Hymen conservative techniques for vaginal surgery – a practical approach

Abstract

Vaginal approach remains one of the safest and easiest surgical procedures to treat many gynaecological pathologies such as cervico-vaginal fibroids or vaginal septum.These classical procedures are, however, hindered by the disruption of the integrity of the hymen, an issue that remains controversial if not unfavourable in certain conservative geographical areas such as the Middle East.Herein, we describe 3 alternative surgical laparoscopic techniques to deal with the issue of hymen conservation. In the first 2 cases we suggest a laparoscopic approach through an anterior or a posterior colpotomy to treat large cervico-vaginal fibroids. In the third case, we propose a laparoscopic technique for the resection of a vaginal septum in a young girl with obstructed hemivagina and ipsilateral renal agenesis syndrome.

Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature

“…The absolute indication for abdominal total hysterectomy is severe uterine bleeding, sepsis or an unsuccessful vaginal approach ( 17 ). Vaginal myomectomy is considered a safe and easy surgery for the treatment of prolapsed pedunculated submucosal uterine leiomyoma, as it is associated with a low recurrence rate and minimal morbidity ( 18 , 19 ). Conversely, the increased risk of intraoperative hemorrhage that may be associated with some pedunculated submucosal leiomyomas can be controlled with hysteroscopy.…”