Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap (original) (raw)
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Creation of a neovagina in Rokitansky syndrome: comparison between two laparoscopic techniques
Fertility and Sterility, 2011
Objective: To compare Vecchietti's and Davydov's laparoscopic techniques for creation of a neovagina in patients with Rokitansky syndrome. Design: Comparative retrospective study. Setting: Tertiary referral center for the treatment of Rokitansky syndrome. Patient(s): Eighty patients with Rokitansky syndrome. Intervention(s): Patients underwent surgical creation of a neovagina. Fifteen patients who underwent the Vecchietti procedure from October 2003 to December 2004 and 30 patients who underwent the Davydov procedure from June 2005 to August 2008 were also included from two previously published studies. Follow-up lasted at least 12 months. Main Outcome Measure(s): Intraoperative parameters and anatomic results were compared. Functional results were compared through the Female Sexual Function Index. Epithelization of the neovagina was assessed in both groups through vaginoscopy and Schiller's test. Result(s): No major intraoperative complications were encountered in either group. Mean (AESD) duration of surgery was 30 AE 9.6 and 134 AE 24 minutes in Vecchietti's and Davydov's approach, respectively. At 12 postoperative months, length and width of the neovagina in the two groups were 7.5 AE 1.1 and 2.8 AE 0.6 cm, and 8.5 AE 1.6 and 2.8 AE 0.65, respectively. Epithelization of the neovagina at 6-month follow-up was 60% and 80%, respectively, and 100% in both groups at 12 postoperative months. Conclusion(s): Anatomic and functional outcomes of the two approaches tend to be comparable at 12-month follow-up; the only significant difference seems to be in greater length for the neovagina obtained by Davydov's approach.
Fertility and Sterility, 2005
Objective: To introduce a simple and quick surgical alternative for creating a neovagina in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome that offers good anatomic and functional results. Design: Historical report. Setting: Tertiary center for gynecologic endocrinology. Patient(s): Three patients with MRKH syndrome. Intervention(s): The creation of a neovagina according to Wharton-Sheares-George in patients with MRKH syndrome. Main Outcome Measure(s): Axis, length, and width of neovagina. Result(s): The George modification of the Wharton-Sheares neovaginoplasty was successfully performed in three patients. The results were excellent (normal axis and adequate length and width of neovagina), and there were no major complications. Conclusion(s): The George modification of the Sheares technique represents a simple, safe, and effective surgical option for creating a neovagina. The procedure is not highly complex and is therefore easy to learn and perform; no special surgical equipment is needed. Anatomic and functional results are very satisfying. Short-term hospitalization, accelerated recovery, and a rapid return to everyday life are important benefits for these young patients. These benefits also result in lower surgery-related expenses and therefore reduce the strain on the hospital's budget compared with other therapeutic options. The creation of a neovagina according to Wharton-Sheares-George might provide a satisfactory alternative for the surgical management of vaginal aplasia in patients with MRKH syndrome.
Journal of Minimally Invasive Gynecology, 2020
Study Objective: To report a new improved laparoscopic Vecchietti vaginoplasty in patients with congenital vaginal agenesis and to investigate its efficacy and safety. Design: A retrospective descriptive and case-control study. Setting: Single academic institution. Patients: Women who were diagnosed with Mayer-Rokitansky-K€ uster-Hauster (MRKH) syndrome and underwent our new improved laparoscopic Vecchietti procedure from July 2010 to June 2019 were selected as the study group. The eligible participants had congenital vaginal agenesis with normal 46,XX karyotype and ovarian function. Age-matched, nulliparous, sexually active women were selected as the control group. Interventions: Women with MRKH syndrome in the study group underwent the novel improved laparoscopic Vecchietti procedure. All participants in both groups were required to complete Female Sexual Function Index and Female Genital Self-Image Scale questionnaires. Measurements and Main Results: The effects of our procedure, including the anatomic and functional efficacy of the neovagina, were the primary outcomes. The secondary outcomes consisted of the perioperative complications, surgical morbidities, and long-term postoperative discomfort. A total of 79 patients with MRKH syndrome underwent our new improved Vecchietti vaginoplasty, of whom 44 (55.7%) were diagnosed as Type I MRKH syndrome, whereas 35 (44.3%) were Type II MRKH syndrome. At a 30-month follow-up after surgery, an anatomic neovagina measuring 10.44 cm in length and 1.30 cm in width was achieved. All 79 patients obtained anatomic success with 92.41% of functional efficacy. Compared with 81 age-matched, nulliparous women in the control group, there was no statistical difference regardless of individual measure or total Female Sexual Function Index scores (p >.05). The Female Genital Self-Image Scale assessment showed a significantly lower score in patients undergoing the vaginoplasty (20.14 § 3.05 vs 22.95 § 2.12; p <.001). There were no severe perioperative complications except 1 mild bladder injury and 1 transient fever. Conclusion: Our novel improved laparoscopic Vecchietti vaginoplasty is a relatively safe and effective method for surgical treatment of congenital vaginal agenesis. It may be an alternative to neovagina creation for reaching satisfying anatomic and functional efficacy and improving patients' sexual function.
International Journal of Gynecology & Obstetrics, 2012
The mullerian ducts can be identified in all patients with MRKH syndrome, 2 cm dorsal to the external urethral ostium and 1 cm paramedially. The rudimentary müllerian ducts were dilated step by step by gently pushing Hegar dilatators (2.5-14) in the direction of the pelvic axis. A double-barreled canal was createdthe median raphe was intersected with diathermy. The dome of the recesses is formed by peritoneum reflected from the superior surface of the bladder to the anterior aspect of the rectum. Then using light reflex of the telescope on the peritoneum-it is held by two tissue forceps and incised with scissors and the peritoneum is sutured with 2-0 vicryl to the created introitus at 12-3-6 and 9-O clock position. Then laparoscopic purse string suture using the two rudimentary horns and pelvic peritoneum is given using 2-0 PDS. Subsequently, a vaginal mould soaked with estriol and antibiotic cream is inserted in the created neovagina. The median follow-up was 12 months (range 2-23). Evaluation of the postoperative results after intervals of 2-6 months revealed a well-formed neovagina in each patient, with a length of 7-8 cm and a two-finger width. Results: The new technique using hegar's dilators and laparoscopic neovaginoplasty using pelvic peritoneum was successfully performed in eight patients. The results were excellent (normal axis and adequate length and width of neovagina), and there were no major complications. Conclusions: The new technique using hegar's dilators and laparoscopic neovaginoplasty using pelvic peritoneum represents a simple, safe, and effective surgical option for creating a neovagina. Anatomic and functional results are very satisfying. Short-term hospitalization, accelerated recovery, and a rapid return to everyday life are important benefits for these young patients. This method might provide a satisfactory alternative for the surgical management of vaginal aplasia in patients with MRKH syndrome.
Fertility and Sterility, 2011
Objective: To evaluate the long-term outcomes and degree of satisfaction after neovaginoplasty according to Wharton-Sheares-George in women with Mayer-Rokitansky-K€ uster-Hauser syndrome. Design: Open, monocentric follow-up study. Setting: University hospital and referral center for pediatric and adolescent gynecology. Patient(s): Ten patients with Mayer-Rokitansky-K€ uster-Hauser syndrome with neovaginas created according to Wharton-Sheares-George 3 to 77 months ago. Intervention(s): Gynecologic follow-up examination, including vaginal swab, bacterial culture, Papanicolaou smear, hybrid capture test for human papillomavirus typing, biopsy, pelvic ultrasound, and 2 questionnaires concerning global quality of life and degree of sexual satisfaction. Main Outcome Measure(s): Satisfaction with sexual function, quality of life, length and width of neovagina, structure of vaginal epithelium, and type of bacterial colonization. Result(s): Functional long-term follow-up results showed a high subjective degree of general well-being and sexual satisfaction in affected women. A satisfactory neovaginal length (mean, 8.3 AE 1.06 cm; range, 7-10 cm) and width (mean, 3.3 AE 0.5 cm; range, 2.5-4 cm) was obtained. As revealed by smears and biopsy, the neovagina resembled a natural vagina with regard to type of bacterial colonization and structure of epithelium. Conclusion(s): The goal of any method of creating a neovagina is to provide the patient the possibility to have satisfactory sexual intercourse and to enhance well-being and quality of life. These aims can be achieved by creating a neovagina according to Wharton-Sheares-George.
Fertility and Sterility, 2010
Objective: To present and evaluate the results of the Creatsas modification of Williams vaginoplasty for the creation of a neovagina in young women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: Retrospective study. Setting: Patient(s): Two hundred patients with the MRKH syndrome. Intervention(s): Clinical examination, pelvic ultrasound, intravenous urography and/or renal ultrasound, laparoscopy, karyotyping, orthopedics and ears, nose, and throat examination, magnetic resonance imaging, and Creatsas modification of Williams vaginoplasty. Main Outcome Measure(s): Neovaginal functional dimentions, neovaginal axis deviation, and quality of sexual life. Result(s): A functioning vagina of 10-12 cm in depth and 5 cm in width was created in 191 cases (95.5%). A vagina between 7 and 9 cm in depth and 2 and 3 cm in width was created for the remaining nine patients (4.5%). In addition, 94.5% declared themselves to have a satisfactory quality of sexual life, while only 5% of the cases reported an adequate one. Conclusion(s): Creatsas modification of Williams vaginoplasty is a simple, quick, and effective method for the treatment of vaginal agenesis. (Fertil Steril Ò 2010;94:1848-52.
Intestinal vaginoplasty: seven years' experience of a tertiary center
Fertility and Sterility, 2010
Objective: To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: Prospective study. Setting: Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a women's and children disease education and research hospital. Patient(s): Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty. Intervention(s): Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty. Main Outcome Measure(s): The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra-and postoperative complications were evaluated.
BMC Urology, 2017
Background: Although vaginal agenesis as may occur in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition, it is associated with not only anatomical problems but also serious psychological and social problems like painful sexual intercourse, primary amenorrhea and infertility. Surgery, which is aimed at reconstruction of a vagina of adequate length and width to serve the function, is the main method of treatment. Many methods for vaginal reconstruction have been described but each has its complications and limitations. The most commonly preferred procedure for treating this condition is the McIndoe vaginoplasty which involves dissection into the recto-vesical space, inserting two split thickness skin grafts folded over a mold in this newly created space and regular dilatation of the neovagina postoperatively to avoid stenosis. However surgeons with this expertise in this part of the world are rare to find and where they are available, the special molds on which to fold the skin grafts into the neovaginal space are not readily available. Case presentation: A 21-year-old female with vaginal agenesis was operated on using a modification of the McIndoe procedure using a cylinder of a 60cm 3 syringe as a vaginal mold/form and kept in place. We left a Foley in place for 10 days and we did a dye test after removing the syringe to ensure that there was no leakage resulting from fistula formation. Conclusion: The operation was successful and on subsequent monthly reviews of the patient, she has a patent functional vagina of about 9 cm in length at 8 months after the operation with resumption of sexual intercourse.
Possibility of Generation of An Efficacious Neovagina in Cases of Mayer Rokitansky–Kuster–Hauser syndrome with Satisfactory Vaginal Length, and Sexual Working of the Neovagina with an Innovative Technique-A Short Communication, 2024
Earlier we have extensively detailed Mayer Rokitansky-Kuster-Hauser Syndrome as well as procedures meant for generation of neovagina inclusive of utilization of graduated dilators of the non-surgical methodologies in the generation of neovagina dilators. Here our presentation is the manipulation of other surgical methodologies detailed is the innovative dissection of the neovagina utilizing bilateral 12 x5 cm fasciocutaneous skin flaps from the labiocrural folds implicating substantially greater dissection in contrast to other tissue grafts as well as there was prolongation of surgical time period in addition to stay in the postoperative period. Nevertheless, the plausible benefits of such tissue graft regions (for instance sufficient vaginal length, width leading to sexual working of the neovagina) might finally provide greater working postoperative results in contrast to other tissue grafts utilized with greater frequency. Need for the objective determination of nerves as well as sexual working is there in reference to theoretical estimation of such surgical methodology leads to greater advantages prior to the broader utilization of the tissue grafts by multidisciplinary teams gets put in to action.
To investigate the clinical appearance and morphologic and ultrastructural aspects of the mucosa of the peritoneal neovagina after laparoscopic Davydov neovaginoplasty in patients with Mayer-Rokitansky-K€ uster-Hauser syndrome. Design: The study group was a prospective, observational, experimental cohort of cases treated in the same institution between 2015 and 2019. Patients were followed up at 3, 6, and 12 months after surgery and then every 12 months. Setting: Single-center academic institution and teaching hospital in Milan, Italy. Patients: Fifty-one consecutive subjects with clinical and imaging diagnosis of Mayer-Rokitansky-K€ uster-Hauser syndrome surgically treated by the same team and postoperatively followed. Interventions: All the subjects underwent the same standardized surgical procedure and thereafter were followed up at 3, 6, and 12 months after surgery and then every 12 months; a minimum follow-up of 12 months was achieved in all cases. Vaginoscopy and Schiller test were performed at each follow-up visit, and a biopsy specimen of the neovagina was obtained in a limited number of patients (6 out of 51) for light microscopy (LM) and scanning electron microscopy (SEM) analysis of the tissue. Measurements and Main Results: In vaginoscopy, the neovaginal mucosa appeared homogeneous, smooth, and pink all along the neovaginal tract; the Schiller test detected iodine positivity at different degrees of extension upward from the hymenal ring, starting at 3 months postoperatively with almost complete positivity between 6 to 12 months in all cases. LM demonstrated adequate thickness and differentiation of the new mucosa along with the presence of glycogen storage; SEM revealed an ultrastructural surface appearance very close to normality. The main difference compared with a normal vagina was the reduced presence of vaginal mucosal folds. Conclusion: Under different techniques (vaginoscopy, Schiller test, LM, and SEM), a minimum of 6 months after surgery, the peritoneal neovagina epithelium showed aspects comparable to the natal mucosa of the vagina.