is a well-approximated, obliterated vagina ~3 cm deep and ~1 cm wide. Levator myorrhaphy and perineorrhaphy are typically performed concurrently to reinforce the repair.[1]

Indications and Patient Selection​

ACOG PB 214 lists colpocleisis as appropriate for women with POP who have significant comorbidities, wish to avoid hysterectomy, and no longer desire vaginal coital function.[3]

CriterionDetail
StageStage III–IV; > 90% of published series have stage ≥ 3[5]
AgeMean 69–84 yr in published series[5]
Coital functionPatient (and partner if applicable) must accept that the procedure is irreversible and eliminates vaginal intercourse[3][2]
FrailtyDominant predictor of perioperative complications — better than age alone[7]
AnestheticCan be performed under local anesthesia + IV sedation in selected patients[6]

Shorter operative time, smaller anesthetic burden, and lower perioperative morbidity make colpocleisis particularly suited to medically frail patients vs reconstructive alternatives.[2]

Preoperative Evaluation​

  • Occult SUI. All women with significant apical or anterior prolapse should undergo cough stress test or urodynamic testing with prolapse reduced — prolapse may mask SUI by kinking the urethra.[3]
  • Cervical and endometrial evaluation (Le Fort only). Document normal cervical cytology, HPV testing, and endometrial sampling preoperatively because the uterus will be inaccessible postoperatively.[3]
  • Frailty assessment. Frail patients have significantly higher overall (23.3% vs 10.3%) and serious (5.0% vs 1.8%) complication rates than non-frail.[7]

Surgical Technique​

Shared technical principles​

  • Hydrodissection with lidocaine + epinephrine (or dilute vasopressin) submucosally — facilitates dissection, provides hemostasis, and develops the epithelial-muscularis plane.[2][6]
  • Push-spread technique with Metzenbaum scissors — push and spread the tissue plane rather than cutting blindly; minimizes bleeding and inadvertent injury.[1]
  • Allis clamps with rubber bands on hemostats for retraction in the confined field.[1]
  • Critical landmark: dissection must not pass distal to the urethrovesical junction — risks urethral angulation and postoperative voiding dysfunction.[1]
  • Meticulous hemostasis at every layer — eliminates dead space and prevents hematoma.[2][6][7]
  • Transverse epithelial closure of the introitus is standard.[2][6]

Le Fort (partial) colpocleisis — step-by-step​

The uterine-sparing operation; creates a midline septum by suturing denuded anterior and posterior walls together with lateral drainage channels for cervical secretions.[1][2]

  1. Hydrodissection. Submucosal lidocaine + epinephrine (or pituitrin / vasopressin) into anterior and posterior walls.[2][3]
  2. Mark and denude epithelium. Electrosurgery to mark rectangular patches centered on the midline anteriorly and posteriorly, leaving lateral epithelial strips intact (these become the drainage channels).[1]
  3. Excise sharply with the push-spread technique. Stop proximal to the urethrovesical junction.[1]
  4. Proximal closure (cervical inversion). Re-approximate the proximal margins of the anterior and posterior denuded rectangles with absorbable sutures, inverting the cervix back into the canal.[2]
  5. Bilateral lateral channels. Suture the lateral margins of the anterior and posterior rectangles together on each side, creating bilateral tunnels. Channels should admit one finger to confirm patency.[1][2][3]
    • Vessel-loop technique (Dessie 2015): a blue vessel loop placed across the cervix and threaded through each lateral channel during suturing — pulled through after closure to confirm patency.[14]
    • Alternatively, a urinary catheter placed within the lateral tunnels during suturing.[1]
  6. Serial plication. Plicate anterior and posterior denuded muscularis surfaces together with serial rows of interrupted or figure-of-eight absorbable sutures, progressively reducing the prolapse from proximal to distal — each row inverts the walls further, telescoping the prolapse into the pelvis.[2]
  7. Distal epithelial closure. Bring distal vaginal epithelial edges together; close transversely with absorbable suture.[2][6]

Total colpocleisis (colpectomy) — step-by-step​

For post-hysterectomy vault prolapse — the entire vaginal epithelium is removed circumferentially.[1][6]

  1. Hydrodissection. Circumferential lidocaine + epinephrine submucosally.[6]
  2. Quadrant epithelial denudation. Sharp dissection in four quadrants (anterior, posterior, right lateral, left lateral). For ulcerated mucosa, the friction of a sharp-edged knife on remaining non-eroded areas can be used.[6][7]
  3. Serial purse-string reduction. Concentric purse-string sutures of absorbable material from the apex (cuff) distally; each tied down sequentially to invert the vault and obliterate dead space. Place purse strings closely to eliminate potential spaces.[6][7]
  4. Vaginal epithelial closure. Close remaining edges transversely.[6]
  5. Ulcerated prolapse variant. Two mirror-image triangles excised from anterior and posterior walls; the resulting diamond-shaped incision is closed vertically to narrow the introitus.[7]

Variant techniques​

VariantNotes
Rouhier's colpocleisis (Constantin 2019)Vaginal hysterectomy first, followed by total-style circumferential denudation and serial purse-string reduction; time-saving and reproducible when hysterectomy is indicated[8]
Modified Le Fort (Lv & Rong 2021)Anterior and posterior midline incisions rather than rectangular excision; lateral flaps to expose bladder/rectal fascia; purse-string sutures push viscera back; excess wall trimmed; result is a solid longitudinal central septum with most vaginal-wall tissue preserved[15]
Standardized purse-string (Bern, Hoehn 2025)A single standardized purse-string approach applicable to both Le Fort and total — designed to be easy to learn and reproducible. n = 88: 16% overall recurrence; 7% in patients without prior surgery; reoperation 9.2%[9]

Concurrent procedures​

  • Levator myorrhaphy. Sutures through the levator-ani muscles bilaterally to narrow the genital hiatus.[1]
  • Aggressive perineorrhaphy. Reconstructs the perineal body and further narrows the hiatus, reducing risk of recurrent posterior wall prolapse — recommended in Le Fort.[1][2][6]
  • Anti-incontinence procedure. Retropubic synthetic midurethral sling for occult SUI is placed after the obliterative portion is complete, before perineorrhaphy.[2]

Concomitant Procedures — When and What​

Hysterectomy — generally not required​

Adding vaginal hysterectomy to colpocleisis is associated with longer operative time (144 vs ~110 min), higher EBL (253 vs ~140 mL), greater postoperative pain, and longer hospital stay — without clear prolapse benefit in most patients with procidentia.[9][4][10] Reserve hysterectomy for documented uterine pathology.

Anti-incontinence procedure​

  • Suburethral plication or midurethral sling is often recommended to decrease postoperative SUI risk.[3][5][9]
  • After concomitant midurethral sling at colpocleisis: 86.8–94% continence, with 0–14% sling revision for retention.[3][5]
  • Evidence regarding prophylactic anti-incontinence procedures for occult SUI remains conflicting.[3][9]

Outcomes and Efficacy​

EndpointResult
Anatomic success92.5–100% (no prolapse beyond hymen 87.5–100%)[1][2][3][4]
Subjective success77.5–100%[2][3]
Reoperation for prolapse0–1.8%[1][4][5]
Durability vs reconstructive repairMore durable — failure 1.8% vs 3.5% (p < 0.01)[5]
Patient satisfaction81–99% satisfied / very satisfied[1][2][4][6]
Regret rate0–13.8% overall; 0–12.9% specific to loss of coital ability[1][2][3][4]

A 208-patient cohort with mean ~5-year follow-up reported no anatomical recurrence, 98.6% satisfaction, and 0.96% regret.[13] Significant improvements in PFDI-20, POPDI, and UDI scores are consistent across series.[12]

Complications​

ComplicationRate / note
Overall perioperative complication rate6.8–11.1%[3][7]
UTIMost common — 4.3–34.7% depending on definition[5][10]
Persistent urinary incontinence~30% in patients with pre-existing incontinence; de novo incontinence rare[11][6]
Urinary retention3.8%[13]
Bowel injury0–2.7% (related to concomitant procedures)[5]
Urinary tract injury0–9.1% (related to concomitant procedures)[5]
VTERare; associated with concomitant hysterectomy[10]
ICU admission2.8%[3]
Mortality0.15–1.3%[3][5]

Predictors of persistent urinary incontinence[11]​

  • Preoperative urodynamic stress incontinence — OR 7.5
  • BMI ≥ 30 — OR 5.0

Quality of Life​

Studies consistently show substantial QoL improvements without alteration in body image.[2] One series reported median PFDI-20 scores improving from 78.1 → 16.6 (p < 0.001).[12]

Counseling Points​

  • The procedure is irreversible and eliminates vaginal intercourse.[3]
  • Preoperative urodynamics identifies occult SUI and informs concomitant anti-incontinence planning.[3]
  • For Le Fort, complete cervical-cancer screening and endometrial evaluation preoperatively — the uterus will be inaccessible.[3]
  • Hysterectomy is not mandatory and adds operative morbidity without clear benefit in most cases.[9][4]
  • Regret rates remain consistently low despite irreversibility — appropriate counseling and patient selection drive this outcome.[11][12][5][13]

Key Principles​

  • Colpocleisis is the most durable POP repair with the shortest operative time and lowest morbidity of the obliterative options — first-line for elderly / frail patients without future intercourse goals.[2][3][5]
  • Le Fort preserves the uterus; total colpocleisis is for post-hysterectomy vault prolapse; Rouhier's combines vaginal hysterectomy with obliterative closure.[1][8]
  • Target endpoint: ~3 cm deep × 1 cm wide obliterated vagina with adequate lateral channels (Le Fort).[1]
  • Never dissect distal to the urethrovesical junction — the principal anatomic safety landmark.[1]
  • Hydrodissection + push-spread + meticulous hemostasis + transverse closure are the shared technical pearls.[2][1][6]
  • Hysterectomy is generally not required and adds morbidity without prolapse benefit.[4][9]
  • Pre-existing SUI persists in ~30%; occult SUI drives the case for concomitant midurethral sling — continence rates 86.8–94% with sling.[3][5][11]
  • Frailty drives complication risk far more than age alone — assess and counsel accordingly.[7]
  • Regret rates are low (0–13.8%) — appropriate selection and counseling are protective.[11][5][13]

References​

1. Welch EK, Dengler KL, Wheat JE, et al. Colpocleisis techniques: an open-and-shut case for advanced pelvic organ prolapse. Urology. 2023;176:252. doi:10.1016/j.urology.2023.03.011.

2. Raju R, Occhino JA, Linder BJ. LeFort partial colpocleisis: tips and technique. Int Urogynecol J. 2020;31(8):1697-1699. doi:10.1007/s00192-019-04194-3.

3. Committee on Practice Bulletins—Gynecology and American Urogynecologic Society. Pelvic organ prolapse: ACOG Practice Bulletin, Number 214. Obstet Gynecol. 2019;134(5):e126-e142. doi:10.1097/AOG.0000000000003519.

4. Shalabna E, Cohen N, Assaf W, Zilberlicht A, Abramov Y. Frailty and pelvic organ prolapse: colpocleisis with or without hysterectomy as a treatment modality in elderly patients. Eur J Obstet Gynecol Reprod Biol. 2025;306:2-5. doi:10.1016/j.ejogrb.2024.12.051.

5. Grzybowska ME, Futyma K, Kusiak A, Wydra DG. Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review. Int Urogynecol J. 2022;33(1):31-46. doi:10.1007/s00192-021-04907-7.

6. Linder BJ, Gebhart JB, Occhino JA. Total colpocleisis: technical considerations. Int Urogynecol J. 2016;27(11):1767-1769. doi:10.1007/s00192-016-3034-4.

7. Dallas KB, Anger JT, Rogo-Gupta L, Elliott CS. Predictors of colpocleisis outcomes in an older population based cohort. J Urol. 2021;205(1):191-198. doi:10.1097/JU.0000000000001239.

8. Constantin F, Veit-Rubin N, Ramyead L, Dubuisson J. Rouhier's colpocleisis with concomitant vaginal hysterectomy: an instructive video for female pelvic surgeons. Int Urogynecol J. 2019;30(3):495-497. doi:10.1007/s00192-018-3765-5.

9. Hoehn D, Egli H, Marak MC, et al. Colpocleisis — still a valuable option: a point of technique. J Clin Med. 2025;14(20):7433. doi:10.3390/jcm14207433.

10. Hill AJ, Walters MD, Unger CA. Perioperative adverse events associated with colpocleisis for uterovaginal and posthysterectomy vaginal vault prolapse. Am J Obstet Gynecol. 2016;214(4):501.e1-501.e6. doi:10.1016/j.ajog.2015.10.921.

11. Abaza I, Nizar A, Yossef D, Ali M, Bhal K. A decade of colpocleisis: a retrospective analysis of outcomes, complications, and long-term patient satisfaction. Eur J Obstet Gynecol Reprod Biol. 2026;322:115116. doi:10.1016/j.ejogrb.2026.115116.

12. Yildiz Ç, Özdemir AZ, Barutçu B, et al. Colpocleisis as an obliterative surgery for pelvic organ prolapse: a single-center experience. Medicine. 2026;105(4):e46411. doi:10.1097/MD.0000000000046411.

13. Wang YT, Zhang K, Wang HF, et al. Long-term efficacy and patient satisfaction of Le Fort colpocleisis for the treatment of severe pelvic organ prolapse. Int Urogynecol J. 2021;32(4):879-884. doi:10.1007/s00192-020-04380-8.

14. Dessie SG, Rosenblatt PL. Use of a vessel loop to ensure tunnel patency during LeFort colpocleisis. Int Urogynecol J. 2015;26(10):1541-3. doi:10.1007/s00192-015-2694-9.

15. Lv H, Rong F. Modified LeFort partial colpocleisis. Int Urogynecol J. 2021;32(4):1043-1045. doi:10.1007/s00192-020-04545-5.

16. Buchsbaum GM, Lee TG. Vaginal obliterative procedures for pelvic organ prolapse: a systematic review. Obstet Gynecol Surv. 2017;72(3):175-183. doi:10.1097/OGX.0000000000000406.

17. Aydın S, Gorchiyeva İ, Tanoglu FB. Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse. Int Urogynecol J. 2020;31(10):2169-2171. doi:10.1007/s00192-020-04288-3.

18. Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg. 2019;25(6):397-408. doi:10.1097/SPV.0000000000000794.