Intestinal vaginoplasty: is it optimal treatment of vaginal agenesis? A pilot study

Abstract

The outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. Patients were between 18 and 37 years old. Ileum vaginoplasty and sigmoid colon vaginoplasty were carried out in two and nine cases, respectively. Ileum necrosis at donor site requiring ileum resection and bilateral ileostomy encountered in one of the cases was the major complication. Mild stenosis responsive to finger dilatation had been detected in two women with sigmoid vaginoplasty. Excess mucous production, long operation time, and shortness of mesentery of ileum led us to abandon ileum vaginoplasty, and sigmoid colon vaginoplasty was performed in the following cases with vaginal agenesis. All of the neovaginas were patent and functional. We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilatators or in those who experienced previous failure of the other treatment modalities.

Vaginal reconstruction with sigmoid colon in vaginal agenesis

“…Average operative time was 184 min (160-210). Average hospital stay was 11 days (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

“…b Ten patients are currently sexually active. the distribution of the sigmoid arteries and their relation with the left colic and superior rectal arteries [21].…”

Introito-cervical sigmoid colon transpositioning procedure

“…Intestinal transposition was the best surgical option for the correction of her malformation. Because of some disadvantages of ileum vaginoplasty such as excessive mucous production, higher tension on vascular structures of the flap because of a short mesentery, narrow lumen and unpleasant cosmetic results of lower and upper vertical incision , sigmoid vaginoplasty was chosen [6,5,11,12].…”

“…The method of transpositioning a sigmoid flap isoperistaltically or antiperistaltically, depends on several factors including arterial distribution of inferior mesenteric artery (IMA), length of the mesosigmoid, distribution pattern of branches of sigmoid artery (SA) in the mesosigmoid, and the localization of the preserved branches of SA [5]. Generally, in sigmoid flap transposition procedures, the flap is prepared considering one anastomosis at introital level.…”

“…The most common non-surgical technique used for vaginal construction is Frank's method, which requires long term dilatation [2]. Surgical methods include Vecchietti technique, a laparotomic surgical variant of Frank's method, Abbe-McIndoe procedure using pudental thigh or peritoneal flap or buccal mucosa and finally intestinal transplant methods [3][4][5].…”