An Operation for the Cure of Congenital Absence of the Vagina

Abstract

THE treatment of congenital absence of the vagina appears to have exercised the patience and skill of gynaecologists for many years. A glance at the literature shows that there is no settled opinion as to the correct management of the condition, while there are some definitely opposed to its surgical treatment by any existing method. Three procedures have been used by those who are surgically inclined : ( a ) Free gvafts. Heppner,' Abbe,' Flynn,' Kirschner and Wagner,'' Monod aRd Iselin.' Here free skin grafts, usually in multiple small pieces, are applied to the walls of the cavity made between the rectum and the bladder and maintained there by some form of flexible or rigid mould for 7 to 10 days. At the end of that time the mould is removed and the calibre of the cavity maintained as far as possible by intermittent dilatation. In the words of Monod and Iselin this must be begun early, repeated frequently and prolonged indefinitely. Judging from reported cases the results are indifferent and appear to run parallel with the efficacy of the subsequent dilatation. ( h ) Pediculated paps. Gravesfi first advocated the use of two full thickness pediculated flaps turned up from the thighs and inserted into a pre-formed vaginal cavity. Frank and Geist' modified this as an application of the Gillies tubed pedicle with better results. They stated that the only methods which can compare with it are the Baldwin,8 Mori,' and Schubert'O operations.