This protocol addresses enterocele in patients who carry significant medical comorbidities — such as cardiac disease, chronic obstructive pulmonary disease, or thromboembolic disease — and who do not desire future vaginal intercourse or vaginal preservation.
Obliterative procedures are effective for the treatment of pelvic organ prolapse and are considered a first-line surgical option specifically for women with significant medical comorbidities. They are associated with low rates of complications, intensive care unit admissions, and mortality, making them well-suited for this patient population.
Obliterative surgical repair is the recommended first-line intervention for this patient profile; the specific procedure type and any concomitant steps are detailed in the full regimen below.
DOI: 10.1097/AOG.0000000000003519
Obliterative procedures––which narrow, shorten, or completely close the vagina––are effective for the treatment of POP and should be considered a first-line surgical treatment for women with significant medical comorbidities who do not desire future vaginal intercourse or vaginal preservation.
In addition, obliterative procedures for the treatment of POP are associated with low rates of complications, intensive care unit admissions, and mortality.
Common types of obliterative surgical repair of POP include a Le Fort-style partial colpocleisis and total colpectomy.
In total colpectomy procedures, the entire vaginal epithelium is denuded and sutures are used to invert the vagina.
With any obliterative procedure, a suburethral plication or midurethral sling and a perineorrhaphy often are recommended to decrease the risk of postoperative stress urinary incontinence and recurrent posterior vaginal wall prolapse.
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