Three Original Methods of Laparoscopic Colpopoiesis from the Pelvic Peritoneum. Tactics Selection and Results of Treatment

Abstract

Study Objective To compare results of 3 original techniques of laparoscopically assisted colpopoiesis from pelvic peritoneum. Design Level II-1, Canadian Taskforce. Setting Department of Operative Gynecology, National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of Russia Patients or Participants We recruited 203 patients with utero-vaginal aplasia, gonadal dysgenesis, testicular feminization, congenital adrenogenital disorders, male-to-female transgenders. Interventions Adamyan's technique of laparoscopically assisted colpopoiesis from pelvic peritoneum has been used for more than 30 years. Since 2012, we have used three original methods of laparoscopic neovagina creation from pelvic peritoneum: laparoscopic-perineal technique, total laparoscopic technique and combined laparoscopic-perineal technique with ligatures used for bringing down the peritoneum. Measurements and Main Results Total of 71 patients underwent colpopoesis using a laparoscopic-perineal technique: in 94 cases - total laparoscopic technique of colpopoiesis and in 38 - laparoscopic-perineal technique with ligatures were used. 27 patients had history of unsuccessful attempts for surgical neovagina creation. There were no significant differences between three types of colpopoesis in blood loss, duration of surgery, length of postoperative hospital stay and in use of pain relievers postoperatively. From the standpoint of complications, 1 case of bladder injury, 1 case of rectal injury in patients with previous fibrosis were diagnosed and eliminated during surgery followed by asymptomatic recovery. Postoperative neovaginal stricture was seen in 5 cases and dyspareunia was seen in 11 cases, which improved with vaginal maintenance dilation within 1 month. Conclusion Laparoscopy Involving neovagina creation is an effective and safe operation even in patients with unsuccessful previous neovagina attempts and radiation induced fibrosis.which provides sufficient length of neovagina of 10-12 сm, functional aspects such as lubrication, epithelialization, extensibility and sensibility. However, such interventions especially in complex cases should be provided in the specialized medical centers.