Laparoscopic vaginal reconstruction using an isolated sigmoid segment: a five-year experience

Abstract

Purpose Sigmoid vaginoplasty is an alternative technique for vaginal replacement. A major disadvantage is the need for an extensive laparotomy. Our main goal was to avoid laparotomy and its consequences. Material and methods This laparoscopic procedure was performed in 16 girls, whose mean age was 17 years and 2 months. Eleven patients had the Mayer - Rokitansky - Kuster syndrome and five, the androgen insensitivity syndrome. We used four ports. After isolating a segment of the sigmoid using two endostaplers, we made an incision in the deepest part of the vaginal vestibule. Performing a blunt dissection, a two- finger - wide space was created between the posterior wall of the urethra, bladder and the rectum. This allowed for the passage of the isolated sigmoid segment. Results The average operative time was 5 hours. None of the girls required conversion to open surgery. In all patients no significant blood loss or any other complications were noted. The average length of the postoperative stay was 5 days. Conclusions The laparoscopic technique employed in vaginal reconstruction utilizing a pedicled sigmoid colon segment is a treatment characterized by a low degree of invasiveness. The absence of a need for conversion or a blood transfusion and the uneventful course indicates that the method is not only favourable, but also safe for the patients. No strictures were observed within the vaginal vestibule and neovagina. The cosmetic and functional results were very good.