Laparoscopic rectosigmoid flap vaginoplasty

Abstract

Various methods have been developed for vaginoplasty, of which the rectosigmoid flap has its own advantages including sufficient increase in the vaginal length and lower incidence of complications such as contracture or strain after vaginoplasty. Laparoscopic operation can greatly minimise the abdominal scar associated with laparotomy and allow cosmetically superior outcomes. Its minimally invasive procedure can also achieve rapid recovery and shorten the duration of hospital stay. Twelve patients (age range 18-40 years) had vaginoplasty using the rectosigmoid colon. We evaluated the ecological changes of the neovagina from the change of pH in the neovagina, culture of the normal flora, and vaginal wall biopsy taken 6 to 12 months postoperatively. Details of sexual activity were also examined. No patient from interviews developed vaginal narrowing as a result of the contracture that caused painful intercourse, or had smelly discharge or spontaneous bleeding from the vagina. Laparoscopic procedures may need only five-openings of 1-1.5 cm in diameter. Mean operating time was 130 minutes (IQR, 113-140) and duration of hospital stay 8.5 days (IQR, 7-11). Twelve months postoperatively the intravaginal pH was about 6. In one case, the histological test showed that the original columnar cell of the intestinal mucosa had been transformed to stratified squamous cell tissue. The key to the vaginoplasty is that it should give functional satisfaction and a minimal rate of complications. The laparoscopic rectosigmoid flap technique of vaginoplasty allowed less morbidity and excellent aesthetic and functional postoperative outcomes.

Successful laparoscopic sigmoid transposition for cervicovaginal agenesis in the presence of a functioning uterus: A case series

“…19 In 2011, Kim et al reported that 6 and 12 months postoperation, the sigmoid neovaginal pH level was 6.5 and 6, and squamous transformation of columnar epithelium was observed in only one of the 12 patients. 20 Predisposing factors for bowel-related complications in sigmoid vaginoplasty are tension over the vascularized pedicle, short mesentery, obesity, and masculinized pelvis; therefore, surgeons should be highly skilled. 21 We had a small intraoperative complication in only one patient whose rectum was inadvertently opened, which was diagnosed and repaired immediately.…”

“…In 2011, Kim et al reported that 6 and 12 months postoperation, the sigmoid neovaginal pH level was 6.5 and 6, and squamous transformation of columnar epithelium was observed in only one of the 12 patients 20 …”

Successful Laparoscopic Sigmoid Transposition for Cervicovaginal Agenesis in Presence of Functional Uterus; a Case Series

“…In 2011, Kim et al reported that 6 and 12 months post operation, sigmoid neovaginal pH was 6.5 and 6, and squamous transformation of columnar epithelium was observed in only one of the 12 patients [20].…”

“…Sigmoid cervicovaginoplasty is a safe and effective procedure with satisfactory outcomes during long term followups. This surgery eliminates the psychological burden of hysterectomy in these patients and if it is done by laparoscopy, patients will bene t from the advantages of minimally invasive procedures such as cosmetics (open surgery requires at least 12 to 15 cm of incision) [20], less adhesion formation, lower infection rate and wound complications, ileus, and accelerated recovery time [17]. By preserving the uterus, we can make future pregnancy possible by performing abdominal cerclage in these patients.…”

Robotic approach to vaginal atresia repair in an adolescent girl

“…Minimally invasive techniques to create a neovagina have been developed gradually and some results have been published [ Table 1 ]. [ 4 5 6 7 8 9 10 ] Now days, these surgeries are increasingly being done with robotic assistance. The three-dimensional view with depth perception is remarkable.…”