Anatomic and functional results of laparoscopic-perineal neovagina construction by sigmoid colpoplasty in women with Rokitansky's syndrome

Abstract

Our results confirm the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty, when performed by surgeons with extensive experience in both gynaecological and gastrointestinal laparoscopic surgery. The anatomic and functional results were good.

Introito-cervical sigmoid colon transpositioning procedure

“…The anatomic and functional success of this method ranges from 43% to 100% respectively and requires long term catheterization and highly motivated patients [7].…”

“…A laparotomic technique developed as an alternative to Frank's method is called Vecchitti procedure end and does not require vesicorectal dissection [7].…”

“…This surgical procedure has the advantages of being relatively easy and avoiding intestinal complications [7]. However, the disadvantages include shrinkage of the proximal third of the neovagina, lack of lubrication and dyspareunia which gives anatomic and functional success rates from 57% to 91% and from 81% to 100% respectively [7].…”

Long-term outcome after laparoscopic creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome by a modified Vecchietti procedure

“…On the other hand, conservative approaches according to Frank [13,20] or Ingram [8] have been shown to be successful in patients with a pre-existent vaginal groove who do not wish to undergo surgery [15]. The use of an isolated segment of the sigmoid colon for vaginal construction has also been reported to yield satisfying post-operative outcomes [3,4]. However, some reports point at major intra-and postoperative complications such as necrosis of the sigmoid graft, intestinal anastomosis dehiscence, prolapse of the neovagina or persistent vaginal outflow [2,7,17].…”

“…Non-surgical approaches include dilatation of the vaginal groove with a hand-held dilator in a squatting position first described by Frank [13,20] or by passive dilatation using the patient's own weight according to the method of Ingram [8]. In addition, various surgical methods have been described such as the creation of a split-thickness skin graft which covers a stent inserted into the space between bladder and rectum (McIndoe and Bannister) [11], the use of the patient's own peritoneum for vaginal reconstruction (Davydov technique) [5] or creation of a neovagina with a sigmoid graft [4]. Although there is no standardized method, the majority of surgically treated cases (up to 300) have been described by Vecchietti [18,19] who proposed a combination of the surgical and conservative approaches by performing a laparotomy, dissection of the vesico-rectal septum followed by fixation of a vaginal "dilatation olive" with two sutures passing from the abdominal wall through the pseudohymenal septum.…”