Introduction: LeFort colpocleisis is a well established surgical procedure for treatment of advanced pelvic organ prolapse (POP), particularly for those are frail and who do not wish to conserve their sexual function. Over the recent years, LeFort colpocleisis may have lost its popularity with the development of novel techniques such as transvaginal placement of mesh and laparoscopic sacrocolpopexy. The aim of these case studies are to demonstrate that LeFort colpocleisis remains a viable surgical option in a carefully selected group of women.

Case Studies: Case A, a 63 year old Para 4 with previous vaginal hysterectomy for prolapse, presented with stage 4 vault prolapse. Case B, a 67 years old Para 4, presented with stage 4 POP involving all 3 compartments. Ring pessaries had failed to reduce these POP and these women subsequently developed decubitus ulcers. Attempts to reduce the oedematous POP failed despite vaginal packing as inpatients.  Biopsies were taken to exclude malignancy as the decubitus ulcers were slow healing.  Of note, both cases had underlying hypertension with poorly controlled diabetes and did not wish to conserve vaginal sexual function, hence LeFort colpocleisis was performed. Both surgeries were uncomplicated intra- and post-operatively. Both patients were asymptomatic of POP when reviewed at 6 weeks postoperatively.

Discussion: These case studies demonstrate that LeFort colpocleisis remain a good option for treatment of advanced POP in women with and without uterus. However, for those with uterus, uterine and cervical pathology must be excluded prior to surgery. Both cases were huge procidentias involving all 3 compartments which implied failure of all three levels of pelvic floor support. Failure to retain ring pessary and vaginal packing resulted from downward pressure of grossly oedematous tissue in the presence of a widened genital hiatus. A trial of oestrogen-soaked vaginal packing was to facilitate healing of decubitus ulcer. However, when ulcers of the genital tract to do heal, it is essential to exclude malignancy.

LeFort colpocleisis has been shown to have high success rate and minimal complications in many studies in treating similarly advanced POP. Thorough counselling regarding the nature of the surgery and its implications particularly with regard to loss of sexual function is paramount. Decision not to perform a concurrent vaginal hysterectomy in Case B was to reduce the risk of ureteric injury and blood loss once endometrial pathology was excluded.