Comparison of two laparoscopic vaginoplasties using a single peritoneal flap in patients with Mayer-Rokitansky-Küster-Hauser syndrome

INTRODUCTION AND HYPOTHESIS

To compare two laparoscopic vaginoplasties using a single peritoneal flap (SPF), namely the Hebei I technique and the Hebei II technique, for creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

METHODS

A comparative retrospective study was conducted at a university-based tertiary care hospital. From September 2008 to September 2019, 72 patients with MRKH syndrome underwent either the Hebei I technique (n = 49) or the Hebei II technique (n = 23). The perioperative results, complications and anatomical outcomes of two groups were recorded and compared. The functional results of patients who became sexually active were assessed through the Female Sexual Function Index (FSFI) questionnaire.

RESULTS

Two techniques achieved anatomical and functional success without intraoperative complications. There was no significant difference in perioperative results, anatomical findings and the FSFI scores between the two groups. Patients in the Hebei II group had a relatively shorter operative time than those in the Hebei I group (P = 0.064). What is more, compared with the Hebei I group, the Hebei II group had significantly fewer granulomatous polyps at the top of the neovagina (P = 0.029) and less mucous production of the neovagina (P = 0.025) during the first 3 months after surgery.

CONCLUSIONS

Both the Hebei I and Hebei II techniques are feasible approaches for creating a neovagina which can bring satisfactory anatomical and sexual outcomes in patients with MRKH syndrome. However, the Hebei II technique may be a good alternative to the Hebei I technique because of its relatively shorter operative time, fewer neovaginal secretions and fewer granulomatous polyps.

Anatomic and Functional Outcomes of Paramesonephric Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: Uncu Modification

OBJECTIVE

To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification.

DESIGN

Case series (Canadian Task Force classification III).

SETTING

Tertiary care university hospital.

PATIENTS

Women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who underwent surgery between 2010 and 2016.

INTERVENTIONS

Laparoscopic double-layer peritoneal pull-down vaginoplasty with paramesonephric remnant support to the neovagina.

MEASUREMENTS AND MAIN RESULTS

Long-term anatomic and functional satisfaction results. Twenty-seven women with MRKHS underwent surgery with the Uncu-modified Davydov procedure. At 1 year after surgery, the mean vaginal length in these patients was 7.91 ± 1.4 cm. Among the 23 patients who had regular vaginal intercourse, the mean functional satisfaction score was 8.65 ± 1.2. One patient had a perioperative bladder injury, and another patient had a rectovaginal fistula at 3 months after the operation. One woman who did not comply with the prescribed postoperative mold exercises had complete closure of the introitus.

CONCLUSION

The Uncu modified laparoscopic double-layer peritoneal pull-down technique appears to be an effective and safe surgical management option that is easy to learn and perform by gynecologic surgeons.

Creation of a Neovagina by Laparoscopic Modified Davydov Vaginoplasty in Patients with Partial Androgen Insensitivity Syndrome

STUDY OBJECTIVE

To evaluate the feasibility, safety, and outcome of laparoscopic modified Davydov vaginoplasty in subjects with partial androgen insensitivity syndrome (PAIS).

DESIGN

A retrospective cohort study (Canadian Task Force classification III).

SETTING

A tertiary referral center.

PATIENTS

Ten continuous patients operated on between October 2008 and May 2014.

INTERVENTIONS

Laparoscopic modified Davydov vaginoplasty. The surgical technique was tailored on PAIS subjects who presented a male pelvic anatomy and, frequently, anomalies of the external genitalia.

MEASUREMENTS AND MAIN RESULTS

Anatomic success was defined as a neovaginal width allowing the insertion of 2 fingers and a neovaginal length of at least 5 cm. Functional success was defined as the presence of regular sexual intercourse. Laparoscopic modified Davydov vaginoplasty was successfully performed in all patients without surgical complications. At hospital discharge, anatomic success was achieved in all patients. At the 12-month follow-up, anatomic success was achieved in 9 patients and functional success in 7 patients. Two patients with anatomic success did not start any sexual activity by personal choice. One patient had an anatomic failure with a neovaginal length of 2 cm. This patient had not complied with the postoperative use of vaginal dilators.

CONCLUSION

This is the first study reporting the outcomes of laparoscopic modified Davydov vaginoplasty in subjects with PAIS. Postoperative long-term outcomes were comparable with those achieved in women with Rokitansky syndrome. The laparoscopic modified Davydov operation may represent the procedure of choice for the creation of a neovagina and the concomitant correction of anomalies of the external genitalia in subjects with PAIS.