LeFort: RIP

There is some magic in LeFort's operation. It draws some gynecs like honey draws some bees. I remember the time I was a first post resident in Gynecology. My room partner was working as a resident in the other unit in our ward. All residents in that unit were a different breed. They used to post eight major operations on one day, knowing the boss would operate on two of them, which would leave six and the houseman would get to operate on one of them. The boss started performing a vaginal hysterectomy on a patient with alleged menorrhagia. Unfortunately the cervix came off after dividing the uterosacral ligaments, and there was no uterus above it. Then it turned out that the patient had undergone abdominal subtotal hysterectomy in the past. How she had menorrhagia is beyond comprehension. The boss got wild and ordered them to take the next patient, one scheduled to undergo LeFort's operation. After induction of anesthesia, she discovered that the patient had no prolapse at all. How they posted a patient without genital prolapse for LeFort's operation is also beyond comprehension. Perhaps they did not manipulate the OT list very well. That was 29 years ago. I thought things would have improved with time. But today they informed me that there was a very high risk patient scheduled to undergo LeFort's operation tomorrow. The registrar informed me that the patient had second degree uterine prolapse, and minimal cystocele and rectocele. She further told me that I had advised LeFort's operation for that patient. I knew I had not, because my concepts on indications for LeFort's operation are clear and firm, and this one did not fit in those concepts. So I asked them to recheck. Then it turned out that my Assistant Professor and Associate Professor had seen her and advised LeFort's operation. So I finally went to see the patient myself. She had only uterine prolapse, C point at +1 in POP-Q classification. There was no cyctocele or rectocele. "How can you perform LeFort's operation if there is no cystocele or rectocele?" I asked my registrar. "You have to make bladder and rectal surfaces bare and suture them to each other, as we did a month ago on another patient. If there is no prolapse, that will not be possible." "But madam has advised that" she said. "You will qualify at the end of this post. How will you practice gynecology if you cannot think for yourself?" I countered. She had no answer. "I agree that the patient is at ASA grade III for anesthesia. But if a condition is not treatable by LeFort's operation, it cannot be treated by LeFort's only because it can be done under local anesthesia. If at all, you have to perform hysterectomy under local anesthesia." Then I counseled the patient and left her to decide what she wanted, hysterectomy or living with the minimal uterine prolapse she had. Poor LeFort must have been turning in his grave because of what people do with his operation. May his soul rest in peace.