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Vaginoplasty by using amnion graft in patients of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser syndrome

January 2010
Journal of Ayub Medical College Abbottabad 22(1):7-10

Source
PubMed

Authors:

Iram Sarwar

Ruqqia Sultana

Khyber Medical University

Iftikhar Qayum

Rehman Medical Institute

Vaginal agenesis is congenital anomaly of the female genital tract and may occur as isolated developmental defect or as part of a complex of anomalies. The aim of this study was to determine the effectiveness of vaginoplasty by using amnion as graft in the creation of neovagina for patients with Mayor-Rokitansky-Kuster-Hauser Syndrome. this is a retrospective study of 28 cases of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser Syndrome, over the period of 20 years, in which vaginoplasty was done by modified McIndoe procedure by using amnion as graft. vaginoplasty using amnion graft was successfully performed in all except one case in which rectum got opened and procedure was abandoned after the repair of rectum. The functional results were quite satisfactory. Except one case none had any significant peri-operative complication. Post surgical results were acceptable to the patients sexually and aesthetically. Although new techniques of vaginoplasty have evolved over the years using laparoscopic approach and by use of different materials as graft, vaginoplasty with amnion graft is still a safe and effective procedure to treat patients of vaginal agenesis. The technique is simple and safe and provides a satisfactory and functional vagina in majority of the patients.

Before surgery

…

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J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Iram.pdf

VAGINOPLASTY BY USING AMNION GRAFT IN PATIENTS OF

VAGINAL AGENESIS ASSOCIATED WITH MAYOR-ROKITANSKY-

KUSTER-HAUSER SYNDROME

Iram Sarwar, Ruqqia Sultana, Rahat Un Nisa, Iftikhar Qayyum*

Department of Obstetric and G ynaecology, Ayub Teaching Hospital Abbotta bad. *Rehman Medical Institute, Peshawar, Pakista n

Background: Vaginal agenesis is congenital anomaly of the female genital tract and may occur as

isolated developmental defect or as part of a complex of anomalies. The aim of this study was to

determine the effectiveness of vaginoplasty by using amnion as graft in the creation of neovagina for

patients with Mayor-Rokitansky-Kuster-Hauser Syndrome. Methods: this is a retrospective study of 28

cases of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser Syndrome, over the period

of 20 years, in which vaginoplasty was done by modified McIndoe procedure by using amnion as graft.

Results: vaginoplasty using amnion graft was successfully performed in all except one case in which

rectum got opened and procedure was abandoned after the repair of rectum. The functional results were

quite satisfactory. Except one case none had any significant peri-operative complication. Post surgical

results were acceptable to the patients sexually and aesthetically. Conclusion: Although new

techniques of vaginoplasty have evolved over the years using laparoscopic approach and by use of

different materials as graft, vaginoplasty with amnion graft is still a safe and effective procedure to treat

patients of vaginal agenesis. The technique is simple and safe and provides a satisfactory and functional

vagina in majority of the patients.

Keywords: vaginoplasty, amnion graft, vaginal agenesis, vaginal atresia, Mayor-Rokitansky-

Kuster-Hauser Syndrome

INTRODUCTION

Vaginal agenesis is congenital anomaly of the female

genital tract and may occur as isolated developmental

defect or as part of a complex of anomalies.1 vaginal

agenesis is estimated to occur in 1 in 4000-5000 live

female births.2 vaginal agenesis is most commonly

associated with Mayor-Rokitansky-Kuster-Hauser

(MRKH) syndrome and androgen insensitivity

syndrome.2 MRKH syndrome is a congenital

malformation characterised by an absence of the vagina

associated with a variable abnormality of the uterus and

the urinary tract but functional ovaries.3 Two types of

this syndrome are described. Type-I MRKH syndrome

is characterised by an isolated absence of the proximal

two thirds of the vagina, whereas type II is marked by

other malformations; these include vertebral, cardiac,

urologic (upper tract), and otologic anomalies.4 Patients

with MRKH syndrome and vaginal agenesis are

phenotypically and genotypically female with a 46XX

karyotype.1

Although numerous methods for creating a

neovagina have been proposed, there is no unanimity of

opinion concerning which procedure should be chosen.

The most commonly used techniques to create a

neovagina are the non surgical Frank technique, which

relies on serial dilation of vaginal pouch and surgical

Vecchietti technique (continous pressure). The Abbe

McIndoe procedure in which split thickness skin graft is

used to cover a stent inserted into a surgically created

space between the bladder and rectum.4 several

investigators have described modifications of the Abbe

McIndoe procedure, including methods that use

amnion5,6, peritoneum7, intercede8, artificial dermis and

recombinant basic fibroblast growth factor9, autologous

buccal mucosa10 and rotational flap procedures using the

pudendal, thigh, gracilis myocutaneous, labia minora

and other fasciocutaneous flaps4. In addition bowel

vaginoplasty using segment of sigmoid colon or ileum

to line newly formed vaginal canal is also used and

some centres are now using laparoscopic approach for

it.11 Williams vaginoplasty and its modifications is

another technique.12 Latest techniques include robotic

sigmoid vaginoplasty13 and laparoscopic formation of

neovagina followed by extraperitoneal traction on

Foley’s catheter.14

In 1910 Davis was the first to report the use of

foetal membranes as surgical material in skin

transplantation. Since then the use of amniotic

membrane in surgery has been expanded.15 we present a

personal series of creation of neovagina by modified

Abbe McIndoe method using amnion as graft material

in patients presented with MRKH syndrome. The aim

was to create functionally and cosmetically normal

neovagina using simple available technique and to bring

this operation to the attention of gynaecologists.

PATIENTS AND METHODS

The study was conducted at Ayub Teaching Hospital

Abbottabad from January 2009 to June 2009. It included

patients of MRKH syndrome diagnosed and treated at

Women and Children Hospital Abbottabad and Ayub

Teaching Hospital Abbottabad over the last 20 years,

i.e., from 1989 to 2009. Only those patients who were

married or about to get married in near future (three

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Iram.pdf

months before marriage) were operated and included in

study due to our social setup. It is a descriptive study

with data collected retrospectively. All patients

exhibited primary amenorrhoea, normal female

secondary sex characteristics and a vaginal dimple

without vaginal orifice. Patients underwent pre-

operative workup which included apart from routine

investigations karyotyping, abdominopelvic ultrasound

and diagnostic laparoscopy. Patients and their parents

were thoroughly counselled before operation about the

optimal operation time, method as well as the possible

complications of the procedure. All patients were

followed for at least 6 months.

Amniotic membranes were obtained under

sterile conditions from elective Caesarean deliveries.

Amnion donors (mothers) were screened for hepatitis B

and C as well as HIV viral infections and syphilis. Inner

amniotic membrane was separated from outer

membrane and rinsed in sterile normal saline solution

containing cephalosporin injection.

Under general anaesthesia, the patient was

placed in lithotomy position after catheterisation and

perineal area cleaned and draped. A transverse incision

was made just below the dimple and a potential space

was created in between the bladder and urethra and

rectum by blunt dissection, carefully palpating the

catheter in front and a finger in the rectum to guard

against the injury. A cavity size of depth 8–10 cm in

length and about 4–5 cm in diameter were achieved.

A vaginal mould made with 50 ml syringe

wrapped with foam, covered with latex condom and

sterilised in cidex solution was then wrapped with

amnion tent and placed in the constructed cavity. The

amnion graft was fixed to mould by suturing the edges

of amnion to the mould. The labia majora was then

sutured together loosely with silk sutures to hold the

mould in position and T bandage applied. Prophylactic

antibiotics were given for 7 days. Mould was removed

on day 8 along with catheter. The graft was retained and

well taken in all the cases. Vaginal douching was done

with pyodine and second mould made with 20 ml

syringe (with upper drainage hole created) was kept in

place. Patients were counselled about the method of

placement, removal and washing of mould to facilitate

the further change of mould herself. Patients were

discharged with the advice to wear the mould for 3

months continuously followed by nightly insertions for

another 3 months to prevent contractions. Fortnightly

follow up visits were advised. Physical relation was

allowed after 3 months in married women.

RESULTS

A total of 28 females underwent the surgical procedure

during these 20 years. Their ages ranged from 16 to 22

years; 26 (93%) were unmarried and 2 were married.

The unmarried females presented with primary

amenorrhoea; the married ones with primary

amenorrhoea and inability to have sexual intercourse.

On clinical examination, all subjects had

normal female secondary sexual characteristics and the

external genitalia were normal female. However all of

them had absence of vagina. Ultrasound and

Diagnostic laparoscopy revealed a small nodular/

rudimentary/absent uterus in all cases with normal

ovaries and distal part of fallopian tubes.

Associated renal tract anomalies were found

in 4 patients (14%). These included horse shoe shaped

kidney in one (25%), double unilateral kidney in one

(25%) and a single kidney in 2 patients (50%).

Karyotypes were performed in 18 patients

(64.3%) who showed a normal XX female pattern.

Serum testosterone levels were done in 15 cases

(53.6%) with normal female levels.

The operation times ranged from 20–45

minutes. There was immediate per-operative

complication of rectal injury in 1 patient requiring

abandonment of vaginoplasty; the remaining patients

underwent successful vaginoplasty. Outcome of

vaginoplasty at 3 months showed that 24/27 (89%) had

normal recovery with vaginal depths of up to 7 cm.

Three patients (11%) had vaginal constriction due to

poor compliance with second mould placement

protocol; digital dilation was performed under General

Anaesthesia.

At 6 months follow up, all patients had

adequate vaginal lengths and diameters. All of them

had normal sexual intercourse after 3 months of

surgery (unmarried patients also got married by then)

obviating the need for second mould placement.

Figure-1: Before surgery

Figure-2: Transverse incision below dimple to

create potential space

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Iram.pdf

Figure-3: Mould

Figure-4: Mould removal on day 8

Figure-5: Second mould placement

Figure-6: 3 months after surgery

DISCUSSION

Amniotic membranes have been used as surgical

material in different procedures including as dressing

for burned skin, skin wounds and chronic leg ulcers,

surgical reconstruction o f vagina and repair of

omphalocoeles, and to prevent tissue adhesions in

surgical procedures. It has also been used in treating

variety of ocular surface disorders.15

We selected amnion as graft for

vaginoplasty over skin/other grafts because it is

easily available and its supply is nearly unlimited.

Amniotic membranes do not express HLA-A, B or

DR antigens hence immunological rejection does not

occur. It is also believed to have antimicrobial

properties reducing the risks of postoperative

infection. Antifibroblastic activity and cell

migration/growth promoting activity have also been

demonstrated which stimulates epithelialisation.15

and lastly its preparation method and time did not

pose any challenge. Other methods using skin and

buccal mucosa and peritoneum may scar the patient.10

Use of intestine cause continuous profuse secretions

and unpleasant odour.1 Laparoscopic techniques are

lengthier and require specialised skills and training.

Dilation techniques although simple, require

motivation and long term follow up.

Twenty-eight cases were recorded for

vaginoplasty. All patients except one (96.43%) had

uneventful surgical procedures and successful

outcomes. In one patient rectum got opened during

the procedure and then the procedure was abandoned.

Follow up at 3 months was satisfactory in 89% of

patients, while 1 1% required a minor second

procedure in the form of digital dilation due to

vaginal constriction secondary to poor compliance.

Follow-up at 6 months was satisfactory in 100% of

patients in terms of anatomical and functional results.

A study conducted at Lahore in Pakistan in

2006 on 10 patients over 4 years using amnion graft,

had similar results. In that study one patient had rectal

injury during surgery (90% operative success rate);

however operation was carries out after rectal repair.

At 6 months they had 80% success rate, one patient

had cicatrisation and one was lost to follow-up.5

Another study from Germany conducted in

2009 on 7 patients also reported similar outcomes.

Operative success was 85.71% and one patient had

major operative complication. After 18 months follow

up anatomical and functional results were 100%.6

Although few studies have used amnion as

graft in the creation of neovagina but the results are

very satisfying. Advantages of this procedure is that

it is safe, inexpensive and easy to perform. Epithelial

lining of the neovagina resembling normal vagina is

found, which facilitates comfortable sexual

intercourse. There is less emotional stress and better

cosmetic and economic benefits.

CONCLUSION

The ideal method for vaginoplasty is not currently

known and depends on numerous factors including

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Iram.pdf

patient preparedness, surgeon experience, and patient

and surgeon preference. Although new techniques of

vaginoplasty have evolved over the years using

laparoscopic approach and by use of different

materials as graft, but in developing country like

Pakistan where facilities and expertise for newer

techniques are not available freely, vaginoplasty by

modified Abbe-McIndoe procedure using amnion

graft is still a safe and effective procedure to treat

patients of vaginal agenesis.

RECOMMENDATIONS

Vaginoplasty by modified Abbe-McIndoe procedure

using amnion graft should be recommended in

developing countries lacking modern facilities as

well as in developed countries because this procedure

is simple, safe and effective and requires less

expertise as compared to more modern and

sophisticated procedures.

REFERENCES

1. Saxena AK, Herman MI. Vaginal Atresia. Webpage. Cited

June 02, 2009. Available at: http://emedicine.medscape.com/

article/954110-print.

2. Saraf S, Sar af P. McIndoe vaginoplasty: revisited. Internet J

Gynecol Obstetr 2007;6(2). Online Journal. Cited August 18,

2008. Available from: http://www.ispub.com/journal/the

_internet_journal_of_gyne cology_and_obstetrics/volume_6_

number_2_6/article/mcindoe_vaginoplasty_revisited.htmls.

3. Gupta NP, Ansari MS. Mayer-Rokitansky-Kuster-Hauser

(MRKH) syndrome–a review. Indian J Urol 2002;1 8:111–6.

4. Kirsch AJ, Kaye JD, Carter SM, Gross SJ. Mayer-Rokitansky

syndrome. Webpage. Cited June 02, 2 009. Available from:

http://emedicine.medscape .com/article/953492-print.

5. Chohan A, Burr F, M ansoor H, Falak T. Amnion graft in

vaginoplasty–an experience at 3 teaching hospitals of Lahore.

Biomedica 2006;22(1):21–4.

6. Fotopoulou C, Sehouli J, Gehrmann N, Schoenborn I,

Lichtenegger W. Functional and anatomical results of

amnion vaginoplasty in young women with Mayer-

Rokitansky-Kuster-Hauser syndrome. Fertil Steril 2009;

(Epub ahead of print).

7. Rothman D . The use of peritoneum in the construction of a

vagina. Obstet Gynecol 1972;40:835–8.

8. Jackson ND, Rosenblatt PL. Use of interceed absorbable

adhesion barrier for vaginoplasty. O bstet Gynecol

1994;84:1048–50.

9. Noguchi S, Nakatsuka M, S ugiyama Y, Chekir C, Kamada

Y, Hiramatsu Y. Use of artificial dermis and recombinant

basic fibroblast growth factor for creating a neovagina in a

patient with Mayer-Rokitansky-K uster-Hauser syndrome.

Hum Reprod 2004;19:1629–32.

10. Lin WC, Chan g CYY, Shen YY, Tsai HD. Use of autologous

buccal mucosa for vaginoplasty: a study of eight cases. Hum

Reprod 2003;18:604–7.

11. Cai B, Zha ng JR, Xi X W, Yan Q, Wan XP. Laparoscopically

assisted sigmoid colon vaginoplasty in women with Mayer-

Rokitansky-Kuster-Hauser syndrome: feasibility and short

term results. BJOG 2007;1 14:1486–92.

12. Creatsas G, Deligeoroglou E, Makrakis E, Kontoravdis A.

Papadimitriou L. Creation of a neovagina following Willia ms

vaginoplasty and Creatsas modification i n 111 patients with

Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril

2001;76:1036–40.

13. Kim C, Campbell B, Ferrer F. Robotic sigmoid vaginoplasty:

a novel technique. Urology 2008;72:847–9.

14. El-Saman AM. Retropubic balloon vaginoplasty for

management of Mayer-Rokitansky-Kuster-Hauser syndrome.

Fertil Steril 2009; (Epub a head of print).

15. Dua HS, Azuara-Blanca A. Amniotic membrane

transplantation. Br J Opthalmol 1999;83:748–52.

Address for Correspondence:

Dr. Iram Sarwar, Department of Obstetric and Gynaecology, Ayub Medical College, Abbottabad-22040, Pakistan.

Cell: +92-333-5058286

Email: iramsarwar@hotmail.com

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In 1910 Davis was the first to report the use of fetal membranes as surgical material in skin transplantation.1Since then the use of amniotic membrane in surgery has been expanded.1-9 It is now utilised as a biological dressing for burned skin, skin wounds, and chronic ulcers of the leg,9-16 as an adjunctive tissue in surgical reconstruction of artificial vagina,9 17-19 and for repairing omphaloceles.9 20 It has also been used to prevent tissue adhesion in surgical procedures of the abdomen, head, and pelvis.9 21 22 In the 1940s several authors reported the beneficial role of amniotic membrane in treating a variety of ocular surface disorders.5-7 23 However, its use was abandoned for decades until recently, when it was reintroduced to ophthalmologists. Several studies have addressed this subject and the scope of the application of amniotic membrane transplantation (AMT) in the management of ocular surface disorders is ever increasing. Certain characteristics make the amniotic membrane ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. The tissue can be preserved at −80°C for several months, allowing sufficient time to plan surgery or consider a trial of other options. Amniotic membrane does not express HLA-A, B, or DR antigens and hence immunological rejection after its transplantation does not occur.24-26It is also believed to have antimicrobial properties, reducing the risks of postoperative infection.27 Antifibroblastic activity28-30 and cell migration/growth promoting activity31-33 have also been demonstrated with regard to the amniotic membrane. The purpose of this paper is to review the characteristics of amniotic membrane that make it potentially useful to treat ocular surface abnormalities and to discuss the current indications, the surgical technique, and the outcome of AMT. Mammalian embryos lie …

Use of autologous buccal mucosa for vaginoplasty: A study of eight cases

Article

Full-text available

Apr 2003

Vaginal agenesis is a rare condition and treatment methods are varied. The difference between most of the surgical techniques is the graft material used. The purpose of this study was to describe the procedure and outcome of creating a neovaginal pouch lined with autologous buccal mucosa. Between August 2000 and February 2002, eight patients with Mayer-Rokitansky-Kuster-Hauser syndrome were admitted to our hospital. All of the patients successfully underwent neovaginoplasty with autologous buccal mucosa as graft material. The buccal mucosal wound completely healed 2 weeks after the operation and the neovaginal length and calibre were well formed. Follow-up ranged from 0.5 to 1.5 years. One patient encountered post-operative vaginal bleeding and another patient suffered from urinary bladder injury. This is the first reported procedure of vaginoplasty with autologous buccal mucosa as graft material. Our method is ideal in its simplicity, provides good cosmetic results, and improves the vaginal length of the patient.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - a review

Article

Mar 2002

Purpose: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital malformation characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract butfunc-tional ovaries. We review the embryological, endocrino-logical, clinical, diagnostic, psychosocial and therapeutic features of this syndrome. Material and Methods: We performed a computer-ised Medline search and manual bibliographical review of more than 100 relevant articles on MRKHS published in the last 25 years. A thorough analysis of embryo-logical, endocrinological, clinical, psychosocial, diag-nostic and therapeutic features of this syndrome was performed and the important findings are summarised. Results: Embryologically, MRKHS appears to be the result of non fusion of the mesonephric duct (MD) with the Wolff an (WD). The various Mullerian defects found are agenesis of vagina or uterus, rudimentary vagina or uterus with normal ovarian function. Nearly 50% of these patients have renal anomalies like renal agenesis, ectopic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. Skeletal abnormalities are found in 10% of these patients, 2/3 of whom have anoma-lies of the spine, ribs or limbs. Clinical observations also support the view that 2 or more syndromes lie behind the title of MRKH syndrome, namely an isolated form of con-genital agenesis of the vagina and uterus (typical/type A) and a more generalized condition, in which agenesis of the vagina and uterus is a major and perhaps even an obligatory characteristic (atypical/type B). Conclusion: Mayer-Rokitansky-Kuster-Hauser syn-drome (MRKHS) is a congenital malformation charac-terized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. The various urinary tract anomalies described are renal agenesis, pelvic kidney, fusion anomaly like horse-shoe kidney and vesicoureteric reflux. It is not only worthwhile to be alert for these anomalies but also to study the skeletal and auditory systems in these pa-tients. The technology of in vitro fertilization enables a woman without a uterus to have her own genetic children.

Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Kuster-Hauser syndrome

Article

Apr 2009

To evaluate the surgical outcome and the long-term anatomic and functional results in young women with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) undergoing neovaginal creation with amniotic membranes. Evaluation of surgical and functional outcome according to clinical records and validated questionnaires about sexuality (Female Sexual Function Index [FSFI]) over a 1.5-year follow-up period. University hospital and referral center for pediatric and adolescent gynecology. Seven patients with congenital vaginal aplasia with a mean age of 20.86 +/- 3.56 years (range 17-26 years). McIndoe procedure modified by the application of human freeze-dried amniotic membranes. Anatomic success was defined by a vaginal length >or=8 cm, and a width allowing the easy introduction of two fingers. FSFI scores were applied to define functional results. Mean neovaginal length was 9.3 cm (range 4-12 cm). The mean FSFI score was 30.0 +/- 6.9. Major operative complications occurred in one patient. In six out of seven patients satisfactory anatomic and functional results were achieved. The surgical dissection of the vesicorectal space and the application of human amnion over a vaginal mold to create a neovagina results in satisfying anatomic and functional outcome with low perioperative morbidity in MRKH patients.

Retropubic balloon vaginoplasty for management of Mayer-Rokitansky-Kuster-Hauser syndrome

Article

Mar 2009

Ali El Saman

To study operative, postoperative, anatomic, and functional outcomes of retropubic balloon vaginoplasty (RBV) for the management of vaginal aplasia. Case series with description of the technique. Assiut University Woman Heath Center. Three women with vaginal aplasia due to müllerian agenesis. All had pelvic adhesions due to previous surgeries. A Foley catheter was inserted in the retropubic space from the suprapubic area to the vaginal dimple. Cystoscopy was done to ensure bladder and urethral integrity. Patients were treated postoperatively by controlled traction and distension for a week. Depth and width of neovagina, penetration, and satisfaction scores. The mean operative time was 9 to 11 minutes. No operative complications were recorded. Pain scores ranged from 0 to 20 points at rest and from 20 to 50 points during dressing. Vaginal depth as well as penetration and satisfaction scores showed statistically significant increases. Retropubic balloon vaginoplasty is a simple, safe, and effective alternative approach for creation of a neovagina, especially when laparoscopy is unfeasible or unsafe.

The use of peritoneum in the construction of a vagina

Article

Jan 1973
OBSTET GYNECOL

D Rothman

A simple and effective operation is described using pelvic peritoneum to construct an artificial vaginaā This procedure was popularized by Davydov, the Russian gynecologist. © 1972 The American College of Obstetricians and Gynecologists.

Use of Interceed Absorbable Adhesion Barrier for vaginoplasty

Article

Jan 1995
OBSTET GYNECOL

Vaginal agenesis is a rare condition that can be treated successfully with a variety of nonoperative as well as surgical procedures. The difference between most of the surgical techniques lies in the material used to line the newly created canal. Skin grafts, peritoneum, and amnion have all been reported for this purpose. In the present study, four women with vaginal agenesis underwent surgical construction of an artificial vagina using Interceed Absorbable Adhesion Barrier to cover an inflatable stent placed within the neovagina. There were no intraoperative or postoperative complications, and epithelialization of the neovagina was complete by 3-6 months. All four subjects were satisfied with the results of the surgery and none of the women reported difficulty complying with postoperative care. This modification of the Abbe-McIndoe technique does not require a separate operative procedure to harvest a lining for the neovagina. The use of Interceed may reduce the cost, operative time, and morbidity associated with other vaginoplasty techniques.

Creation of a neovagina following Williams vaginoplasty and the Creatsas modification in 111 patients with Mayer-Rokitansky-Kuster-Hauser syndrome

Article

Dec 2001
FERTIL STERIL

Evaluation of the Creatsas modification of Williams vaginoplasty for the creation of neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome). Record of perioperative and postoperative results and complications. Follow-up evaluations of patients yearly after the operation. Division of Pediatric-Adolescent Gynecology and Gynecologic Corrective Surgery, University of Athens (tertiary referral center). One hundred eleven patients with MRKH syndrome. Surgical creation of neovagina using the Williams vaginoplasty technique (group A: 10 patients) or the Creatsas modification of the previous method (group B: 101 patients). Length and width of the neovagina, and the quality of sexual life postoperatively. A functioning vagina of 10 to 12 cm depth and 5 cm width was created in eight of the patients in group A (80%) and in 98 of those in group B (97.02%). A vagina of 7 to 9 cm depth and 2 to 3 cm width was created in the rest of the patients in both groups. In group A, two wound openings were reported (20%); in two of the patients hemorrhage occurred during the first intercourse, compared to none in group B. A satisfactory sexual life was reported from 94.4% of the patients and an adequate one from 4.16% of them. The Creatsas modification of Williams vaginoplasty is a simple and effective technique for the creation of a functioning neovagina in young women with vaginal aplasia.

Use of artificial dermis and recombinant basic fibroblast growth factor for creating a neovagina in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

Article

Aug 2004

Vaginal agenesis is an uncommon, but not rare, condition. Although there are many methods for creating a neovagina, the optimal treatment is unknown. An 18‐year‐old woman with Mayer–Rokitansky–Küster–Hauser syndrome received vaginoplasty with a modified Wharton procedure using an artificial dermis (atelocollagen sponge). From 10 days after the operation, the patient was administered human recombinant basic fibroblast growth factor (bFGF) spray to accelerate epithelialization on the neovagina. At 50 days after the operation, we confirmed histological squamous epithelialization of the vaginal epithelium. At 12 months after the operation, the neovagina was at least 3.5 cm in width and ∼8 cm in length. In this case, use of artificial dermis and recombinant bFGF to create a neovagina was an easy, less invasive and useful method.

Laparoscopically assisted sigmoid colon vaginoplasty in women with Mayer-Rokitansky-Kuster-Hauser syndrome: Feasibility and short-term results

Article

Jan 2008
BJOG-INT J OBSTET GY

To evaluate the technical feasibility and anatomical and functional outcomes of laparoscopically assisted sigmoid colon vaginoplasty (LASV) in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. A retrospective review of prospectively collected data. Shanghai First People's Hospital, Shanghai Jiao Tong University. Twenty-six women with MRKH syndrome. A record was made of mean operating time, length of hospital stay, perioperative complications and the anatomical and functional outcomes of surgery. The perioperative results, complications and anatomical and functional outcomes of LASV (with median 20 months follow up, range 5-48 months). The mean operating time and hospital stay were 238 minutes and 9.8 days, respectively. The mean fall in haemoglobin was 2.0 g/dl. The only significant perioperative complications were one case with blood transfusion and three cases with infection (one with urinary tract and two with adjunctive incision). A functioning vagina 10 to 15 cm in length and 4 cm in width was created in all women. Introital stenosis occurred in only two women (2 months later). Twenty-two women subsequently had intercourse and 20 women (91%) were satisfied with the surgery and subsequent sexual activity. LASV is an effective approach for women with MRKH syndrome. Both the anatomical and functional outcomes are satisfactory.