2008, Number 4
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Rev Mex Cir Pediatr 2008; 15 (4)
Vaginoplastia with Colon. Does the Best Technical Quirurgica?
Navarrete-Arellano M, Garibay-González F, Arroyo-López R, Torres-Castañon R, Domínguez-Alaniz MM
Language: Spanish
References: 17
Page: 179-184
PDF size: 332.43 Kb.
ABSTRACT
Introduction: Vaginal agenesis and other malformations share total or partial vaginal abscence. Treatment of these patients represents a challenge for the surgeon, since good cosmetic and functional results are required. The purpose of this paper is to present our experience with colon segment vaginoplasty and its long term results.
Material and methods: 7 patients that required sigmoid or ascendent colon vaginal reconstruction from 1990 to 2006, were analized in a rectrospective study. Diagnosis, surgical technique, complications, cosmetic and functional results were reviewed in clinical files.
Results: Diagnosis were bladder exstrophy, true hermaphroditism, congenital adrenal hyperplasia, mixed gonadal disgenesis, androgen insensibility, cloacal malformation and cloacal exstrophy; a case of each one. Average age and follow up were 7.14 years old and 6.85 years respectively. Excellent cosmetic and anatomical results were obtained in all cases. Only two patients had less complications. The oldest patient (30 years old) has a successful active heterosexual life with a wide patent open neovagina in the 6 remainder.
Discussion: Currently, colon vaginoplasty, to create a neovagina is an effective resource to treat many congenital anomalies. It does not require dilations, or prothesis use, so quality of life and psychosocial issues are improved in these patients.
Conclusion: Sigmoid is the best choice to create a neovagina due to its low morbility and adventages in relation to other surgical techniques.
REFERENCES
Parsons JK, Gearhart SL and Gearhart JP. Vaginal reconstruction utilizing sigmoid colon: Complications and long-term results. J. Pediatr Surg 37:629-633, 2002.
Hensle TW, Shabsigh A, Shabsigh R, et al. Sexual function following bowel vaginoplasty. J Urol 175:2283-2286, 2006.
McIndoe A. The treatment of congenital absence and obliterative conditions of the vagina. Br J Last Surg 2: 254-267, 1950
Joseph VT. Pudendal-Thigh flap vaginoplasty in the reconstruction of genital anomalies. J Pediatr Surg, 32:62-65,1997.
Smith HO, Gensen MC Runowicz CD and Goldberg GL: The rectur abdominis myocutaneous flap. Cancer, 83:510, 1998.
Kapoor R, Kumar SD, Jeet SK, et al. Sigmoid vaginoplasty: Long term results. Urology 67:1212- 1215, 2006.
Ingram JM: The bicycle seat stool in the treatment of vaginal agenesis and stenosis: a preliminary report. Am J Obst Gynecol, 140:67,1981.
Borruto F, Chasen ST, Chervenak FA and Fedele L. The Vecchietti procedure for surgical treatment of vaginal agenesis: comparison of laparoscopy and laparotomy. Suppl Int J Gynecol Obstet, 64:153, 1999.
Roberts CP, Harber MJ and Rock JA: Vaginal creation for Mullerian agenesis. Am J Obstet Gynecol, 185:1349, 2001.
Pratt JH: Sigmoidvaginostomy; a new method of obtaining satisfactory vaginal depth. Am J Obstet Gynecol, 81:535, 1961.
Hensle TW and Dean GE: Vaginal replacement in children. J Urol, 148:677, 1992.
Klingele CJ, Gebhart JB, Croak AJ, et al.: McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life. Am J Obstet Gynecol, 189:1569, 2003.
Goligher JC: The use of pedicled transplants of sigmoid or other parts of the intestinal tract for vaginal construction. Ann R coll Surg Engl, 65:353- 355, 1983.
O’Connor JL, DeMarco RT, Pope IV JC, et al.: Bowel vaginoplasty in children: A retrospective review. J Pediatr Surg, 39:1205-1208, 2004.
Ma CK, Gottlieb C, Haas PA: Diversion colitis: A clinicopathologic study of 21 cases. Human Pathol, 21:429-436, 1990.
Urbanowicz W. Laparoscopic vaginal reconstruction using a sigmoid colon segment: a preliminary report. J Urol, 171:2632-2635, 2004.
Ikuma K, Ohashi S, Koyasu Y, at al: Laparoscopic colpopoiesis using sigmoid colon. Surg Laparosc Endosc, 7:60-62, 1997.