Colporrhaphy

Colporrhaphy (also known as vaginal wall repair, anterior and/or posterior colporrhaphy, anterior and/or posterior vaginal wall repair, or simply A/P repair or A&P repair) is a reconstructive vaginal surgical procedure performed to repair defects in the vaginal wall, commonly used to correct cystocele, prolapse of the bladder into the vagina or rectocele, prolapse of the rectum into the vagina.^[1][2][3]

Colporrhaphy
Other names	Vaginal wall repair
Specialty	Gynecology

Indications

Colporrhaphy is indicated for women experiencing bothersome pelvic organ prolapse symptoms including pelvic pressure, bulging sensation, urinary or fecal dysfunction, or dyspareunia, who have not responded to conservative treatments such as pelvic floor muscle exercises or pessary use.^[4][5]

Surgical technique

Anterior colporrhaphy

This technique involves creating an incision in the anterior vaginal wall, dissecting the vaginal mucosa away from the bladder, then plicating the vesicovaginal (pubocervical) fascia in the midline to reinforce support before closing the vaginal wall, usually with absorbable sutures.^[6][7]

Posterior colporrhaphy

This variant involves a similar approach through the posterior vaginal wall, targeting the rectovaginal fascia to repair rectocele by reinforcing weakened fascia and closing the incision.^[8][9]

Variation and lack of standardization

A systematic review of randomized controlled trials found substantial variation in every step of anterior colporrhaphy including incision, dissection, suture material, perioperative care, and anesthesia with no universally accepted standard.^[10][11]

Use of grafts or mesh

Some surgeons augment colporrhaphy with synthetic mesh to strengthen the repair, but controlled studies show mixed results. Mesh does not consistently reduce recurrence and may increase complications like erosion.^[12][13]

Outcomes and recurrence

Recurrence rates following anterior colporrhaphy are highly variable, ranging from 0% to 92% in the literature, a variability likely linked to the lack of standardized technique.^[14]

Benefits and risks

Advantages

Colporrhaphy is performed transvaginally making it less invasive than abdominal approaches resulting in shorter recovery time, no external incisions, and less postoperative pain.^[15]

Complications

Possible complications include bleeding, infection, dyspareunia, urinary retention, recurrence, and, if mesh is used, risks of erosion and infection.^[16][17][18]

Alternatives

Obliterative surgery such as colpocleisis, which closes the vaginal canal, may be appropriate for women who no longer desire vaginal intercourse.^[19] Abdominal reconstructive procedures like sacrocolpopexy (with mesh), uterosacral, or sacrospinous fixation provide enhanced long-term durability and may be used alone or alongside colporrhaphy in complex cases.^[20][21]