Approximately 20% of women will undergo surgery for prolapse or incontinence during their lifetime. Among patients who are not planning future vaginal intercourse and cannot tolerate extensive surgery, copal chleasis is an excellent surgical treatment consistently associated with high rates of patient satisfaction. Leon Clement Laforte was a French surgeon remembered for his 1877 procedure for partial copal chleasis. He described removing long and narrow areas of mucosa from the anterior and posterior vagina, leaving large lateral channels for uterine drainage and incorporating a copal peroneoplasty. The lateral channels are important for drainage of any uterine discharge or bleeding, allowing awareness of possible pathology after closure of the vagina. We begin by marking rectangles for dissection on the anterior and posterior vaginal walls with a marking pen. The vaginal epithelium is then infiltrated with a marcaine solution at a superficial plane to assist with dissection. The borders of dissection are scored using a 15-blade scalpel. Care is taken to leave enough space anteriorly to allow for midurethral sling and posteriorly for an extended peroneorphy. We begin posteriorly to minimize blood-obscuring visualization. The vaginal epithelium is removed by sharp dissection, with care taken to leave the maximum amount of vaginal wall behind on the bladder and rectum by keeping the epithelium dissected away as thin as possible. A disposable self-retaining retractor is very helpful during this dissection. The most dependent edge of the vaginal epithelium that is being removed is left in place to minimize blood loss. The same procedure is repeated anteriorly as well. Care is taken to maintain excellent hemostasis throughout and keep the previously marked channels as the borders of dissection. We use a blue vessel loop to maintain the patency of our channels during the Laforte procedure. These channels are necessary to provide for drainage of any uterine discharge. The vessel loop runs across the cervix and is then placed within the lateral channels as they are formed. Figure-of-eight 2-ovipral sutures are used to tubularize these lateral channels. Care is taken to suture around and not through the vessel loop. This procedure is done on both sides. We then begin re-approximating the anterior and posterior channels. This procedure is done on both sides. We then begin re-approximating the anterior and posterior channels. This procedure is done on both sides. We then begin re-approximating the anterior and posterior dissected surfaces using figure-of-eight 2-ovipral sutures. We start at our cut edge and again care is taken to go around and not through the vessel loop. The vagina is involuted using several rows of figure-of-eight suture. The vagina is involuted using several rows of figure-of-eight suture. The vagina is involuted using several rows of figure-of-eight suture. The vagina is involuted using several rows of figure-of-eight suture. The vagina is involuted using several rows of figure-of-eight suture. It is important to take superficial purchases of vaginal wall to vaginal wall in order to avoid injury to the bladder or rectum. It is important to take superficial purchases of vaginal wall to vaginal wall in order to avoid injury to the bladder or rectum. This is continued until the epithelial edges can be brought together with figure-of-eight 2-ovipral sutures. This is continued until the epithelial edges can be brought together with figure-of-eight 2-ovipral sutures. It is at this point in the procedure that the vessel loop is particularly helpful in ensuring that the surgeon does not accidentally close the previously made channel openings during the lateral edge closure. It is at this point in the procedure that the vessel loop is particularly helpful in ensuring that the surgeon does not accidentally close the previously made channel openings during the lateral edge closure. It is at this point in the procedure that the vessel loop is particularly helpful in ensuring that the surgeon does not accidentally close the previously made channel openings during the lateral edge closure. It is at this point in the procedure that the vessel loop is particularly helpful in ensuring that the surgeon does not accidentally close the previously made channel openings during the lateral edge closure. It is at this point in the procedure that the vessel loop is particularly helpful in ensuring that the surgeon does not accidentally close the previously made channel openings during the lateral edge closure. After closure of the vaginal epithelium, gentle traction is placed on one end of the vessel loop and it is easily removed, ensuring bilateral channel patency. After closure of the vaginal epithelium, gentle traction is placed on one end of the vessel loop and it is easily removed, ensuring bilateral channel patency. After closure of the vaginal epithelium, gentle traction is placed on one end of the vessel loop and it is easily removed, ensuring bilateral channel patency. After closure of the vaginal epithelium, gentle traction is placed on one end of the vessel loop and it is easily removed, ensuring bilateral channel patency. We then routinely perform an extended peroneoraphy with levator plication, which completes the procedure. We then routinely perform an extended peroneoraphy with levator plication, which completes the procedure.

copal chleasis

surgical treatment

prolapse

incontinence

women