7918 Laparoscopic Repair of Cervico-Vaginal Agenesis in a Previously Failed Attempt of Mcindoe's Vaginoplasty: A Case Report

Abstract

<h3>Study Objective</h3> A unique Laparoscopic approach for surgical repair of Cervico-vaginal agenesis. <h3>Design</h3> A case report with 6 months follow-up. <h3>Setting</h3> laparoscopy surgery with patient in lithotomy position under anaesthesia. <h3>Patients or Participants</h3> A 23-yrs old female came with primary amenorrhea with lower abdominal pain since 2 years. Her MRI was suggestive of: 1) upper 2/3rd vaginal aplasia with hematoma in the cervical canal 2) b/l hematosalpinx 3) b/l ovarian hemorrhagic cysts. McIndoe's Vaginoplasty was attempted 6months back which had failed. <h3>Interventions</h3> Laparoscopic cervico- vaginal agenesis repair was planned <h3>Measurements and Main Results</h3> The occurrence of cervical agenesis is quite uncommon (1:80 000–1:100 000) and only 39% of these cases simultaneously have vaginal agenesis. Initially, these cases were managed by hysterectomy or abdominal cervicovaginoplasty. Later, a minimally invasive approach came to light with the advent of laparoscopy and surgical expertise. Principles of surgery: 1. Laparoscopic management of Hematosalpinx and hemorrhagic cysts. 2. Dissection of UV fold and pushing the bladder down to expose 3-4 cm length of the vagina. 3. Dissection between cervix and vagina in the right plane. 4. Creating neo-vagina by dissection of the vaginal agenesis. 5. Vertical incision on the cervix and horizontal incision on the vagina Suturing techniques between cervix and vagina and placing a silicon catheter in cervical canal and neo-vagina. <h3>Conclusion</h3> Laparoscopic approach for cervico vaginal agenesis is better than vaginal approach with cutting cervix vertically for patency of cervical canal.