Case Report: Laparoscopically assisted full thickness skin graft for reconstruction in congenital agenesis of vagina and uterine cervix

Abstract

In patients with agenesis of the vagina and cervix but with a functional endometrium, the traditional treatment is hysterectomy with construction of a neovagina. We report successful treatment by laparoscopically assisted full thickness skin graft for reconstruction in a patient with congenital agenesis of the vagina and uterine cervix concomitant with haematometra and ovarian endometrioma in a 12 year old girl. Postoperatively, the vaginal skin graft healed well, and menstruation first appeared 4 weeks later. In our opinion, a combined laparoscopic and vaginal procedure with full thickness skin graft is an efficacious alternative in managing such genital defects.

Laparoscopically assisted uterovestibular anastomosis in patients with uterine cervix atresia and vaginal aplasia

“…A successful laparoscopic treatment of the agenesis of vagina and uterine cervix has been reported in which the neovagina was created with the McIndoe technique (14). However, earlier studies have shown that neovagina created with skin grafts maintain a keratinized epithelium with sebaceous glands and hairs many years after the operation (15).…”

A novel approach to cervical reconstruction using vaginal mucosa-lined polytetrafluoroethylene graft in congenital agenesis of the cervix

“…Exposed raw surfaces would form granulation tissues, scarring, and eventually cause restenosis of the anastomosis. [2] The use of autologous tissues for reconstruction is the first choice in most patients, but the use of soft tissues alone in this patient-such as a skin graft, local flap, or free tissue transfer-would likely become functionally obstructed due to the high contractile forces of the uterine musculature.…”

“…More recently, new methods for reconstruction of cervical and vaginal agenesis, including full-thickness skin grafts, prefabricated bilateral pudendal thigh flaps, and free microvascular transfer of the appendix and ascending colon, have resulted in good outcomes (2,5,7). However, they have their disadvantages.…”

“…Traditionally, hysterectomy has been the preferred mode of treatment due to the high rate of recurrent cervical obstruction and risk of ascending infection with attempts to perform an uterovaginal anastomosis (1)(2)(3)(4). More recently, other methods have been reported with good success.…”

“…More recently, other methods have been reported with good success. These methods have included laparoscopically-assisted full-thickness skin grafting and pudendal thigh flaps for reconstruction of the vagina and cervix (2,5,6), as well as microvascular transfer of the appendix and ascending colon for creation of an uterovaginal fistula (7). All these techniques employ the use of soft tissues for the creation of the neocervix.…”