The use of isolated caecal bowel segment in complicated vaginal reconstruction

Abstract

Objective To report a one‐stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation. Patients and methods The vagina was reconstructed using a 15‐cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstructions; four of these had undergone previous fistula formation. Fourteen patients were followed for a mean of 3.6 (1–9) years. The surgical outcome was evaluated using a questionnaire completed by the patients. Results The postoperative course was unremarkable in all patients. Four patients developed an introital stenosis requiring surgical intervention. Two patients were minors at the time of follow‐up, while all the others had had sexual intercourse and reported that they were very satisfied with the functional and cosmetic result. Conclusion In patients in whom previous vaginal reconstruction has failed, the caecal segment should be used to create a neovagina. By considering the patient’s age, the surgeon can optimize the surgical result.

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

“…Transposition of a sigmoid flap in 180°in craniocaudal direction facilitates reaching of the flap to the recipient site. Cecal replacement is recommended in complex cases such as preoperative irradiation and failed previous procedures [22]. In these reports and in our cases, sigmoid colon vaginoplasty resulted in low complication rates and allowed regular sexual intercourse with a low degree of dyspareunia.…”

“…The advantages of bowel segments are the decreased risks of subsequent contraction, no requirement of prolonged dilatation to ensure patency, constant lubrication, sufficient vaginal length availability, and the resistance of the intestinal segment to trauma and the absence of dyspareunia [9]. Abdominal approach and potential bowel complications are disadvantages of these procedures, but reported bowel necrosis complications are extremely low [8,9,21,22]. In the present study, ileum necrosis necessitating colostomy in donor site was encountered.…”

The use of isolated sigmoid colon segment for vaginal replacement in young adults

“…Mucous production decreases dramatically after 3-4 months and in our experience it was never a problem. The daily vaginal douche to evacuate the mucus, as recommanded by Filipas et al [26], was unnecessary in the present patients. Calibration, dilation and irrigation are temporary and well tolerated.…”

Vaginal reconstruction with sigmoid colon in vaginal agenesis

“…Because of associated morbidity, intestinal surgery has not historically been used as a first-line treatment. Nevertheless, this one-step treatment provides good anatomical results and progress in colorectal surgery particularly mechanical intestinal preparation, suture material and antibiotic prophylaxis has permitted the use of sigmoid graft as a first-line surgical therapy [3][4][5][6][7][8][9].…”