The Administration on Aging predicts that by the year 2030,
20 percent of the nation’s population will be over
age 65. As Americans gray, medical professionals are challenged
to reduce the risk of age related diseases and provide alternative
treatments that improve the quality of life.
With more women reaching their 8th and 9th decades, physicians
are seeing an increased number of patients with pelvic organ
prolapse. Surgeons at Saint Barnabas Medical Center’s
Division of Gynecologic Oncology and Reconstructive Pelvic
Surgery offer a less invasive surgery for the long-term treatment
of vaginal and uterine prolapse in women whose advanced age
or medical condition prevent standard vaginal hysterectomy.
Thad R. Denehy, M.D., Associate Director of the Division
of Gynecology Oncology and Reconstructive Pelvic Surgery
at Saint Barnabas Medical Center, and a team of colleagues
conducted a retrospective study that compared the clinical
outcomes of 42 women suffering from prolapse who had undergone
vaginal hysterectomy with 21 elderly women treated with a
modified Le Fort colpocleisis procedure. After two years,
95 percent of the women who underwent the modified Le Fort
procedure continued to have good results with long-term pelvic
support. Since their research was published in the American
Journal of Obstetrics and Gynecology in 1995, the team
has performed another 35 procedures with good outcomes and
is in the process of publishing the most recent phase of
research.
“With an aging population in this country, physicians
are seeing more elderly women who suffer from pelvic organ
prolapse. Aside from being very uncomfortable, a prolapse
raises hygiene issues for the patient and the caregivers,” explains
Dr. Denehy. “We were looking for a procedure that would
offer long-term pelvic support for a narrowly defined population
of elderly and medically frail women who fail management
with a pessary.” A pessary is a medical devise worn
in the vagina that prevents the uterus from dropping.
The minimally invasive surgery takes approximately half
the time of a complete hysterectomy. Small portions of the
surface layer of the protruding vagina are removed. These
sites are sutured together as the vagina is repositioned.
Scarring occurs, joining the walls of the vagina and preventing
future prolapse. Due to the anatomical proximity of the rectum
and the urinary bladder, these organs are often drawn out
when the vagina and/or uterus prolapse. These are also repositioned
and supported during the modified Le Fort partial colpocleisis
procedure.
Dr. Denehy emphasizes that a few disadvantages of the modified
Le Fort procedure require that patients considered for this
surgery be carefully selected. One drawback is the inaccessibility
of the cervix and uterus after surgery. “We recommend
that an endometrial biopsy be performed before surgery to
rule out the presence of cancer.” The procedure may
also restrict sexual intercourse.
“The original Le Fort procedure was developed more
that 100 years ago but fell out of favor with advances in
vaginal hysterectomy. Now we are seeing a resurgence in the
use of modified Le Fort partial colpocleisis as a sound alternative
for medically compromised elderly women,” concludes
Dr. Denehy.
For information, please call (973)
322-5280.
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