Colpopexy

COLPOPEXY, colpopexia, the suturing and fixation of the vaginal walls to correct cystocele; it was first performed in 1889 (Byford), wherein the anterior vaginal wall and the lateral fornix were fixed extraperitoneally by Byford to the walls of the inguinal canal. Baum, in cases of cystocele, proposed fixing the lower part of the vagina to the abdominal wall by making a low transverse incision of the abdominal wall and separating the bladder from the posterior surface of the pubic bone. V. F. Snegirev proposed using unilateral anterior and posterior colpopexy in the treatment of uterine prolapse; the anterior lateral fornix, with the visceral layers of the pelvic fascia covering it, was fixed extraperitoneally to the inguinal ligament during anterior colpopexy; the posterior-lateral vaginal fornix was fixed to the sacrospinous ligament in the case of posterior colpopexy. In view of the possible injury to important adjacent organs (bladder, ureter, rectum), this method did not receive wide application. Considering, however, the possibility of using Snegirev's operation to artificially replace the action of the cardinal ligaments that have lost their tone, Shirshov proposed fixing the vagina, its anterior fornix, to the inguinal ligament, performing this by means of laparotomy—colpopexia bilateralis transperitonealis—and adding to this a ventrofixation of the uterus. Attaching great importance to the connective tissue formations of the pelvis for holding the uterus and pelvic organs, and for preventing their downward displacement, Gubarev considers the most rational method in the treatment of uterine prolapse to be a modified Snegirev operation—the fixation of the anterior or posterior vaginal fornix to the abdominal wall. Kustner (1910), in cases of uterine prolapse with significantly pronounced changes, proposed performing a laparotomy, removing the uterus, and suturing the vaginal stump to the abdominal wall. Bumm (1917), regarding the operation of ventrofixation of the vaginal stump in cases of enterocele vaginalis, pointed out that such a method is the most rational compared to other operative measures proposed in such cases (e.g., suturing the anterior and posterior vaginal walls—the Neugebauer method). Nevertheless, the colpopexy operation did not become widely used, and only Fraenkel (L. Fraenkel) makes wide use of the fixation of the vagina to the abdominal wall: 1) in cases of vaginal prolapse after removal of the uterus, 2) in cases of uterine prolapse (where, in cases of significant changes to the prolapsed uterus, the latter is removed). The operation according to Fraenkel (ventrifixura vaginae) is performed as follows: a Pfannenstiel incision is made; upon dissection of the vesicouterine fold, the bladder is pushed downward and the anterior vaginal fornix is exposed. Having verified that the latter is pulled up to the abdominal wall without excessive tension, 2-3 sutures are placed, passing through the entire thickness of the abdominal wound and through the wall of the vaginal fornix; the vesicouterine fold of the peritoneum is restored. The abdominal wound is closed in the usual manner, and in conclusion, the sutures fixing the vaginal fornix to the abdominal wall are tied over a gauze roll, which allows them to be left in place longer than usual. The possibility of using this operation in cases of significantly pronounced uterine prolapse and the simplicity of the technique are, according to Fraenkel, a great advantage of the ventrifixura vaginae operation. To avoid disturbances on the part of the bladder, the vagina should not be sutured too close to the abdominal wound; there is reason to think that the colpopexy operation does not adversely affect the act of childbirth.