Laparoscopic Approach for Vaginoplasty

Abstract

We describe the use of intestinal transposition to create a neovagina using laparoscopy and avoiding minilaparotomy when performing the restoration of bowel continuity. A 16-year-old girl with mutiple congenital abnormalities, including absent vagina—Mayer- Rokitansky-Kuster-Hauser (MRKH) syndrome—underwent a sigmoid vaginoplasty under laparoscopy. After isolation of the distal sigmoid, a hysterectomy was performed. At the perineum, a cruciform incision was made in the hymeneal region. The uterus was extracted through the perineal approach. The stapled end of the sigmoid was pulled through the perineal opening in order to insert the anvil of a 28-mm circular stapler. The sigmoid was pulled back in the abdomen. Continuity of the digestive tract was restored transrectally, by performing a sigmoidorectal anastomosis with the circular stapler. The vaginoplasty was then completed by pulling the isolated segment to the perineum and creating an introitus. The patient was discharged on postoperative day 4. Mucus discharge is minimal and the introitus wide enough. Different approaches have been described to treat vaginal atresia, with advantages and inconveniences for each. The choice between the various forms of vaginoplasty remains highly controversial, as no vaginal substitute is perfect. Laparoscopic transplant of an isolated segment of sigmoid to create a neovagina is a new option in the treatment of vaginal atresia.