Surgical and functional outcome of sigmoid colon-vaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome

Abstract

Background: The objective of this study is to report our experience with sigmoid vaginoplasty in adolescent female patients of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with emphasis on the effectiveness of surgery, complications, sexual and functional outcomes.Methods: A retrospective study of adolescent females with vaginal atresia and Mayer-Rokitansky-Kuster-Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the case.Results: Eleven females were studied over a period of 15 years. Postoperative complications were perineal rash in 3, ileus in 3, and minor wound infection in 1 patient and urinary tract infection in one patient. Nine patients were on regular follow-up. All the neovaginas were patent and functional. The postoperative mean vaginal length was 12.1 cm (range 11 cm to 14 cm). One of the patients had mild vaginal stenosis which responded to vaginal dilation, one had mucosal prolapse of the neovagina, one had excessive mucus discharge, during follow-up visits. Out of the 11patients, 8 patients are sexually active and 7 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Only one experienced dyspareunia and three patients had not participated in sexual activity.Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not demanding prolonged dilatation and short recovery time.

Comparison of modified McIndoe and Davydov vaginoplasty in patients with MRKH syndrome in terms of anatomical results, sexual performance and satisfaction

“…However, the procedure has some drawbacks, including discharge, dyspareunia, introital stenosis, and prolapse of the mucosa. [ 21 ] Additionally, the vagina created with intestinal grafts will be less sensitive and prone to produce significant mucosa. Therefore, the patient may need to use sanitary pads continuously.…”

“…There is also a rare risk of malignancy. [ 21 22 ] In this procedure, due to the need for laparotomy, the risks of serious infection, intestinal stenosis, dehiscence, and fistula formation preclude it as a first choice for many surgeons. [ 22 23 ]…”

Double Pedicle Artery Rotation Sigmoid Vaginoplasty for Vaginal Aplasia Management

“…Long-term complications (0.2%-13.9%) comprise persistent vaginal discharge, stenosis of the neovagina, prolapse of the neovagina, malodor of the vaginal secretions, and postcoital bleeding. To avoid such complications, preoperative bowel preparation and meticulous suturing are recommended [15].…”

Application of mesocolon rotation and reverse puncture in total laparoscopic sigmoid vaginoplasty

“…Second, in cases where the mesocolon is relatively short but the sigmoid colon artery has wide branches and a large area, it may cut off the proximal end and middle part of the mesocolon may be cut off, followed by rotation of the intestinal segment by 180 degrees clockwise without affecting the blood supply. In addition, the length of the mesocolon may be extended by transversely cutting the anterior and posterior peritoneum in the root or middle part of the mesocolon, thereby reducing the tension (19). Due to the unique anatomical structure of the sigmoid colon, mesocolon rotation may be employed safely and effectively to solve the problem of tension while down-placing the transplanted intestinal segment.…”