Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients

Abstract

We performed a historical cohort study of 62 consecutive patients who underwent abdomino-perineal vaginal re-construction with a segment of the sigmoid colon during a 25-year period. A dedicated database was reviewed for the aetiology of vaginal malformation, surgical complications and post-operative follow-up. Follow-up visits were scheduled 2, 6 and 12 months after discharge from hospital and annually thereafter. Fifty-eight (93.5%) patients were diagnosed as having Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) and four (6.5%) had undergone previous demolitive surgery for gynaecologic malignancy. The mean operating time was 145 min (range 95 to 250 min). The mean hospital stay was 8.3 days (range 5 to 23 days). Post-operative complications requiring additional surgery occurred in 3 (4.8%) patients and were a case of necrotising fascitiis with leakage of the bowel anastomosis, a case of bowel occlusion and a case of neovaginal prolapse. The mean follow-up was 11.3 years (range 3 months to 24 years). We recorded 5 cases (8.1%) of sigmoid graft shrinkage treated successfully by dilation. The time interval between sigmoid vaginoplasty and first intercourse was 4 months (range 2 months to 4 years). During the follow-up, 32 (51.6%) women reported regular and 30 (48.4%) women reported occasional sexual intercourse; 80.6% (50/62) were "satisfied" with the surgical procedure. In this large series, laparotomic sigmoid vaginoplasty was a safe and acceptable technique to treat congenital absence of the vagina. This procedure allowed early sexual intercourse and was associated with a low incidence of shrinkage and a high rate of patients' satisfaction.

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

“…Increased morbidity with sigmoid vaginoplasty due to occurrence of intestinal leakage and intestinal obstruction was reported by another study in 3.2% of patients (18). Intestinal complications are rarely reported with sigmoid vaginoplasty and we suggest that preoperative bowel preparation, previous experience with bowel surgery and meticulous suturing are essential prerequisites to avoid such complications.…”

“…On the other hand, the ileal mucosa was found to be more fragile and may lead to mild bleeding after intercourse. In addition, the mucus production by the ileum is more excessive and less lubricating than that of the sigmoid (18). Moreover, vaginal stenosis was found to be more frequent with ileal than sigmoid vaginoplasty (19).…”

Surgical approaches to treating vaginal agenesis

“…In the recent literature -including this issue of the BJOG -there has been a surge of papers reporting intestinal vaginoplasty as first-line treatment for Rokitansky syndrome. [9][10][11] The accompanying paper on laparoscopic intestinal vaginoplasty in this journal is the largest series of this type of procedure reported so far. 12 It represents a heroic effort by the surgeons but perhaps an even more heroic one by the 26 women undergoing a major and highly complex procedure for a condition, which in most women could be treated with vaginal dilation!…”

Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options

“…A bowel anastomosis is then required. This procedure is most commonly described via laparotomy; however, laparoscopic bowel vaginoplasties have also been described by Liguori et al [2005] and Imparato et al [2007]. More recently a robotic approach to sigmoid vaginoplasty has been illustrated by Kim et al [2008]: the authors claim that the assistance of robotics allows higher degrees of movement and accelerates the procedure allowing freehand sutures for the bowel anastomosis.…”