Table 1 Comparison of CC with VPwVS
From: Vaginal partitioning with vertical septum—an alternative to colpocleisis
Comparison of CC with VPwVS | |
|---|---|
CC | VPwVS |
1. Basic concept | |
Closure (partial or total) of vagina, usually with approximation of anterior and posterior wall | Partitioning of vagina in bilateral tunnels with a vertical, median, and strong septum |
2. Mucosa removal and vaginal shortening | |
Raw area is created for approximation by removal of equal rectangular flaps of vaginal mucosa of anterior and posterior vaginal epithelium or circumcision of entire vaginal mucosa. | There is no removal of vaginal mucosa. Redundancy is used to make a strong and broad septum. |
Mucosa removal and approximation causes vaginal shortening/closure. | Vertical, median septum is created extending to the vault, restoring the vaginal length. |
3. Risk and difficulty | |
Dissection of vaginal mucosa of uniform thickness is difficult. | Linear dissection of vaginal mucosa is easy. |
Vaginal mucosa removal carries the risk of damage to paracolpos or to lateral attachment of fibers which are attached to the pelvic bone. | There is no such risk since the mucosa is not removed. Further, even if the deeper supportive tissue gets traumatized, the outcome is not affected due to its integration with the septum while suturing. |
4. Septum/suture line | |
The new suture line is transverse, hence directly exposed to abdominal pressure changes as shown in Fig. 1. | The new suture line is vertical so the abdominal pressure changes are equally distributed on two neo vaginas and the vertical septum as shown in Fig. 2. |
An under tension suture line may cause a high incidence of hematoma and its subsequent complications. | Tension-free suturing is possible, preventing hematoma and subsequent complications. |
Additional purse-string sutures are needed before approximation if prolapse Baden–Walker grade is 3 or 4. | The procedure is the same irrespective of the Baden–Walker grading. |
5. Plication of bladder neck and/or cystocele repair | |
Kelly’s stitch, TVT, urethral mesh, site-specific repair, etc. are needed to optimize bladder function. | No additional procedure needed. |
6. Supports | |
No reinforcement of supports | Indirect reinforcement of supports |
Central defect of the bladder gets supported with a vertical septum. Lateral defects get corrected with inward turning of the vaginal mucosa, indirectly reinforcing bladder support. A small caliber of neo vaginas prevents prolapse too. | |
Unequal support of urethra and bladder, disturbing UV angle | Equal support to urethra and bladder with no disturbance to UV angle |
7. Vaginal drainage and Pap smear | |
Only a potential canal on either side of the suture line when uterus is conserved, no vaginal canal in total colpocleisis | A 1.5-cm caliber canal on either side of the septum, neo vagina is lined by smooth vaginal epithelium all over as before, eliminating possibility of total closure |
Drainage possible; Pap smear difficult | Neo vagina allows vaginal drainage, and Pap smear collection is possible. |