Wiesław Urbanowicz 1, Jerzy Starzyk 2, Michał Wolnicki 1, Marek Górniak 1, Janusz Sulisławski 1
- 1 Klinika Urologii Dziecięcej Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie
2 Klinika Endokrynologii Dzieci i Młodzieży Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie
vaginal agenesis, laparoscopic colpopoiesis, sigmoid
- Purpose. Sigmoid vaginoplasty is an alternative technique lor vaginal replacement. A major disadvantage is the need of an extensive laparotomy. Our main goal was to avoid laparotomy and its consequences.
- Patients and method. This laparoscopic procedure was done in 6 girls, mean age was 17y and 5 months. All of the patients had Mayer-Rokitansky-Kusler-Hauser syndrome. We have used 4 ports. After isolating a segment of the sigmoid using two endostaplers we made an incision in the deepest pail of vaginal vestibule. Performing a blunt dissection, a two-linger wide space was created between the posterior wall of the urethra, bladder and the rectum. In the top of thus created space peritoneum was incised under laparoscopic control. This allow the passage of a forceps from the perineum which enabled the descent of the Isolated sigmoid segment. The graft was fixed to the mucosum of the vaginal vestibule using single sutures. The continuity of the intestinal tract was restored using a circular mechanical suture through the rectum.
- Results. None of the operated girls needed a conversion to an open surgery. In all 6 patients no significant blood loss or any other complication were noted. The average length of postoperative stay was 8 days.
- Conclusion. This report suggest that laparoscopic sigmoid vaginal replacement is a feasible and safe operation and may be employed as an alternative procedure.
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