Laparoscopic Redo Vaginoplasty with Uterine Buds: A Case Report

Abstract

Study Objective To show that laparoscopic approach is beneficial for previously operated and failed modified Davydov vaginoplasty. Design A case report. Setting laparoscopy surgery with patient in lithotomy position under anaesthesia. Patients or Participants 20 years female diagnosed as a case of MRKH syndrome with single right sided kidney previously operated by modified Davydov surgery 6 months ago. Interventions Laparoscopic redo vaginoplasty by using uterine buds. Measurements and Main Results In modern era, endoscopy has replaced abdominal and vaginal approach of vaginoplasty. There is hardly any case report of Redo vaginoplasty done by vaginal or laparoscopic approach. Laparoscopic redo vaginoplasty by using uterine buds is done for the first time as per our knowledge and no such case has been reported in literature. The patient presented with complaints of shortening of vagina even with gradual vaginal dilatation. On per speculum examination, the vaginal length had shortened to about 2cm and width around 1.5cm. Patient was planned for redo vaginoplasty by laparoscopic approach. Intraoperatively, the lateral peritoneal flap on left side was tried but because of extensive fibrosis and shrinkage of peritoneum from previous surgery we proceeded with mobilization of Right sided uterine buds as a flap and used for creation of anterior vaginal wall. The vaginal vault was opened after difficult separation of bladder and rectum. The right uterine bud was mobilized into vaginal opening to form anterior vaginal wall and rectum pulled down to create posterior vaginal wall. Purse string suture was taken to create vaginal apex to create a vaginal length of approximately 8-10 cm. Vaginal mold placed and gradual dilatation done. At 1-year follow-up, patient had good anatomical and functional vagina of length 7-8cm. Conclusion Laparoscopic redo vaginoplasty using uterine buds can give successful outcome for failed vaginoplasty with added benefits of laparoscopic routes. To show that laparoscopic approach is beneficial for previously operated and failed modified Davydov vaginoplasty. A case report. laparoscopy surgery with patient in lithotomy position under anaesthesia. 20 years female diagnosed as a case of MRKH syndrome with single right sided kidney previously operated by modified Davydov surgery 6 months ago. Laparoscopic redo vaginoplasty by using uterine buds. In modern era, endoscopy has replaced abdominal and vaginal approach of vaginoplasty. There is hardly any case report of Redo vaginoplasty done by vaginal or laparoscopic approach. Laparoscopic redo vaginoplasty by using uterine buds is done for the first time as per our knowledge and no such case has been reported in literature. The patient presented with complaints of shortening of vagina even with gradual vaginal dilatation. On per speculum examination, the vaginal length had shortened to about 2cm and width around 1.5cm. Patient was planned for redo vaginoplasty by laparoscopic approach. Intraoperatively, the lateral peritoneal flap on left side was tried but because of extensive fibrosis and shrinkage of peritoneum from previous surgery we proceeded with mobilization of Right sided uterine buds as a flap and used for creation of anterior vaginal wall. The vaginal vault was opened after difficult separation of bladder and rectum. The right uterine bud was mobilized into vaginal opening to form anterior vaginal wall and rectum pulled down to create posterior vaginal wall. Purse string suture was taken to create vaginal apex to create a vaginal length of approximately 8-10 cm. Vaginal mold placed and gradual dilatation done. At 1-year follow-up, patient had good anatomical and functional vagina of length 7-8cm. Laparoscopic redo vaginoplasty using uterine buds can give successful outcome for failed vaginoplasty with added benefits of laparoscopic routes.