Novel Method of Cervicoplasty Using Autologous Peritoneum for Cervicovaginal Atresia

Abstract

Cervicovaginal atresia with a functional uterus is rare. There are no established surgical methods to treat this condition, and only a few reports have been published on surgical techniques. Furthermore, postoperative complications, such as restenosis, often require reoperation. A 19-year-old woman was pointed out cervical hypoplasia and referred to our hospital for further examination and treatment. A pelvic examination revealed that the vagina had a slight recession with a blind end. Transrectal ultrasound and pelvic magnetic resonance imaging revealed congenital vaginal agenesis and cervical hypoplasia. Elective surgery was performed after reshaping the vagina. A radical surgery was performed 10 months later after sufficient self-dilation by using Frank's technique in an outpatient setting. At first, we approached by laparoscopically to correct autologous peritoneum and to bladder detach, then the cervical canal was identified. Next, a skin biopsy punch was used several times to hollow out the cervical tissue to shape and expand the cervical canal. A catheter was then placed in the uterus and autologous peritoneum was wrapped around it and fixed to the cervical canal. The catheter was removed 6 weeks postoperatively, and the patient continued dilating her vagina until she was able to have sexual intercourse, and then stopped the self-dilation. Eight months postoperatively, the patient did not report any menstrual irregularities. It is important to make corrections to prevent restenosis of the vagina and cervical canal and prevent the symptoms from recurring. Make use of autologous peritoneum as graft onto the cervical canal is effective method for the treatment of cervicovaginal atresia.

Cervicovaginal reconstruction with small intestinal submucosa graft in congenital cervicovaginal atresia: A report of 38 cases

“…As for the treatment of congenital cervical malformations, conservative management has been gradually performed recently, as it can relieve symptoms, establish the normal sexual function, and preserve the uterus for future fertility [4] . A great variety of materials and techniques have been used to reconstruct the vagina and cervix [6,[12][13][14][15] . Some studies have reported using the SIS graft to reconstruct the vagina and cervix [6,7,16] .…”

“…Due to the presence of vaginal agenesis, all patients underwent vaginoplasty concomitantly with no complications in this study. Fujino et al reported a two-step technique in which a radical surgery was performed ten months later after vaginoplasty [15] . It was thought to be safer but may increase the risk of pain or endometriosis.…”

Reassessment of Surgical Procedures for Complex Obstructive Genital Malformations: A Case Series on Different Surgical Approaches

“…Each of these steps is crucial for the unremarkable development of the female internal genitalia, and disruption at any point can cause different types of genital developmental disorders, including cervical agenesis or aplasia [ 1 , 2 , 3 ]. In general, Müllerian duct anomalies are described in 4–7% of the female population, although cases of cervical agenesis or aplasia (with or without a vagina) but with a functional uterus are rare [ 4 , 5 , 6 , 7 ].…”

“…Nowadays, gynecological specialists seek not only to reduce morbidity but also to conserve the possibility of reproductive capacity. Therefore, there have been some reports describing surgical management [ 6 , 10 , 11 ]. In this article, we present different surgical approaches to uterus-conserving surgical therapy for different Mullerian anomalies performed at the Department for Women’s Health of the University of Tuebingen, Germany, between 2017 and 2022.…”